Kathy Costello , Nurse Practitioner
Have you been recently diagnosed with MS? If so, you may have already been prescribed a disease-modifying treatment (DMT) by your healthcare provider. With over 20 FDA-approved DMTs available, the decision-making process can be overwhelming. Whether this is your first medication or you’re considering switching to a new DMT, the high cost may lead you to ask, “How can I afford this?”
Fortunately, there are resources to help make DMTs more affordable and accessible.
We often hear about the high cost of medicines — particularly specialty medications like MS DMTs — and the prices keep increasing yearly. You may be asking why. It is due to several factors, including the cost of research leading to FDA approval (which can be over $2 billion per drug), the complex manufacturing process, and the specialized handling needed during manufacturing, shipping, storage, and disposal.
Prescription and over-the-counter medications are available from a variety of pharmacies. Your health insurance program may have a list of pharmacies with whom they partner. These are referred to as “in-network” pharmacies. When you use an “in-network” pharmacy, your cost for the medication may be lower than at a pharmacy that is not on their list. Some pharmacies that you may have encountered include:
Many people have a healthcare insurance plan with prescription coverage that pays for all or part of the prescribed medications. There are several types of health insurance available:
Provided as a benefit through your employer, with some of the insurance cost (premium) covered by the employer and some covered by the employee. Plans are reevaluated each year and may change based upon plan coverage and cost.
Healthcare purchased through the Affordable Care Act offers various plans that provide different services at different costs.
A federally-funded healthcare plan originally developed for people over 65 but expanded over the years to include people with disabilities and other special circumstances. Several types of plans are available, including those covering different aspects of healthcare, one of which is prescriptions.
Federal and state-funded healthcare coverage, generally available for people with limited or no income, is administered state-by-state – meaning that it differs somewhat from state to state.
It’s incredibly important that you adhere to medications prescribed by your MS care provider. If cost is a limiting factor for you, here are some tips for extra assistance to afford your MS DMT.
If you have health insurance, your prescription coverage begins there. It is important to contact your insurance company or pharmacy benefit manager to investigate the formulary options, your share of the cost, and what is needed from you and your MS provider to obtain pre-authorization.
Specialty pharmacies provide many benefits beyond providing your MS medications. They have financial expertise to help you navigate your insurance benefits. They are also aware of financial assistance programs and organizations that can help you afford your medication.
While the MS patient advocacy organizations cannot pay for your medications, they can often help you identify resources for financial assistance.
Many drug companies have assistance programs that can help with your share of the cost. Each program has specific requirements for assistance.
GoodRx or Blink Health have discounted prices for many medications.
While it may seem daunting, the time spent on researching and reaching out for help can ultimately save you money and stress. Arming yourself with knowledge will help you understand your coverage, your costs, and your rights as a healthcare consumer.