Disease-Modifying Therapies for Multiple Sclerosis
What’s the Access?
Multiple sclerosis poses a significant economic burden—on those living with MS, our health care systems, the Canadian economy, and broader society.
For most people, DMTs can help.
Although they are not a cure for MS, disease-modifying therapies (DMTs) are a type of medication that help reduce disease activity.
For people living with MS, DMTs can:
• reduce the frequency and severity of relapses
• slow the formation of new brain lesions and protect brain health
• slow the progression of disability
Prescribing guidelines
Evidence informs when and how treatment should start or change.
The choice to pursue DMTs as a course of treatment is made in consultation with health care professionals and depends on several factors, including:
Disease course
Depends on the type of MS—for example, relapsing-remitting MS or progressive MS.
Life stage
For example, receiving treatment as a child, as an older adult, or while pregnant.
Lifestyle
Lifestyle can influence a person’s preferred route of administration: oral, infusion, or injection.
Personal risk tolerance
Some DMTs have a higher risk of serious complications, such as infections, than others.
Drug tolerance
The presence or type of side effect(s) brought on by treatment.
Drug coverage
Public and private drug plans decide which DMTs are eligible for coverage and how they can be used.
When do DMTs make sense?
Currently, 12 DMTs (by active ingredient) are approved by
Health Canada for the treatment of MS. These include oral, injected, and infused medications.
The big issue
Here’s the problem: There is a disconnect between what experts recommend and the policies we have in place—and it’s making some DMTs harder to access.
Expert recommendations
Current policy environment
Early intervention is essential
Close monitoring of disease activity, with rapid adjustment or change of DMTs if needed
Access to a broad range of treatment options
Removal of financial barriers to improve medication adherence
Most Canadian provinces have a policy of two relapses before starting therapy
Strict prescribing and reimbursement criteria makes “switching” more difficult
Public access to new and innovative DMTs is lagging behind private drug coverage access
Cost-sharing in the form of premiums, deductibles, and co-payments can make treatment unaffordable
But our research shows that some Canadians can’t get sufficient, equitable, or affordable access to these medications.
Rising demand, rising costs
Drug innovation is changing the market. Demand for DMTs is growing, thanks to new oral and higher efficacy drugs. But so are the costs.
Between 2010 and 2018, the number of DMT claims grew by 50 per cent. This came with a 57 per cent rise in reimbursement costs, from $386.9 million in 2010 to $607 million in 2018.
Oral DMTs’ 2013 arrival increased utilization and costs
(number of claims, 000s; reimbursement costs for DMTs, 2018 $ millions)
Sources: IQVIA; Canadian Institute for Health Information (CIHI); The Conference Board of Canada.
How much will you pay?
It depends where you live.
One major barrier to equitable access is geographic location.
In 2018, Canadians living with MS and their families paid $39.3 million out of pocket for DMT drugs.
Proportion of costs by payer varies across provinces
(Drug costs by payer and province, $, 2018)
Sources: IQVIA; CIHI; The Conference Board of Canada.
But not everyone paid the same amount. Those living in Manitoba, British Columbia, and Newfoundland and Labrador paid relatively more for their DMTs.
Where do we go from here?
People affected by MS could benefit from a more tailored approach to treatment. This requires timely, equitable, and affordable access to the full range of medications currently available in the market.
One strategy to improve access—and therefore outcomes—
would be to lower the reimbursement criteria needed to start treatment with a more effective (i.e., second-line) DMT.
Who benefits from better access?
People living with MS
maximizes brain health and delays progression of disability
Health care systems
reduces medical costs from MS symptoms and hospitalizations
Economy and society
lowers indirect costs from lost productivity
and informal care
Download our primer, Accessing Disease-Modifying Therapies for Multiple Sclerosis: A Pan-Canadian Analysis.
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Want to know more?
The Conference Board of Canada created this research with funding and support from the MS Society of Canada, EMD Serono Canada, and Bristol Meyers Squibb. In keeping with Conference Board guidelines for custom research, the design and method of research, as well as the content of this study, were determined solely by the Conference Board.
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• reduce the frequency and severity of relapses
• slow the formation of new brain lesions and protect brain health
• slow the progression of disability
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