Managing the High Cost of MS Treatment

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.  

Exploring the High Cost of DMTs

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. 

Finding the Right Pharmacy

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: 

Community pharmacies 

• Small locally owned pharmacies 
• Larger chain pharmacies 
• Pharmacies within other stores, such as grocery stores

Hospital and medical clinic pharmacies

• Located within medical facilities that provide in-patient and often out-patient services. 

Specialty pharmacies

• Provide comprehensive services to people with complex conditions, such as handling and delivering specialized medications, financial counseling to identify cost assistance and information about the medical condition and the medication.  For more about Specialty Pharmacies, see our article Specialty Pharmacies and the Role They Play in Your MS Treatment.

Understanding Your Health Insurance 

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: 

Employer-provided insurance plans

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. 

Affordable Care Act (also called Obamacare) 

Healthcare purchased through the Affordable Care Act offers various plans that provide different services at different costs.  

Medicare

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. 

Medical assistance 

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.  

Assistance Programs for MS Medication Costs

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. 

Healthcare insurance prescription benefit

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

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. 

Advocacy organizations

While the MS patient advocacy organizations cannot pay for your medications, they can often help you identify resources for financial assistance. 

Drug company assistance

Many drug companies have assistance programs that can help with your share of the cost.  Each program has specific requirements for assistance.  

Non-profit groups providing assistance

Several non-profit groups, such as Good Days, Extra Help (Social Security Administration), Healthwell Foundation, NeedyMeds, PAN Foundation, and others.  

Pharmacy drug savings programs

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.