Recently, BC Pharmacare decided to discontinue coverage of Copaxone, a first line disease modifying therapy (DMT), in place of Glatect, a new bio-similar glatiramer that has a lower cost. Our clinic informed each patient of the change in coverage and asked whether they would prefer to remain on Copaxone, switch to the biosimilar or switch to a different DMT all together.
We looked to investigate whether the traditional forces, those being patient and physician collaborative decision making, would still be in use for patients using Copaxone, or if other forces would result in decision making of medication usage. Our objective was to determine which forces guide a patient’s decision to use DMTs when faced with an opportunity to switch.
A chart review study was conducted to identify patterns and causes for changes in medication usage among patients with MS at the Fraser Health Multiple Sclerosis Clinic in British Columbia, Canada.
A total of 79 patients that had been using or have previously and recently used Copaxone as of November 2018 were reviewed. Of these 79 patients, 51 (65%) had documented their primary rationale for discontinuing use of Copaxone in favour of another drug as due to the BC Pharmacare coverage changes. Of those 52 patients, 34 patients had already started or planned to start Glatect, 5 patients chose to remain on Copaxone, while 7 patients chose to remain on Copaxone if their insurance covered it, and if not would begin Glatect. Of the remaining patients, 4 chose to not use any DMT, while the other 23 had already switched or were planning to switch to an oral DMT, Ocrelizumab or Tysabri. Those that chose to not use Copaxone or Glatect did so because they either wanted to use an oral medication or needed to use a stronger medication due to progression of their disease while on Copaxone.
Traditionally changes in medication management occur as a collaborative effort between patient and physician. Our review points to a new force, the BC Pharmacare coverage drop of Copaxone, as a factor that influences DMT decision-making. It is clear in this scenario that this change was influenced not only by a medical necessity but also by financial decision and thus this variable should be considered during DMT decision-making.