Though 1 million Americans are currently diagnosed with multiple sclerosis, living with the illness can vary greatly from case to case. Some experience loss of mobility, while others experience cognitive issues, or even blindness. No two MS stories are exactly the same, but one thing many have in common is the frustrating process of finding a treatment that works for them.
For many, this is a long process of trial and error in which they will try a treatment only to find it does not work, and then try another, doing so again and again until finding the one that works best for them.
Further complicating this process is identifying what treatments are covered by health insurance plans. All too often, individuals living with MS have to live with the possibility that the treatment they worked so long to find will no longer be covered by their insurance or will be too expensive due to changes in formularies.
An Act promoting continuity of care for multiple sclerosis treatment, also known as S.686, will help bring stability to the lives of Massachusetts residents with MS by ensuring they are not forced to give up beneficial disease modifying treatments if a health insurer decides to change its formulary, or if individuals change their health insurance plan.
This bill makes individuals eligible for a “transition fill” if they are changing plans and need a prescription to last them until their new insurance approves their prescription. It also guarantees that the treatments individuals have already been prescribed are not subject to any greater deductible, coinsurance, copayments or out-of-pocket limits than any other disease-modifying prescription drug for multiple sclerosis provided by the insurer.