Insurance Type Affects Healthcare Resource Utilization in Patients with MS

By Kaitlyn D’Onofrio - Last Updated: February 11, 2021

A study observed significant differences in healthcare resource utilization (HCRU) between patients with multiple sclerosis (MS) who had Medicare versus commercial insurance.

The study collected medical and pharmacy claims data from commercial and Medicare Advantage with Part D (MAPD) plans for patients with MS aged 18 to 64 years between January 1, 2014, and May 31, 2017. Patients were compared by whether they were commercial or MAPD enrollees for all-cause HCRU and disease-modifying treatment (DMT) use over one year, overall, and by five-year age groups.

Of 28,427 patients with MS, 67% had commercial coverage. Patients with MAPD, compared with commercial beneficiaries, had statistically significantly higher mean counts of all-cause inpatient, emergency room (ER), and ambulatory visits. Differences were observed in all age groups ≥30 years, except for ER visits in the age 40 to 44 years and 60 to 64 years groups. DMT use was significantly lower among patients with MAPD compared with patients with commercial insurance in all age groups starting at ≥35 years.

“Reasons for lower prevalence of DMT use among MAPD patients may include their more advanced disease state, older age, and higher prevalence of comorbid conditions compared with commercially insured patients, as well as more restrictive formularies for MAPD versus commercial plans,” the study authors concluded. “These findings suggest that there may be an opportunity for recently approved DMTs indicated for active secondary progressive MS to fulfill an unmet need for treatment among MS patients <65 years without contraindicated comorbid conditions who are enrolled in MAPD plans.”

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