MS Medication Utilization in Texas Medicaid

Background: Disease-modifying therapies (DMTs) provide relief to patients with multiple sclerosis (MS) through prevention and mitigation of relapses and disease progression. Despite the availability of several DMTs, some patients do not use these medications. Research indicates patients covered by Medicaid may be less likely to receive DMTs than those with Medicare or private insurance. As such, Medicaid patients with MS are an important group for study.

Objectives: (1) Identify the demographic and clinical characteristics of Texas Medicaid (TXM) patients with MS (TXM-MS patients); (2) Compare these characteristics with those of MS patients from a combined 5-state MarketScan Medicaid (MM5) claims database; and (3) Determine the relationships between patient characteristics and the receipt of DMTs in TXM-MS patients.

Methods: Medical and prescription data from the TXM and MM5 databases were used in this study. Non-dual eligible adults (18-64 years) with an MS diagnosis (ICD-9-CM=340) and continuous eligibility in 2013 were identified in both datasets. Logistic regression was used to study TXM-MS patient demographic and clinical characteristics associated with DMT utilization.

Results: A total of 894 TXM-MS patients met the study criteria. The mean age of patients was 45 years (sd=11.9), 80% were female, and 38% were white. Less than half of MS patients (TXM-49%, MM5-43% of 3,476) had Medicaid claims for DMTs during 2013. Compared to the MM5 sample, TXM-MS patients were older (45 vs 42 years) and sicker (Charlson Comorbidity Index: 1.6 vs 1), and a greater proportion was Hispanic (21% vs 1%). Among TXM-MS patients, compared to those 50-59 years: those >60 years had lower odds of having DMT claims (OR: 0.544; 95%CI: 0.359-0.823), those <40 years had greater odds (<30, OR: 2.572, 95%CI: 1.705-3.878) (30-39, OR: 1.424, 95%CI: 1.035-1.959), and those 40-49 years showed no difference. Among TXM-MS patients, the odds of having DMT claims were lower for fee-for-service compared to managed care patients (OR: 0.184, 95%CI: 0.140-0.240), and for sicker patients compared to their healthier counterparts (OR: 0.893; 95%CI: 0.838-0.951).

Conclusions: Similar to the results using the MM5 database, less than half of the non-dual-eligible, non-elderly TXM-MS patients had Medicaid claims for DMTs. Follow-up studies are warranted to investigate the reasons for the absence of DMT claims among a large proportion of Medicaid patients.