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Multiple Sclerosis (MS)

Affects approximately 1 million people in the U.S.·10 treatments

Multiple sclerosis is a chronic autoimmune disease of the central nervous system where the immune system attacks the myelin sheath surrounding nerve fibers. This causes communication problems between the brain and body, leading to vision problems, muscle weakness, coordination difficulties, and cognitive changes. Early and aggressive treatment can slow disability progression.

You may qualify for clinical trials that provide Ocrevus at no cost

Clinical trials may give you access to this treatment while helping advance medical research

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OcrevusinfusionOcrevus ZunovoinjectionKesimptainjectionBriumviinfusionTysabriinfusionGilenyaoralVumerityoralMavencladoralTecfideraoralRebifinjection

Many insurers still require trial of a platform therapy (interferon beta or glatiramer acetate) before approving high-efficacy DMTs like Ocrevus or Kesimpta, despite growing evidence favoring early high-efficacy treatment. Some plans now allow Ocrevus as first-line for both relapsing and primary progressive MS. Tysabri requires JCV antibody testing and REMS enrollment.

Must fail platform therapies (interferons, glatiramer acetate) before high-efficacy DMTs

Very Common

MRI findings not submitted or insufficient for diagnosis confirmation

Common

Ocrevus/Kesimpta denied as first-line without step therapy completion

Common

JCV antibody testing not documented for Tysabri requests

Occasional

Switching between high-efficacy DMTs denied without documented disease activity

Occasional

  1. 1.Cite AAN guidelines supporting early high-efficacy treatment for active relapsing MS
  2. 2.Document MRI findings showing new or enhancing lesions, clinical relapses, and EDSS score
  3. 3.For primary progressive MS, note that Ocrevus is the only FDA-approved therapy — no step therapy should apply
  4. 4.Include JCV antibody status for Tysabri requests and document risk-benefit discussion
  5. 5.For treatment switches, document breakthrough disease activity on current DMT

Active clinical trials that may provide treatment at no cost.

Copay cards, patient assistance programs, and foundation grants for this condition's treatments.

Want to know what you'll actually pay?

Estimate your annual out-of-pocket cost with and without assistance programs.

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Denied for Multiple Sclerosis (MS) Treatment?

Ellen can decode your denial, find your appeal strategy, and generate your appeal letter — free.

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