New Study Finds Specialized Support Programs Can Increase Treatment Adherence and Persistence, Reduce Relapses for People with Multiple Sclerosis

Published February 08, 2010

  • Study Patients Also Reported Improved Ability to Manage Their Health
  • Support Programs May Yield Cost Savings

A new study reveals that multiple sclerosis (MS) patients enrolled in a seven-month disease therapy management (DTM) program show greater adherence to injectable MS medications and treatment persistence than patients who receive injectable MS medications through a community pharmacy.

In addition, the percentage of DTM patients who reported an MS relapse decreased by more than a third at the end of the program. These findings provide important insights into the benefits that DTM programs provide in helping patients better manage their health, while also yielding potential cost savings.

The study, published today in the American Journal of Managed Care, was conducted by Prescription Solutions, a leading pharmacy benefits management organization and a UnitedHealth Group (NYSE: UNH) company.

“At Prescription Solutions we work ‘beyond the prescription’ to ensure that patients receiving specialty drugs, like those used to treat MS, benefit from DTM programs that have been demonstrated to improve clinical and cost outcomes,” said Joseph Addiego, MD, chief medical officer, Prescription Solutions. Specialty pharmacy, which focuses on high-cost medications requiring significant involvement and monitoring by health professionals, is expanding at twice the rate of traditional prescription drugs, making specialty the fastest growing component of overall drug spend.

For many MS patients, treatments can be as challenging as the disease itself. The most widely used MS treatments are injectable drugs, which have a variety of side effects, including flu-like symptoms and injection site reactions. While the drugs have been proven to reduce disease progression, many patients do not stay on therapy because of the side effects. This has a significant impact on health outcomes and health costs.

The study shows that DTM programs can have a positive impact on the rate of medication adherence and treatment persistence, resulting in better health outcomes for MS patients and cost savings for the health system. These findings provide additional evidence that high-touch clinical support programs can reduce additional medical spend incurred by patients with MS.

Previously published research has shown that insured patients with MS incur two- to three-times more health-related expenses than insured patients who do not suffer from MS. Based on this new study, which showed a 33.6 percent reduction in MS relapses in 283 patients, the DTM intervention would save an estimated $173,246 in relapse costs (based on $13,026/MS relapse), or $612 per patient participating in the program.

Patients who fill their prescriptions for MS injectable medications through Prescription Solutions’ Specialty Pharmacy may participate in a seven-month voluntary DTM program, with an extension period of at least three months for people requiring additional support. Patients in the DTM program receive periodic telephone consultations, educational material mailings, and a personalized care plan to help them manage their health and medication therapy, in addition to being provided with a contact name and number they can reach out to should the need arise.

Among the key study findings was that the DTM group demonstrated a significantly greater persistence on therapy (220 days) compared with the two control groups (specialty pharmacy, 188 days; and retail pharmacy, 177 days), and a lower medication discontinuation rate (7.7 percent vs. 21.8 percent for specialty pharmacy and 28.2 percent for retail pharmacy). Medication adherence for MS patients completing the DTM program was slightly higher (mean medication possession or MPR = 0.92) compared to the control patients simply receiving their MS medications from a specialty pharmacy (MPR = 0.90) and significantly higher compared to the control patients receiving their MS medications from a community pharmacy (MPR = 0.86).

The study found that MS relapses were reported by 14 percent of patients at program onset and by 9.3 percent of patients at the end of the program1. Because of the improved medication persistence demonstrated in patients participating in the program beyond the seven-month mark (where patients who did not participate in the program typically discontinued their medication), this study does not address the question of whether patients who had participated in the program would likely experience fewer relapses after the seven-month mark than those who did not.

Patients Report That DTM Programs Help Them to Better Manage Health
About 97 percent of participants reported that the DTM program was “very helpful” or “somewhat helpful” in enabling them to better manage their health. The program was rated as “very good” or “excellent” by more than 91 percent of patients.

“Previous studies have shown that 43 percent of patients starting MS therapy become non-persistent within 14 months,” said Karen Stockl, Pharm.D, Prescription Solutions and lead author of the study. “The higher medication adherence and treatment persistence rates observed with our MS DTM program may indicate a positive influence of the program on patients’ behavior.”

Prescription Solutions routinely conducts scientific studies on various disease states as a way to use its clinical expertise to advance the practice of medicine and add to the scientific literature. This is a key element of Prescription Solutions' ongoing search for the most current, highest-quality evidence available to further its goal of continuously improving the cost-effectiveness of patient medications and drug treatment outcomes. The company’s DTM programs are intended to help patients more clearly understand the importance of proper treatment for their disease, to more effectively manage their disease symptoms or medication side effects, and to provide support to help patients overcome other obstacles to improved health and proper care, such as addressing stress-related issues or financial hardship.

Study Methodology
This is the first study to examine the impact to patients of an MS DTM program that incorporates both a disease self-management and a medication therapy management component. Pharmacy claims were evaluated to calculate injectable MS medication adherence and persistence among eligible patients who filled a prescription for an injectable MS medication through the Prescription Solutions specialty pharmacy and who were enrolled in and completed the seven-month DTM program (N=156), compared with patients (N=156) in each of two control groups: retail pharmacy and specialty pharmacy. Retail pharmacy patients were those who filled a prescription for an injectable MS medication at a retail pharmacy but not through the specialty pharmacy. Specialty pharmacy patients were those who filled a prescription for an injectable MS medication through the specialty pharmacy but who did not participate in the DTM program.

The primary outcome was adherence to injectable MS medications. Additional medication utilization outcomes evaluated during the post-period among the claims data population included duration of therapy, medication persistence, medication discontinuation or switching, and pharmacy ingredient costs. The study also assessed health-related quality of life, work productivity, MS relapse rates, and MS-related resource utilization among patients in the DTM program.

About Prescription Solutions
Prescription Solutions is an innovative pharmacy benefit management company managing the prescription drug benefit of commercial, Medicare and other governmental health plans, as well as those of employers and unions. A UnitedHealth Group company, Prescription Solutions serves customers through a national network of 64,000 community pharmacies and state-of-the-art mail service pharmacies in Carlsbad, Calif., and Overland Park, Kan., both of which have earned the prestigious Verified Internet Pharmacy Practice Sites™ (VIPPS®) accreditation by the National Association of Boards of Pharmacy® (NABP®). The company was recently named by WilsonRx® as the No. 1 National Top-Tier PBM, and No. 1 National Mail Order Pharmacy for customer satisfaction two years in a row. Prescription Solutions also won two Silver Awards for URAC’s Best Practices for Consumer Empowerment and Protection Awards – Geriatric RxMonitor Program (2008) and the Drug Interaction Alert Program (2009). Additional information can be found at

About UnitedHealth Group
UnitedHealth Group (NYSE:UNH) is a diversified health and well-being company dedicated to making health care work better. Headquartered in Minneapolis, Minn., UnitedHealth Group offers a broad spectrum of products and services through six operating businesses: UnitedHealthcare, Ovations, AmeriChoice, OptumHealth, Ingenix, and Prescription Solutions. Through its family of businesses, UnitedHealth Group serves more than 70 million individuals nationwide.