|
A landmark study of healthcare professionals, multiple
sclerosis patients, and managed care professionals has found that individuals
living with MS could more effectively manage their disease through greater
collaboration and more efficient disease management involving managed
care organizations, neurologists, and specialty pharmacies. Teva Neuroscience
and the National MS Society partnered on The Multiple Sclerosis Trend
Report: Perspectives from Managed Care, Providers, and Patients, released
on November 1, 2007.
Early treatment and patient adherence to that treatment are essential
in slowing the progression of multiple sclerosis and managing its symptoms.
But the report found many significant obstacles to optimal disease management
— denials of prescribed drugs and time-consuming appeals, referrals
to specialists, lack of MS-specific patient information, insurer ignorance
about the differences between MS disease-modifying therapies and drugs
that treat MS-related symptoms, and high co-payments and deductibles.
The report further found that the managed care industry does not fully
comprehend MS as a life-changing, chronic disease, and often does not
allow doctors to treat it properly. And it found that neurologists are
shouldering much of the burden of prior authorizations, payment issues,
claims appeals, and other issues — and are becoming discouraged
to the point of avoiding MS patients.
Solutions to these obstacles need to be integrated and efficient, involving
greater communication and collaboration among MCOs, neurologists, and
specialty pharmacies. It would ease the burden on neurologists, capitalize
on the expertise of specialty pharmacies, and help people living with
MS to delay progression of the disease, save money, sustain their economic
and professional contributions, and have a better quality of life. Diagnosing
MS more quickly, starting treatment sooner, ensuring drug adherence, and
better managing the disease could reduce costs for MCOs in the long run,
because these changes could help to delay progression (especially as new,
expensive MS drugs are introduced).
According to the report, specialty pharmacies are playing an ever-increasing
role in this solution — managing and dispensing medication for rare
and chronic diseases, such as MS. They supply drugs directly to patients
and provide a more intense level of patient contact and attention. In
providing education on medication usage, side effects, disease progression,
and reimbursement to this comparatively well-educated patient sector,
specialty pharmacies aim to address barriers to successful MS therapy.
They also provide disease management programs for payers and manufacturers,
including prior authorization and strategies for maximizing patient compliance
and adherence. These companies have the potential to influence adherence
to MS therapies, provide patient education, improve the management of
MS, and provide costs savings in MS patient care.
Supporting Results:
Nearly two-thirds (64%) of MS patient respondents said their health insurer
does not offer a disease management program for MS patients. Yet MS patients
said they would welcome the development of a disease management program,
as one-quarter of respondents clearly appreciate the benefits of such
programs. In fact, MS patients cited the availability of a disease management
program as a reason for satisfaction with current insurers. The development
of these programs could lead insurers to approve more prescriptions and
tests, and even reduce costs for MCOs in the long term, when treatment
of more progressed MS is more costly.
Collaboration among other providers allows for efficiencies and can benefit
patients. Case managers are more intently focused on advancing patient
education, according to the report, and opening more pathways of communication.
As a result, MS patients are asking for therapies by brand name and therefore
could have a greater rate of adherence to those drugs.
Many neurologists (59% of respondents) indicated that barriers to diagnosing
and treating MS in their practices — primarily economic concerns,
clinical issues, and difficulties with insurance carriers — interfere
with more effective management of the disease. In fact, 64% of neurologists
surveyed would prefer not to take on more MS patients. More than two-thirds
would welcome a specialty pharmacy program in assisting with the management
of MS treatment.
Nearly all specialty pharmacy respondents (95%) said they believe specialty
pharmacies can add value to and enhance the ways in which MS specialists
and neurologists deliver care to MS patients, given the multitude of services
that they offer.
Case managers reported many barriers to care for MS patients. For example,
65% of case managers cited cost and 54% cited approval by payers as barriers
reported by their patients. Communication among healthcare professionals
and with patients could help better educate both case managers and patients
on treatment, service delivery, and cost. Education also helps increase
adherence. And adherence to the prescribed MS therapy could lead to a
delay in disease progression. This would give patients what they want
— better quality of life and continued employment.
Employment and quality of life — and the relationship between the
two — are among the top concerns of patients with MS today. The
patient survey highlighted the dilemma of more than two-fifths (43%) of
MS patients who leave the workforce owing to the progression of their
disease or to symptoms such as fatigue that prevent them from sustaining
full-time jobs.
|
 |
