Disease-modifying therapies for relapsing-remitting multiple sclerosis (RRMS) are effective for delaying onset of disability. But these medications can be expensive without insurance.
Studies estimate that the annual cost of first-generation MS therapy has increased from $8,000 in the 1990s to more than $60,000 today. As well, navigating the complexities of insurance coverage can be challenging.
To help you maintain financial stability while adapting to a chronic illness like MS, here are seven concrete and creative ways to pay for new RRMS medication.
1. If you don’t have health insurance, take steps to get insured
Most employers or large businesses provide health insurance. If this isn’t the case for you, visit healthcare.gov to see your options. While the normal enrollment deadline for 2017 health coverage was January 31, 2017, you may still qualify for a special enrollment period or for Medicaid or the Children’s Health Insurance Program (CHIP).
2. Understand and get the most out of your health insurance
This means reviewing your health plan to understand your benefits, as well as plan limits. Many insurance companies have preferred pharmacies, cover specific drugs, use tiered copayments, and apply other limits.
The National Multiple Sclerosis Society has compiled a helpful guide to different types of insurance, as well as resources for the uninsured or underinsured.
3. Speak with your MS neurologist to help get insurance coverage for your RRMS therapy
Physicians may submit a prior authorization to provide medical justification for you to receive a specific treatment. This increases the chances that your insurance company will cover the therapy. In addition, speak with coordinators at your MS center to understand what your insurance covers and doesn’t cover so you’re not surprised by your health costs.
4. Contact financial assistance programs
The National Multiple Sclerosis Society has compiled a list of manufacturer assistance programs for each MS medication. In addition, a team of MS navigators from the society can answer specific questions. They can also assist with changes in insurance policy, finding a different insurance plan, covering copayments, and other financial needs.
5. Participate in clinical trials for MS
Those who participate in clinical trials help advance treatment of MS, and usually receive a treatment free of charge.
There are a variety of clinical trials. Observational trials provide an MS therapy while monitoring participants with additional diagnostic tests.
Randomized trials may provide an effective therapy that isn’t yet approved by the U.S. Food and Drug Administration (FDA). But there is a chance that a participant could receive a placebo or an older FDA-approved MS drug.
It’s important to understand the benefits and risks of participating in a clinical trial, especially for therapies that aren’t yet approved.
Ask your doctor about clinical trials in your area, or do your own research online. The National Multiple Sclerosis Society has a list of clinical trials conducted around the country.
6. Consider crowdfunding
Many people with high medical debt have turned to crowdfunding for help. While this requires some marketing skills, a compelling story, and some luck, it isn’t an unreasonable avenue if other options aren’t available. Check out YouCaring, a nationwide crowdfunding site.
7. Manage your personal finances
With good planning, a diagnosis of MS or other chronic medical condition shouldn’t cause sudden financial uncertainty. Use this opportunity to start fresh financially. Make an appointment with a financial planner, and understand the role of medical deductions in tax returns.
If you experience significant disability due to MS, speak with your doctor about applying for Social Security disability insurance.
Don’t let finances prevent you from receiving the MS therapy that’s right for you. Speaking with your MS neurologist is an excellent first step. They often have access to valuable resources and can advocate on your behalf more effectively than many other members of your care team.
Take responsibility for your finances, and know that it’s possible to live a rewarding and financially independent life despite having MS.
Disclosure: At the time of publication, the author has no financial relationships with MS therapy manufacturers.