The decision would benefit many MS patients -- the drug typically costs about $1000.00 per month.
Even with the decision, however, many patients who cannot take Avonex due to lack of effectiveness or side effects will be left out in the cold, Arney Rosenblat, spokesperson for the National Multiple Sclerosis Society, told United Press International.
The causes of multiple sclerosis, or MS, remain unknown. The disease destroys the lining around nerve cells in the brain and spinal cord called the myelin. It can be a crippling disease, leaving some patients unable to work and on disability.
Although MS patients can collect social security disability insurance, which falls under the purview of Medicare, the Centers for Medicare and Medicaid Services traditionally have not covered self-administered medications, such as all five of the MS drugs.
Last year, however, Congress passed legislation requiring the centers to change their policy to cover drugs "that are usually not self-administrable and so we had to implement that," CMMS spokesperson Don McLoud told UPI.
The National Multiple Sclerosis Society believes the ruling will only apply to Avonex, Rosenblat said. This is because even though Avonex can be self-administered, it is given by injection into muscle, which is generally done at a doctor's office. Medicare typically has covered these types of medications.
The other MS drugs -- Copaxone, Betaseron, Rebif and Novantrone -- are given by injection under the skin, generally at home and not at a doctor's office. This classifies them as self-administered medications and therefore they probably will not be covered by this ruling, Rosenblat said.
McLoud would not specify the date when the ruling would be announced, but he said, "We're working on it." He added the agency typically will not release such decisions until after the stock market has closed for the day.
McLoud noted the decision will not name a specific drug but will contain language to guide Medicare contracting agencies on which types of drugs to cover. Essentially, it comes down to how the agency decides to define "usually not self-administrable," he said.
"It actually makes no difference" how they define it, Rosenblat said "because MS patients often have tremors or spasticity and can't give either drug to themselves. This should be a medical judgment and based on person's disabilities and which drug will work best not on which drug is covered.
Rosenblat noted, "We're certainly pleased that something is covered for people on Medicare." But the society would like to see all five drugs covered under Medicare because some patients cannot tolerate Avonex and may do better on the other drugs, she said.
Robin Wright, 35, is an example of such a patient. She has suffered from MS since she was 15 and has an underlying muscular disease that prevents her from receiving Avonex injections, she told UPI.
Wright's doctor recommended Copaxone, she said. "We couldn't mess around, I had to get on Copaxone one way or another."
Wright has not been able to start on Copaxone, however, because she has not been able to afford it. Her only insurance is Medicare and her husband's insurance will not cover the drug because the company considers her MS to be a pre-existing condition. She takes steroids to help control some of the symptoms of the disease but they do not prevent it from progressing, as Copaxone and the other MS drugs may.
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