Financial Assistance Value for Equitable Access to Specialty Medications for Adults With Multiple Sclerosis Using Health System Pharmacy Services.

Abstract

Background: Contributing to the total economic burden of multiple sclerosis (MS) in the United States, the estimated direct medical costs of MS in 2019 were $63.3 billion, with medications accounting for over half of these expenses.¹ MS disease-modifying therapy (DMT) costs can limit access, causing patients not to adhere to the medication regimen, which may lead to relapse, progression, disability, hospitalizations, and increased health care costs. Integrated health system specialty pharmacies (HSSPs) provide assistance to patients to alleviate the financial burden of specialty medications. MS center medication access specialists (MAS) obtain assistance for DMTs. This study quantifies the financial assistance obtained for patients with MS receiving medications through an integrated HSSP or infusion center.

Methods: This single-center retrospective chart review evaluated claims data for University of Rochester MS Center patients receiving financial assistance for MS specialty medications dispensed through the HSSP or infused at the MS center between July 20, 2020, and July 20, 2022. Descriptive statistics were used to assess all outcomes data.

Results: Patients received $3,377,172.96 in financial assistance. The median financial assistance used per patient per day of medication coverage was $2.08 (IQR, 12.02). The median out-of-pocket cost per patient per day after financial assistance was $0 (IQR, 0). Manufacturers provided the most financial support with a total contribution of $2,404,883.31, followed by grant foundations, which provided $574,659.27. Internal facility funds and the New York State Elderly Pharmaceutical Insurance Coverage program provided $241,377.97 and $156,252.41, respectively.

Conclusions: Patients at this MS center were able to save thousands of dollars in out-of-pocket costs using financial assistance. Integrated HSSPs and MAS teams can help reduce the out-of-pocket cost of MS specialty medications, which may improve access to these medications.