Dr. Virginia Devonshire
Neurologist & Clinical Associate Professor, Department of Medicine, University of British Columbia
Dr. Mark Freedman
Professor of Neurology, University of Ottawa, & Director, Multiple Sclerosis Research Unit, The Ottawa Hospital
Dr. Daniel Selchen
Neurologist, Multiple Sclerosis Clinic, St. Michael’s Hospital
Multiple sclerosis (MS) is a progressive immune-mediated disease that has been known for two and a half centuries, and its complex nature has meant that effective therapies were slow to develop and costly. Today, patients have more treatment options than they’ve ever had before but, as a result, they also have more questions than they’ve ever had before, including about the potential financial burden.
Subsequent entry non-biologic complex drugs have changed the lives of many MS patients, including Sarah Walker, a military spouse and mother of three, originally from Sault Ste. Marie, ON. “I was diagnosed with relapsing-remitting MS on June 30th, 2014,” Sarah says. “The journey to diagnosis was one of the scariest experiences of my life. I began experiencing seemingly unrelated symptoms around the age of 12. It all started with my ankles giving out and it would lead to me falling and appearing quite clumsy. I experienced symptoms like issues with memory, word finding, understanding what was being said, swallowing, temperature regulation, chronic fatigue, and insomnia — sometimes on a daily basis.”
The last thing anyone wants to worry about while adjusting to a life-changing diagnosis is money. And some options are helping to make that much less of a concern. “Although most medications today are covered by insurance, rarely are they fully covered, so patients are on the hook for a percentage,” says Sarah’s doctor, Dr. Mark Freedman. “So, the more expensive the medication, the higher the cost to a patient. Subsequent entry non-biologic complex medication significantly reduces the cost for patients because it’s a less expensive medication.”
Although most medications today are covered by insurance, rarely are they fully covered, so patients are on the hook for a percentage.Dr. Mark Freedman
Transforming the extreme into the routine
Sarah began treatment on a non-biologic complex molecule in the same year she was diagnosed and switched to a subsequent entry complex drug that worked better with her health benefits four years later, in 2018. She has been happy and healthy on the treatment ever since. The effect of the medication has been transformative, and the switch to the more cost-effective medication relative to her health plan was quite welcome.
In health care, as in everything, the question is always whether we could be doing the same or more for less. “These subsequent entry treatments don’t offer anything unique but they do offer the system cost savings, which is of course important,” says Dr. Virginia Devonshire, Clinical Associate Professor at the University of British Columbia.
Because the molecules involved are so complex, subsequent entry complex medications for MS aren’t precisely considered generics — or an exact copy. “Sometimes patients may be worried because of the potential variability among subsequent entry medication,” explains Dr. Daniel Selchen, Neurologist at St. Michael’s Hospital. There’s a Health Canada standard to accommodate and ensure treatment efficacy, but it really depends on what the best treatment plan is for a patient.
For Sarah, there was no noticeable difference. “I didn’t see any difference in how each of the medications helped manage my MS,” she says. “Before I started the subsequent entry complex treatment, I was on a needle that I self-injected daily, and afterwards it was the same. So it was easy to adjust. My experience with both medications has been absolutely fantastic. Before I started receiving treatment, I felt so run down and defeated, but it really didn’t take long for me to start feeling the changes. It was helping me live with MS, instead of constantly feeling like I was run over by a truck.”
The effect of the medication has been transformative, and the switch to the more cost-effective medication relative to her health plan was quite welcome.
Effective treatment depends on the person
What has really mattered for Sarah is knowing that her doctors take every aspect of her condition and her personal situation into consideration when deciding on the specific treatment that’s best for her. “Having a personalized treatment plan, I feel, is of the utmost importance for patients with MS,” she says. “This disease is as individual in its presentation as the patients themselves. I know three other MS patients in my area and we’ve compared notes, and while we have similarities in how MS affects us, it’s never exactly the same from one person to the next.”
Because the experience of MS is so individual, Sarah has found great solace in having a patient support program available. “The Ally Patient Support Program has been a huge help for me, especially financially,” she says. “They helped my family out so much by approving me for financial support which covers the upfront cost of my medication, in turn lowering any anxiety I would’ve had about coming up with the funds myself.”
For Canadian MS patients, knowing that there is a spectrum of medication available — and associated support programs — is reassuring. People with MS just want to live their lives. Having more options helps them do so.
This article was made possible with support from Pendopharm, a division of Pharmascience.
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