On March 6, the Institute for Clinical and Economic Review released their Final Evidence Report for Disease-Modifying Therapies for Relapsing-Remitting and Primary-Progressive Multiple Sclerosis: Effectiveness and Value
. While ICER's review found that MS DMTs offer important clinical benefits in terms of reduced relapse rates and delayed disability progression, the report noted that prices of the DMTs do not align with the benefits they provide to patients. The report contains a summary of votes taken by an ICER committee during a public meeting, as well as key policy implications stemming from a policy discussion panel that followed the meeting. ICER also released a Report-at-a-Glance document
, which summarizes key points of ICER’s evidence review and economic model, value-based price benchmarks for each drug, the voting results, and policy implications discussed at the roundtable.
ICER assessed the value of disease-modifying therapies (DMTs) for multiple sclerosis (MS) by considering price, how well a medication works compared to others, quality adjusted life years (QALYs) and other cost-effectiveness factors through a value assessment framework
As insurers may use ICER recommendations to develop their formularies, these recommendations could potentially impact access to DMTs for MS. Yet, while ICER found that most of the DMTs do not bring good value per Quality Adjusted Life Year (QALY), ICER also stated the medications offer important clinical benefits. The voting panel also determined that generally there is not adequate evidence to determine that one DMT provides a net health benefit to another. The Society has continuously stated that we believe that people with MS and their providers require access to a full range of disease-modifying therapies so that all factors can be considered in treatment decision making and we believe the ICER voting results supports this.
ICER noted that the high price of MS DMTs was “contributing to pervasive access problems and large financial burdens for patients with a lifelong disease.” Steven D. Pearson, MD, MSc, ICER’s President, stated that ICER “agreed with the view expressed by many patients and patient groups: despite important treatment advances, the health care system is broken for MS patients. High prices and regular price increases contribute significantly to restrictions on coverage and access that make it difficult for patients to get the medications they need.”
The Society believes all stakeholders need to work together to find solutions for people with MS. The ICER report does put forward some helpful policy implications, notably that price increase for medications should be limited and that payer policies should allow a patient to continue using a treatment that works for them, regardless of coverage and formulary changes. We know it is challenging for people with MS to get the medications they need due to the cost of the MS DMTs, restrictions within the insurance system and an increasingly complicated supply chain that often treats the patient as an afterthought. This is why the National MS Society developed recommendations to Make Medications Accessible
. Medications can only change lives if people can access them. Medications and the process for getting them must be affordable, simple and transparent.
Past National MS Society comments: