Why injection first on list for MS

[Jamiesmom32]

Hi  everyone, wanting to figure out the drug line up for ms.   As I've said before my daughter has been told she has ms and its been a struggle to get Copaxone for her. Dr wants 40 . Insurance wants her to have 20 . Called shared solution they said they would help.  Now they won't    Back to dr to prescribe the 20.  She won't  ! What a girl to do ? It's going on a good 3 months and no meds ! She having slight relaspes with speech  when eating swoling , she fears of chocking  , a limp on her leg thats getting  worse , not to mention she a bundle of nerves all jumbled up . She worked full time hass husband and three children all under 12.    
Her dr said she has to do Copaxone before she can go to other meds.    Can anyone shed some light and tell me why they can't putt her on a med that we could get sooner or why the injections before the pills
I don't understand the tier thing . Thanks for reading Your response would be appreciated
Cheryl

[HVAC]

I heard you have MS, Blah, blah, blah. I was so much in shock even thought I thought I had MS. There is a lot to learn when you are new to MS.

Alex

[kwarendorf]

We've all been where you are :-) If you can, get a hold of a booked called MS for Dummies. It covers a lot of ground in plain English. It helped me a bunch when MS first became my constant companion.

Also, ask us. There are no dumb questions at this point.

Kyle

[Jamiesmom32]

Thanks so much for your quick response ! I didnt realize at all how the drugs worked in the tiers they fall in . As far as the dr we've only seen her once after the lumbar punture and then was when we had a dionosise .
It was like headlight to a deer we didn't no what to ask or what she was explaining to us at that time . So little by little were getting this picture painted.   I do feel very uneducated  about ms.  So thanks again so very much for helping us understand  
Cheryl

[Jamiesmom32]

Thanks so much for your quick response ! I didnt realize at all how the drugs worked in the tiers they fall in . As far as the dr we've only seen her once after the lumbar punture and then was when we had a dionosise .
It was like headllights  to  deer.    So we didnt know what to ask or really what she was explaining to us .

[HVAC]

The reason Copaxone is a shot is they tried it first as a pill but it broke down in the digestive system and did not work.


Alex

[HVAC]

As far as the insurance Copaxone 20 is $25,000 and the orals $50,000 a month. A tier usually means instead of a copay you pay a percentage of the drug's cost.  

Alex

[kwarendorf]

PS - None of the available meds will address current symptoms. They are all designed to prevent or delay progression of MS. Current symptoms may be alleviated with high dose IV steroids. IVSM will work to reduce current inflammation that is causing the sympotms.

[kwarendorf]

Hi JM -

There are currently 10 FDA approved MS treatments available. There does seem to be a hierarchy.

The first line meds are known as CRAB's; Copaxone, Rebif, Avonex and Betaseron. They are all injectables and are generally tried before moving on to other options.

The 20/40 issue relating to Copaxone is a question of injection frequency. 20mg Copaxone is given once a day and 4omg is give 3X/week. I do not think one is more effective than the other.

I would ask the neuro why she won't discuss other options. In light of the insurance company resitance it would seem to make sense. If she continues to hold the line at Copaxone 40 I would start thinking aboiuot finding another MS specialist.

Kyle

[HVAC]

The injections have been around longer and they are safer in the beginning of MS they do not want to use the big guns. The oral drugs are less safe, more side effects, but work better on progressive MS. When you start say Gilenya they warn you that down the road they do not know if you might not need organ transplants. The drug has not been out long enough to know what the long term effects may be. You probably will never need an organ transplant but it does give you an idea the orals are stronger drugs. It is all risk/benefit. As the disease progresses Doctors and patients are willing to take greater risks to slow progression. But like if you have a small cancer they may cut it out and give you no chemotherapy where as if you are stage 4 Cancer you use a drug that may make your heart give out.

I did not think the injections were that bad I did them every day.

Alex