What Is Multiple Sclerosis?
Multiple sclerosis is a chronic disease that affects the brain and the spinal cord. The immune system attacks nerve fibers, along with the myelin sheathing surrounding healthy nerve fibers, causing inflammation. This inflammation destroys the myelin and nerve cell processes, thus altering the messages going to the brain. Multiple sclerosis can be an unpredictable disease. Some may have only mild symptoms, while others can lose their ability to walk, speak, or write. There are four primary progressions of multiple sclerosis, including:
- The vast majority of those with multiple sclerosis will have relapsing-remitting disease courses.
- Secondary-progressive multiple sclerosis usually begins as relapsing-remitting MS, then over time, the symptoms begin to get progressively worse, with little time in between flares.
- Primary-progressive multiple sclerosis occurs when symptoms steadily get worse without any obvious relapses or remissions. About 15 percent of all of those diagnosed with MS have primary-progressive MS, but for those diagnosed after the age of 40, this is the most common progression of multiple sclerosis.
- Benign multiple sclerosis is a mild course where an individual will have mild symptoms following being diagnosed and living with MS for about 15 years. The only way to identify benign multiple sclerosis is after individuals have had a diagnosis of MS for at least 15 years, and their symptoms have not worsened.
Common symptoms associated with a multiple sclerosis flare, or progressive MS, include:
- Overwhelming fatigue
- Vision issues, including blurry vision, double vision, or loss of vision
- Unsteady gait
- Muscle weakness
- Tingling and numbness
- Muscle spasms
- Mobility issues
- Stiffness and weakness
- Issues with thinking, learning, and planning
FDA Approved Drugs Used for Treating Multiple Sclerosis
There are many drugs used in the treatment of multiple sclerosis, including:
- Corticosteroids, including IV methylprednisolone, or oral prednisone are used for those with multiple sclerosis to reduce nerve inflammation.
- Plasma exchange—a process where the plasma is taken out, then separated from blood cells. The blood cells must then be mixed with an albumin solution before they are returned to the bloodstream. Generally speaking, MS patients who have not seen improvements following the use of corticosteroids will try plasma exchange as the next step.
Infusion treatments for MS include the following:
- Ocrevus (ocrelizumab) is a monoclonal antibody medication to treat both relapse-remitting and primary-progressive types of MS. Ocrevus is given via an intravenous infusion.
- Tysabri (natalizumab) is a medication designed to block the movement of damaging immune cells from the bloodstream to the brain and spinal cord.
- Lemtrada and Campath (alemtuzumab) are drugs that help reduce relapsing MS by targeting a protein on the surface of immune cells, depleting the white blood cells.
- Gilenya is a once-daily oral pill used to treat relapsing forms of MS in patients as young as 10.
- Avonex (interferon beta-1a) is used to treat relapsing forms of MS.
Treatments for relapsing-remitting MS, include:
- Aubagio (teriflunomide) is a once-daily oral medication that reduces relapse rates among those with multiple sclerosis.
- Mavenclad (cladribine) is a medication that is generally prescribed as a second-line treatment for those with relapsing-remitting MS, or for those with secondary-progressive MS.
- Vumerity (diroximel fumarate) is a twice-daily oral medication that is similar to Tecfidera but with generally fewer side effects.
- Interferon-beta medications are injected under the skin or into the muscle.
- Copaxone and Glatopa—medications that block the immune system’s attack on myelin that are injected beneath the skin.
- Gilenya (Fingolimod) is an oral treatment that reduces the relapse rate of MS.
- Tecfidera (dimethyl fumarate) is a twice-daily oral medication than can help reduce relapses among those with MS.
- Mayzent (siponimond) is a once-daily oral medication that may slow the progression of MS.
Are Multiple Sclerosis Treatments Expensive?
Treatments that can lessen symptoms of MS while slowing the progression of the disease can be expensive. Avonex, a drug taken once a week for MS via injections into the muscle can cost almost $4,000 per month or $47,000 per year. Tysabri can cost as much as $43,000 per year, and Gilenya can cost as much as $54,000 per year. As you can see, the treatments for MS can be expensive, however, can make a significant difference among those with MS regarding how quickly their disease progresses and how bad the symptoms are.
Can Your Insurance Company Deny Treatment for Your Multiple Sclerosis?
When a health insurer denies payment for a necessary MS drug, it can be devastating for the person with the disease as well as for their loved ones. A denial for a necessary MS drug can be appealed. This means you, your physician, or your attorney can submit an appeal, asking the insurance company to reconsider its decision to deny payment for your prescribed MS drug. There is a process of appeals and reviews that can be undertaken by your attorney when an insurance company—like one of the following—denies these necessary treatments.
- Anthem Blue Cross
- Blue Shield
- Health Net
- And many others
What Should I Do if My Health Insurance Company Won’t Pay for My Multiple Sclerosis Treatment?
If your health insurance company refuses to pay for your MS medications or has insisted that you go through a lengthy process of “step therapy,” it could be time to speak to an experienced attorney. Having a knowledgeable person in your corner who has dealt with insurance companies—and is not afraid of dealing with big insurance companies—can truly make a difference in the outcome of your MS drug denial. Attorney Scott Glovsky is that attorney. Scott will fight for you, your health, and your future, never afraid of going toe to toe with a big insurance company and insisting it does the right thing.
How Can an Attorney Help if I’ve Received an Insurance Denial for Multiple Sclerosis Treatment?
Attorney Scott Glovsky and his team fight against injustice for those who cannot fight for themselves. When big health insurance corporations take you to a low point in your life, the Law Offices of Scott Glovsky will step in and make a positive difference. Attorney Scott Glovsky will first let you know that you are no longer alone in this fight when justice seems elusive. When your health insurer has denied a medically necessary medication for your multiple sclerosis, Scott will work tirelessly for a better outcome. Contact the Law Offices of Scott Glovsky—we listen to your needs and goals and then help you determine the next step.