Transparency of Coverage and Cost - National Multiple Sclerosis Society

Skip to navigation Skip to content

Transparency of Coverage and Cost

Lack of public information on the price of healthcare services, the paperwork required to attain care, and insufficient notification of benefit changes contribute to the burden of living with MS.

Take Action Now

Share

About This Issue

What We Are Trying To Accomplish: A more transparent healthcare system that provides the healthcare consumer with necessary information to make informed decisions. The Affordable Care Act (ACA) is making the cost of care more transparent for consumers living with MS, but additional advocacy and awareness are needed. MS activists can look to address these questions in their advocacy efforts during the next legislative session in their state:

  • Are health plans required to notify consumers in writing in advance of a formulary change that would impact the enrollees out-of-pocket cost or ability to access a previously available drug or service?
  • Are prior authorization requirements for MS disease-modifying or symptom management medications and imaging services reasonable and easily accessed? 
  • Do consumers have tools to estimate the cost of care, like access to All-Payer Claims Databases (APCDs) and Cost Calculators? 
  • Should standards for cost calculators be developed (since these databases are common, but often limited and under-utilized by the public?)

Why It’s Important:  Lack of public information on the price of healthcare services, the paperwork required to attain care, and insufficient notification of benefit changes contribute to the burden of living with MS.

Updates:  Recent price transparency successes have resulted from supporting state legislation that requires insurers to notify plan members before moving a drug to a different formulary tier or removing a drug from the formulary, such as in Arkansas and Oklahoma.

Take Action Now

Make sure consumers have the information they need to make good healthcare decisions.

Take Action In Your Area

Interested in taking action nearby? Simply filter by state and see what you can do in your area.

Share


Affordable Care Act
Learn about health care reform and how it impacts people living with MS.

Learn More

Share Your Story
Have you experienced difficulty accessing services or drugs due to lack of transparency?

Share Your Story