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Managing the Treatment Costs of Multiple Sclerosis in a Managed Care Setting
KANSAS CITY, Mo., Jan. 29 /PRNewswire-FirstCall/ -- Multiple sclerosis (MS) patients incur healthcare costs at a rate two to three times higher than patients without MS. As a result, managed care companies that insure MS patients must establish cost-effective disease management programs that initiate treatment early, decrease relapses, and minimize side effects in order to control both direct and indirect costs. According to a paper published in the November edition of Formulary, several steps can be taken by managed care companies to provide optimum care while effectively managing costs.
Critical to effectively managing patient outcomes and associated costs of worsening disease is selecting the most effective drugs for formulary inclusion. Immunomodulators such as COPAXONE® (glatiramer acetate injection) and the interferons provide a major improvement over previous drugs, such as steroids, that only treated the symptoms of MS. Treating early and aggressively is recommended by the National Multiple Sclerosis Society.
Indirect costs, such as productivity loss to society, income loss to the patient, disability payments, and lost opportunity costs resulting from time spent receiving treatment are even greater than direct costs.
"On average, using 1994 dollars, patients may lose about $18,000 annually," said Dr. Thomas Morrow, president of the National Association of Managed Care Physicians. "The total costs annually may be as much as $34,000 per patient. As a result, it is imperative that cost-effective disease management programs are in place and executed consistently by managed care insurance plans."
Dr. Morrow suggests in the Formulary article that managed care companies can benefit from adopting approaches that provide cost-effective, high-quality care. This involves coordinating and reducing variability of care, including early use of disease-modifying agents by neurologists to reduce risk of relapse and improve patient adherence. It also includes a series of specific interventions such as:
- Stepped care management that requires use of COPAXONE® (glatiramer acetate injection) or a preferred interferon therapy as the initial step. This includes carefully defining treatment failure or non-response, and assessing other outcomes such as quality of life, side effects, and occurrence of neutralizing antibodies, which may render interferon therapy ineffective. - Prior authorization protocols that ensure accurate diagnosis and treatment with immunomodulatory drugs. - Internet-based education programs to increase understanding and involvement of patients in their care and the care of other MS patients. Shared information and experiences among patients and with their physicians can result in improved outcomes and reduced patient visits. - Changing benefit designs, but avoiding shifting more costs to the patient that may result in reduced adherence and resultant increase in relapses and associated treatment costs. Effective benefit design changes may include designating preferred drugs and penalizing use of non-preferred drugs. - Use of specialty pharmacy services that may utilize specially trained case managers and pharmacists to educate patients and caregivers, gain better treatment pricing through bulk purchasing from manufacturers, and institute programs that gather data that benefit the managed care company and help improve patient adherence. - Setting maximum rates for physician-infused or physician-injected MS drugs.
"It is tempting for managed care companies to focus just on pharmaceutical acquisition costs when trying to manage costs associated with MS," Dr. Morrow said. "Although every attempt should be made to negotiate the lowest possible costs, other factors must be considered to avoid negatively affecting quality of life, or shifting costs to another component of the managed care system."
COPAXONE® (glatiramer acetate injection) is indicated for the reduction of the frequency of relapses in relapsing-remitting multiple sclerosis.
The most common side effects of COPAXONE® are redness, pain, swelling, itching, or a lump at the site of injection, flushing, chest pain, weakness, infection, pain, nausea, joint pain, anxiety, and muscle stiffness. These reactions are usually mild and seldom require professional treatment. Patients should tell their doctor about any side effects.
Some patients report a short-term reaction right after injecting COPAXONE®. This reaction can involve flushing (feeling of warmth and/or redness), chest tightness or pain with heart palpitations, anxiety, and trouble breathing. These symptoms generally appear within minutes of an injection, last about 15 minutes, and go away by themselves without further problems.
COPAXONE® is now approved in 42 countries worldwide, including the U.S., Canada, Australia, Israel, and all the European countries. In Europe, COPAXONE® is marketed by Teva Pharmaceutical Industries Ltd., and Aventis Pharma. In North America, COPAXONE® is marketed by Teva Neuroscience, Inc.
See additional important information at http://www.copaxone.com/pi/index.html or call 1-800-887-8100 for electronic releases. For hardcopy releases, please see enclosed full prescribing information.
Source: Teva Neuroscience