Insurance, Finances Affect Treatment Decisions in Multiple Sclerosis

Insurance coverage can be the determining factor on whether a patient receives DMT or not.

INDIANAPOLIS — The majority of patients with multiple sclerosis rely on payment assistance through insurance for their disease-modifying therapy, making them and their treatment plans particularly vulnerable to fluctuations and changes in insurance coverage.

That was the conclusion of a large NARCOMS participant study that aimed to identify how insurance and financial situations affect disease-modifying therapy (DMT) choices. The study was presented in a poster session at the Consortium of Multiple Sclerosis Centers 2015 Annual Meeting.

Stacy Cofield, PhD, of the University of Alabama at Birmingham, and colleagues surveyed 5,106 NARCOMS participants about health insurance and DMT choices. Nearly 97% of the participants, who were 78.8% female, completed the health insurance questions. Mean age was 56.7 years and 62.1% had relapsing-remitting multiple sclerosis (RRMS).

Nearly all participants (99.5%) had health insurance, with 98.6% reporting insurance for the prior six months, 68.6% reporting no changes in insurance in the prior year, and 23% reporting worse insurance coverage than the prior year. There were no differences in insurance coverage by gender, however females reported worse insurance coverage than 12 months ago. More respondents with progressive MS reported no change in coverage compared to those with RRMS (73.3% vs 66.8%, P=0.0003).

Thirty percent of respondents said their not taking DMT was by choice or by physician recommendation. Nearly 16% of respondents took their DMT of choice with full coverage, 46.6% with a co-pay, and 19.1% with a free/discounted program. When faced with changing DMTs, 3.6% were able to switch with insurance approval, 1.3% who wanted to switch could not due to lack of insurance approval/coverage, and 2.4% had to stop, change, or skip DMTs due to higher co-pays. In all, 1.6% of respondents did not take DMTs due to lack of insurance or insurance denial for their DMT of choice.

In a related study, Cofield and colleagues looked at reasoning behind changes in DMTs, and the decision processes involved. The majority of the 5.108 respondents reported that they shared treatment decisions with their doctor or considered their doctor’s opinion when making a decision about DMT.

The shared responsibility between a doctor and patient creates a positive relationship between the two parties, however financial situations and varying insurance coverage often comes between such decisions, putting physicians in an unfortunate place and leaving many patients to settle for second-choice treatments or no treatment at all.


  1. Cofield S et al. Disease Modifying Therapy & the Decision Making Process for MS patients in NARCOMS. Presented at: Consortium of Multiple Sclerosis Centers Annual Meeting 2015; May 27-30, 2015; Indianapolis, IN. 
  2. Cofield S et al. Patient Perspectives on Insurance Changes and Therapy Decisions in Narcoms. Presented at: Consortium of Multiple Sclerosis Centers Annual Meeting 2015; May 27-30, 2015; Indianapolis, IN.