Martin Sipkoff
MANAGED CARE March 2010. ©MediMedia USA

A new study finds that multiple sclerosis (MS) patients enrolled in a seven-month disease therapy management (DTM) program demonstrate increased adherence to injected medications and stay with their treatment regimens more readily than MS patients who do not participate in therapy management.

The study, published in the February 2010 issue of the American Journal of Managed Care and titled “Improving Patient Self-Management of Multiple Sclerosis Through a Disease Therapy Management Program,” also found that the percentage of DTM patients who reported an MS relapse decreased by more than a third at the end of the program. The patients in the study are enrollees of Prescription Solutions, the pharmacy benefit manager owned by UnitedHealth Group.

According to Joseph Addiego, MD, chief medical officer at Prescription Solutions, the cost of specialty drugs “is expanding at twice the rate of traditional prescription drugs, making these drugs the fastest growing component of overall drug spending.”

DTM is Prescription Solutions’ term for its specialty pharmacy medication management program, which utilizes traditional elements of both medication therapy management (MTM) and disease management (DM). The DTM program teaches patients how to use injected drugs (like an MTM program) and addresses lifestyle issues, providing contact information for advice on such things as diet and symptoms (like a DM program).

Poor adherence

The most widely used MS treatments are drugs that are injected. While they have been proven to reduce disease progression, many patients do not stay on therapy because of the side effects, according to Prescription Solution’s Karen Stockl, PharmD, the study’s lead author. “This has a significant impact on health outcomes and health costs,” she says.

Previously published research has shown that insured patients with MS incur 2 to 3 times the health-related expenses of insured patients who do not suffer from MS, according to the authors. Their study showed a 33.6 percent reduction in MS relapses in 283 patients, meaning DTM intervention can save an estimated $173,246 in relapse costs (based on an estimated cost of $13,026 per MS relapse), or $612 per patient participating in the program.

Patients who fill their prescriptions for injected MS medications through Prescription Solutions’ specialty pharmacy are given the option of participating in a seven-month voluntary DTM program, with an extension period of at least three months for people requiring additional support. Patients in the program receive periodic telephone consultations, educational material mailings, and a personalized care plan to help manage their health and medication therapy, in addition to being provided with a contact name and number they can call as needed.

The study found that MS relapses were reported by 14 percent of patients at program onset and by 9.3 percent of patients at the end of the program. “Previous studies have shown that 43 percent of patients starting MS therapy fail to stay on their therapy regimens within 14 months,” says Stockl.

Multiple sclerosis consultation topics are part of a DTM program

The Prescription Solutions specialty pharmacy disease therapy management program for multiple sclerosis teaches patients about these key elements of MS treatment:

  • Pathogenesis of MS
  • Laboratory values pertaining to MS or medication therapy
  • Optimization of medication therapy, including medication adherence
  • Symptom management
  • Pain management
  • Stress management
  • Importance of a balanced diet
  • Importance of exercise
  • Importance of patient–provider communication

Contributing editor Martin Sipkoff can be reached at MSipkoff@ManagedCareMag.com.

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There’s a lot more going on in health care than mergers (Aetna-Humana, Anthem-Cigna) creating huge players. Hundreds of insurers operate in 50 different states. Self-insured employers, ACA public exchanges, Medicare Advantage, and Medicaid managed care plans crowd an increasingly complex market.

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Hub programs have emerged as a profitable new line of business in the sales and distribution side of the pharmaceutical industry that has got more than its fair share of wheeling and dealing. But they spell trouble if they spark collusion, threaten patients, or waste federal dollars.

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