{"id":391454,"date":"2015-01-14T00:00:00","date_gmt":"2015-01-14T00:00:00","guid":{"rendered":"https:\/\/clarivate.com\/life-sciences-healthcare\/report\/pforus2915-biopharma-health-exchanges-and-multiple-sclerosis-physician-payer-forum-us-2015\/"},"modified":"2026-03-31T09:04:08","modified_gmt":"2026-03-31T09:04:08","slug":"pforus2915-biopharma-health-exchanges-and-multiple-sclerosis-physician-payer-forum-us-2015","status":"publish","type":"report","link":"https:\/\/clarivate.com\/life-sciences-healthcare\/report\/pforus2915-biopharma-health-exchanges-and-multiple-sclerosis-physician-payer-forum-us-2015\/","title":{"rendered":"Health Exchanges and Multiple Sclerosis | Physician &#038; Payer Forum | US | 2015"},"content":{"rendered":"<p><em>How Are Payers Responding to High-Cost Therapies on Their Exchange-Based Plans?<\/em><br \/>\nThe Affordable Care Act (ACA) has expanded access to insurance coverage to millions and has reformed health insurance requirements to assure more-comprehensive coverage of behavioral health and prescription drugs. Government reports estimate that more than 8 million people have enrolled in a health plan offered on the health insurance exchange, including 5.8 million estimated to have made their first payments. In addition, as many as 8 million people have gained coverage through the expansion of Medicaid in 27 states and the District of Columbia, creating a new, lucrative sales channel for the pharmaceutical industry. These changes stand to affect reimbursement and prescribing of therapies treating MS, an indication that largely strikes younger individuals who do not qualify for Medicare, and are therefore recipients of commercial coverage, Medicaid, or are uninsured. Expanded coverage means that individuals who were previously uninsured or who had access to less-generous commercial plans can now obtain insurance via exchange-based plans or Medicaid. As a result, demand for MS therapies should increase. However, the desire by MCOs to limit adverse selection in their exchange-based plans may also limit access to some therapies that are not preferred by payers, affecting uptake. MS therapies used include Bayer HealthCare\u2019s Betaseron (IFN-\u03b2-1b), Novartis\u2019s Extavia (IFN-\u03b2-1b), Biogen Idec\u2019s Avonex (IFN-\u03b2-1a, IM), Merck Serono\/EMD Serono\u2019s Rebif (IFN-\u03b2-1a, SC), Biogen Idec\u2019s Plegridy (pegylated interferon-\u03b2-1a), Teva\u2019s Copaxone (glatiramer acetate), Biogen Idec\u2019s Tysabri (natalizumab), Novartis\/Mitsubishi Tanabe Pharma\u2019s Gilenya (fingolimod), Genzyme\u2019s Aubagio (teriflunomide), and Biogen Idec\u2019s Tecfidera (dimethyl fumarate).<\/p>\n","protected":false},"template":"","class_list":["post-391454","report","type-report","status-publish","hentry","report-gateway-biopharma","biopharma-therapy-areas-multiple-sclerosis","biopharma-geography-us","biopharma-date-717"],"acf":[],"publishpress_future_workflow_manual_trigger":{"enabledWorkflows":[]},"_links":{"self":[{"href":"https:\/\/clarivate.com\/life-sciences-healthcare\/wp-json\/wp\/v2\/report\/391454","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/clarivate.com\/life-sciences-healthcare\/wp-json\/wp\/v2\/report"}],"about":[{"href":"https:\/\/clarivate.com\/life-sciences-healthcare\/wp-json\/wp\/v2\/types\/report"}],"version-history":[{"count":2,"href":"https:\/\/clarivate.com\/life-sciences-healthcare\/wp-json\/wp\/v2\/report\/391454\/revisions"}],"predecessor-version":[{"id":576978,"href":"https:\/\/clarivate.com\/life-sciences-healthcare\/wp-json\/wp\/v2\/report\/391454\/revisions\/576978"}],"wp:attachment":[{"href":"https:\/\/clarivate.com\/life-sciences-healthcare\/wp-json\/wp\/v2\/media?parent=391454"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}