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Abstract Details

Comparison of Multiple Sclerosis Disease-modifying Therapy Utilization Between the Department of Veterans Affairs and US Medicare Health Care Systems
Multiple Sclerosis
P11 - Poster Session 11 (5:30 PM-6:30 PM)
6-004
High-cost DMT for MS have created affordability challenges for patients and payers. Policy approaches by major health systems impact DMT utilization with implications for healthcare costs and disease management. 

To compare utilization trends of multiple sclerosis (MS) disease-modifying therapies (DMT) between the Department of Veterans Affairs (VA) and US Medicare healthcare programs. 

Total counts and proportions of patients with MS using specific DMT in the VA and Medicare administrative health claims datasets were used to estimate yearly changes in utilization from 2012 to 2021. Proportionate use of generics was evaluated for dimethyl fumarate and fingolimod. Trends in utilization patterns were compared qualitatively between systems. 

In 2021, 7,836 Veterans and 88,396 Medicare beneficiaries received a DMT. From 2012 to 2021, the proportion of patients using lower-efficacy DMT (interferons, glatiramer) declined more in VA (90% to 32%, 58% decline) than Medicare (81% to 38%, 43% decline) populations. Oral DMT use increased to a similar degree with 39% of patients in both systems receiving oral therapy by 2021. Veterans had higher fumarate use (mostly dimethyl fumarate), while Medicare beneficiaries had higher use of teriflunomide and sphingosine 1-phosphate inhibitors. Proportion of B cell depleting DMT (ocrelizumab, ofatumumab, rituximab) use was 5%-6% higher in the VA, which also utilized more rituximab than Medicare. When available, generic DMT are nearly exclusively used in the VA. In contrast, in 2021 utilization of generic glatiramer (available in 2015) was 51% and generic dimethyl fumarate (available in 2020) was 47% among Medicare beneficiaries. 


While overall DMT utilization trends in both systems were generally similar, VA is distinct in its uniform use of generic DMTs. VA utilization management strategies may also influence use of high-efficacy B cell depleting therapies.

Authors/Disclosures
Rebecca Spain, MD, MSPH, FAAN
PRESENTER
Dr. Spain has received personal compensation in the range of $10,000-$49,999 for serving as an Expert Witness for United States Department of Justice. The institution of Dr. Spain has received research support from Department of Veterans Affairs. The institution of Dr. Spain has received research support from National Multiple Sclerosis Society.
Mitchell T. Wallin, MD, MPH, FAAN The institution of Dr. Wallin has received research support from NMSS.
Glenn D. Graham, MD, PhD, FAAN (Department of Veterans Affairs) Dr. Graham has received personal compensation in the range of $10,000-$49,999 for serving as a Speaker with MER (non-profit CME provider). Dr. Graham has received personal compensation in the range of $500,000-$999,999 for serving as a Employee with Department of Veterans Affairs. An immediate family member of Dr. Graham has received personal compensation in the range of $100,000-$499,999 for serving as a Exployee with Department of Veterans Affairs.
Steven Leipertz (Puget Sound Veterans Administration) No disclosure on file
Daniel Hartung, PharmD, MPH (Oregon State University / Oregon Health & Science University) Mr. Hartung has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Alkermes. Mr. Hartung has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Sandoz. Mr. Hartung has received personal compensation in the range of $50,000-$99,999 for serving as an Expert Witness for Humana. Mr. Hartung has received personal compensation in the range of $10,000-$49,999 for serving as an Expert Witness for US DOJ. Mr. Hartung has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant with NMSS.