Persistence and Adherence to Fingolimod or Brace Therapy Among Medicaid Patients with Multiple Sclerosis in Missouri

Background: Multiple sclerosis (MS) is more common in the Medicaid population than in the private insurance population. Early and persistent use of disease modifying therapies (DMTs) is recommended, but the treatment patterns of Medicaid MS patients using DMTs have not been widely studied. In patients with relapsing forms of MS, Gilenya^® (fingolimod) was the first oral immunomodulatory drug approved by the FDA. Self-injectable DMTs (interferon and glatiramer acetate), known as BRACE therapies, are also commonly used for treatment of relapsing MS. This study seeks to better understand adherence and persistence to fingolimod and BRACE therapies in Missouri MS Medicaid patients.

Objectives: To describe the adherence and persistence among patients with MS on Medicaid treated with BRACE therapy or fingolimod in Missouri. 

Methods: Missouri Medicaid patients with MS in 2009–2014 were identified from state claims data. The index date was the first claim for fingolimod or any BRACE agent in 2012. Patients had to be continuously enrolled for 1 year after the index date (follow-up period). Adherence was defined using proportion of days covered (PDC) >= 80%, while persistence was defined as having no treatment gap of > 60 days from start of index therapy. Patients were considered compliant to BRACE or fingolimod therapy if both adherence and persistence criteria were met. 

Results: The study included 573 MS patients using a BRACE agent and 60 using fingolimod. Over 80% of patients in each group were women, with a mean age of 42.3–44.5 years. The mean adherence for fingolimod and BRACE cohorts was 70.2% and 62.7%, respectively. 61.7% and 49.9% of fingolimod and BRACE patients were considered persistent and 56.7% and 40.8% were considered compliant, respectively. Compliant patients were similar to the overall groups in terms of age and gender. 

Conclusions: This is among the first studies to describe the adherence and persistence rates of Medicaid MS patients treated with DMTs. Results are similar to previous findings in Texas Medicaid patients, and the trend of higher compliance for fingolimod is consistent with published data in commercial patients. Overall, only half were compliant to BRACE or fingolimod therapy, suggesting an opportunity for improved management of MS patients in Medicaid.