well this is interesting...

[doublevision1]

Interferon Maker to Repay Insurer for MS Relapse Costs

By John Gever, Senior Editor, MedPage Today
Published: December 09, 2011

The manufacturer of a major drug for multiple sclerosis has given what appears to be a money-back guarantee that its product will prevent severe relapses when used as directed.

Bayer HealthCare, maker of the Betaseron brand of interferon-beta-1b, has entered into a contract with Illinois-based Health Alliance Medical Plans (HAMP) agreeing to reimburse the insurer for hospitalization costs incurred by member patients who experience severe relapses while taking the drug according to prescribed directions.

"This agreement reinforces our commitment to people taking Betaseron and demonstrates our belief that when patients are adherent to their treatment plan, there may be a greater chance for positive outcomes by reducing clinical exacerbations," said Alex Santini, Bayer's vice president of managed markets, in a statement.

Another Bayer spokesperson said the average cost of hospitalization for severe MS relapses is about $12,000.

Details of the agreement, including the exact amount of compensation that Bayer would pay HAMP for relapses, how adherence would be measured, and whether patients' out-of-pocket costs would also be reimbursed, were not released.

HAMP has about 335,000 members in Illinois and Iowa, according to its website. The insurer did not respond to a request for comment.

Kim Calder, a spokeswoman for the National Multiple Sclerosis Society, told MedPage Today that the agreement was interesting and innovative, but "time will tell" whether it benefits patients significantly.

"We have not seen anything like this before," she said. "It's a little too soon to know the impact [on patients]."

However, she added, the NMSS supports anything that will genuinely promote treatment adherence and relapse prevention in MS patients.

Bayer said it has a patient support program called Betaplus that provides 24-hour access to specialists who can answer questions about insurance coverage and other issues related to starting and staying on treatment.

Calder charged that insurers themselves have created one of the most important barriers to treatment adherence in MS -- the classification of interferon drugs as specialty pharmaceuticals subject to high patient copayments, often 25% to 33% of the retail price.

Such cost sharing "doesn't serve anyone's interest," Calder said.


http://www.medpagetoday.com/Neurology/MultipleSclerosis/30115#.TvDhvE8zBcp.facebook

[sllowe]

I do love how they threw the insurance under the bus though - they are spot on regarding the insurers, classifications, and specialty pharm co., and the prices! Bout time someone blame the true culprits!

[sllowe]

Wow! All I can say is that they are very gracious - especially considering not all meds work the same for all.

Identifying a true attack, especially new MSers is not an easy task - I cannot imagine how they would monitor this, or what criteria they would rely on - i.e., would they use imaging, or clinical dx of true relapse. Either way, it could be costly.

Thanks for putting this one up DB - they are super brave. How do they even know patients are being compliant to their therapy? Ok, enough said... definitely interesting.
-shell

[Lulu54]

Glad you found that DV.  It is interesting to ponder and I wonder if other pharmas will follow suit in one way or another. I am not sure what part of the market Bayer still has with Betaseron.  It was the early MS drug, but there are now many other options.  Perhaos this is a move on their part to gather more of the market share?

There are 50 states here in the US, I wonder why just one (Illinois) has this deal?  

I wonder if this is more a grand gesture than something really revolutionary to the health care reimbursement program?  I have several questions about how they would collect this money guarantee, especially since it is hinged to patient compliance.  Do we ever really know if a patient is compliant?  I know I have not been for the past 3-4 months.  

thanks again for finding this one,
Lulu

[maxthecat9196]

That is interesting.  Thank you for sharing this with us.  I like to see when a company really believes in their product.

Tammy