Last week, the Government Relations Committee of the Delaware Chapter of the MS Society visited Legislative Hall in Dover to advocate for SB 137, which is a bill that would prohibit health insurance providers from charging higher cost sharing for specialty tiers of prescription drugs, for one year.


Last week, the Government Relations Committee of the Delaware Chapter of the MS Society visited Legislative Hall in Dover to advocate for SB 137, which is a bill that would prohibit health insurance providers from charging higher cost sharing for specialty tiers of prescription drugs, for one year.

What is at stake is the potential spread of specialty tiers for high-cost drugs that treat conditions such as rheumatoid arthritis, multiple sclerosis, HIV/AIDS, and hemophilia.  Specialty tiers are the fourth, and sometimes fifth, tier added to a traditional three-tiered drug formulary structure.

While an individual commonly pays a fixed amount for medications on the first three tiers of an insurance formulary, the specialty tier typically forces a co-pay for an individual that is a percentage (20 to 35 percent or more) of the drug cost.

“As advocates for more than 1,550 Delawareans living with multiple sclerosis, we are deeply concerned about the cost of medicine for the people that we serve,” said Kate Cowperthwait, president of the Delaware Chapter. 

“With no generic alternatives available, biologic medications, including MS disease modifying therapies, are increasingly among the medications relegated to the fourth tier.  We believe enacting a one-year moratorium on specialty tiers would allow time for this issue to be researched in Delaware.”

Currently, four of the 12 most common drugs found on a specialty tier are the MS disease modifying therapies: Avonex, Betaseron, Copaxone and Rebif, and thus subject to a 25 to 33 percent co-insurance (Costlier).

The equivalent monthly out-of-pocket cost would range from $826 to $1,238,” said Maria McCabe and Diana Cane, co-chairs of the Delaware Chapter GRC in a letter to Senator Henry & Representative Barbieri, co-sponsors of the bill.  “This cost-sharing structure places a significant and onerous financial burden on the insured individual, and has been shown to discourage adherence (not taking medication as prescribed).

“In fact, a recent Prime Therapeutics study reported a six fold higher decline to fill rate when out-of-pocket expenses for MS medications exceeded $200 in comparison to when out-of-pocket expenses were equal to or less than $100,” they continued.  “With a decrease in medication adherence, comes the very real risk of increases in the numbers of and severity of MS flare ups. 

"More flare ups means more visits to the emergency room, more hospital time, more medical costs, and more burden on the entire health care system.  The one year moratorium proposed in this bill will help us to better evaluate the effect that such increases would have on those living with MS.” 

This bill was introduced on June 16, 2011 and advanced from the Insurance Committee on June 23, 2011, and now awaits consideration of the Delaware General Assembly.

About multiple sclerosis
Multiple sclerosis is an unpredictable, often-disabling disease of the central nervous system that interrupts the flow of information within the brain and between the brain and the body. Symptoms range from numbness and tingling to blindness and paralysis.

The progress, severity, and specific symptoms of MS in any one person cannot yet be predicted, but advances in research and treatment are moving us closer to a world free of MS.

Most people with MS are diagnosed between the ages of 20 and 50 with at least two to three times more women than men being diagnosed with the disease. MS affects more than 1,500 Delawareans, more than 400,000 people in the U.S., and more than 2.1 million worldwide.

About the National Multiple Sclerosis Society
MS stops people from moving; the National MS Society exists to make sure it doesn’t. We help each person address the challenges of living with MS. In 2007 alone, through our home office and 50-state network of chapters, we devoted more than $136 million to programs that enhanced more than one million lives. To move us closer to a world free of MS, the Society also invested more than $50 million to support 440 research projects around the world. We are people who want to do something about MS—NOW.

Join the movement at www.nationalMSsociety.org.