How does the formulary restriction for patients with multiple sclerosis (MS) affect health results? To answer this question, use data from BLAYLOCK, VAN NUYS and Joyce (2025) 2018-2022, use 100% Medicare Claim data, in which both pamphlet drug plans (PDPS) and Medicare Advantage Preference Drug Plan (MA-PDS) have been covered with patients. Individuals were classified as below the width of the above versus average formula, which depends on how many diseases were covered by modified therapy (DMT). The results of interest include the rate of MS relaps.
Using this approach, the authors found that:
Oral or injected MS DMT was often excluded from coverage (> 50% was excluded in 2022: PDPS, 11 out of 11 DMT; MA-PD, 15 of 9 DMT). MS relaps rate low-vs high-coverage PDP (10.6% vs. 9.5%; Auds ratio was higher for ratio [OR]0.88 [95% CI, 0.84-0.92]) And MA-PD (7.8% vs. 6.9; or, 0.88 [95% CI, 0.85-0.91]In multi-reviewable analysis, broad formulary coverage during baseline was associated with low MS relaps during follow-up (PDP: Adjustable or, 0.93 [95% CI, 0.90-0.96] For medicines and 0.94 [95% CI, 0.91-0.97] For classes; MA-PD: adjusted or, 0.88 [95% CI, 0.83-0.94] For medicines and 0.92 [95% CI, 0.86-0.98] For classes).
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