Difficulty can arise when the patient and the physician both agree on a DMT switch, but the patient’s health insurer says no. “The clinician’s best judgment is, ‘I’ve seen the MRI. There’s activity in the brain. I want to change to a different medication.’ But the insurance company says, ‘You don’t meet our criteria,’ ” said Gary R. Cutter, Ph.D., director of the NARCOMS Coordinating Center. “The patient doesn’t know what to do. The physician can fight [that decision by the insurer], can get involved in that battle. But that’s a different battle that not all physicians have the resources around to tackle. It can be a hassle for both the patient and physician.”
Dr. Gary Cutter
Dr. Cutter noted that MS patients who switch DMTs tend to do worse from a clinical standpoint. “If you look cross-sectionally at data, people who have switched end up with higher levels of disability, and it’s because the physician is reacting to something; it’s not that the drug they switched to is bad,” he said. “These drugs are not cures. They’re meant to slow the progression [of MS].”
NARCOMS is supported by the CMSC and the Foundation of the CMSC. Genentech provided additional support for the survey of treatment decision making. Dr. Cutter disclosed ties to several pharmaceutical companies. The other researchers stated that they had no financial conflicts to disclose.
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