Restricted Drug Coverage Tied to Higher Risk for MS Relapse

Restricted coverage of medications for relapsing-remitting multiple sclerosis (MS) was associated with a higher risk for relapse, a new study showed.

Patients with MS enrolled in Medicare Advantage Prescription Drug plans (MA-PDs) with broader formulary coverage were 8%-12% less likely to experience an MS relapse, while those in broad-coverage stand-alone prescription drug plans (PDPs) had 6%-9% lower odds of relapse.

The findings highlight that cost-saving measures used by pharmacy benefit managers to exclude certain drugs from formularies can have tangible negative outcomes, especially for patients with complex or chronic conditions.

“Patients with MS may need to try multiple drugs to find what works best for them. Broad formulary exclusions ultimately undermine the individualized car