The Costs of MS

Multiple sclerosis (MS) can be an expensive disease, and prescription drugs -- specifically, disease-modifying therapies -- are the largest piece of the cost puzzle. One study found that costs for most disease-modifying therapies are greater than $70,000 per year.

While insurance covers part of the costs for MS, out-of-pockets costs are still daunting, and rising. In one study, researchers tracked spending on out-of-pocket costs paid by people with MS who had Medicare Part D. The data showed that they paid about 7 times more for out-of-pocket costs related to their MS treatment in 2016 than a decade earlier.

Out-of-pocket costs for MS will depend largely on the treatments you get and your insurance coverage. Your policy may have a deductible before insurance coverage kicks in. After that, you may owe coinsurance, or a percentage of the total cost, up to an out-of-pocket max. Insurance may also cover some assistive devices, but you may need a prescription for those from your medical provider.

Beyond drug costs, people with MS tend to spend more on health costs in general than others, often due to other conditions that they have as well as MS. Each person with MS is unique, and the disease isn’t the same for everyone. In general, the more the disease has progressed, the greater a person’s costs will be.

Managing the Costs

Since medications generally make up the largest portion of MS expenses, managing the finances of the disease usually involves getting help with prescription costs. Here are strategies to consider.

Discuss drug costs with your doctor. The annual costs of MS drugs can vary widely. Talk to your neurologist about your situation and what you can afford, and how this could affect medication decisions alongside effectiveness and appropriateness. They might also have information about whether you could get help in paying for the drug.

Look into patient assistance programs. The National Multiple Sclerosis Society lists a number of patient assistance programs from pharmaceutical companies that make MS medications. Contacting them can help you find out whether you’re eligible for help and what you can afford. The Multiple Sclerosis Association of America also publishes a list.

Continued

Try nonprofit assistance foundations. The National Multiple Sclerosis Society also lists additional resources for getting help with costs, including The Assistance Fund and GoodDays. The Multiple Sclerosis Association of America lists the nonprofit groups HealthWell Foundation, Patient Access Network (PAN) Foundation, and the Patient Advocate Foundation. If programs are closed to new applicants, you may have to check back often to see when programs start accepting new members again.

Check NeedyMeds.org. This website lists 30+ diagnosis-based assistance programs for multiple sclerosis, including programs that help with insurance copayments and others that provide assistive equipment for home and bathrooms, as well as mobility devices.

Consider secondary insurance to go with Medicare. If you have original Medicare, you can obtain a Medicare supplement (Medigap) plan that covers some of your additional out-of-pocket costs.

Managing your MS costs can be difficult, but there are a number of programs and foundations that might be able to help. It’s important to do your research and talk to your neurologist if you’re worried about being able to afford your treatments.

WebMD Medical Reference

Sources

SOURCES:

Mayo Clinic: “Multiple Sclerosis.”

National Multiple Sclerosis Society: “MS Symptoms,” “Multiple Sclerosis FAQs,” “What Causes MS?” “Patient Assistance Programs.”

The American Journal of Managed Care: “Costs of MS Drugs Almost Triple in 7 Years.”

Neurotherapeutics: “Economics and Cost-Effectiveness of Multiple Sclerosis Therapies in the USA,” October 2017.

JAMA Neurology: “Trends in Prices, Market Share, and Spending on Self-administered Disease-Modifying Therapies for Multiple Sclerosis in Medicare Part D."

OptumRX Insight Report: “Six Cost Drivers of Multiple Sclerosis.”

Johns Hopkins Medicine: “Multiple Sclerosis and Mental Health: 3 Common Challenges.”

Multiple Sclerosis Association of America: “Prescription Assistance Programs.”

NeedyMeds.org: “Diagnosis-Based Assistance Programs for Multiple Sclerosis.”

Medicare.gov: “What’s Medicare Supplement Insurance (Medigap)?”

© 2021 WebMD, LLC. All rights reserved.

Pagination