National MS Society’s Statement on U.S. Supreme Court Ruling of new Healthcare mandates - Multiple Sclerosis (MS) Information, and resources

The National Multiple Sclerosis
Society supports the decision of the United States Supreme Court regarding the
Patient Protection and Affordable Care Act. This ruling will have a
significant, positive impact on many, including the millions of Americans affected
by multiple sclerosis.

Below
are some of the provisions of the law that the National MS Society believes
will have the biggest impact on people with MS and their families:

Prohibition of coverage denials based on pre-existing
conditions: Too many people living with MS
had been routinely denied insurance after receiving their diagnosis,
preventing them from getting the care they need.
Prohibition
of lifetime limits:
Routine, often costly care is needed to manage MS. This may cause those
living with severe forms of the disease to reach their lifetime limit
early in life. Elimination of that limit was critically important for
continued care.
Elimination of annual limits: Similar to lifetime limits, many patients reach their annual
limit of coverage because of the cost of care for MS. These arbitrary
limits should not prevent those in need from receiving care.
Extension of parent’s insurance to 26: Many people with MS are diagnosed in their 20s and may
still be in school or lacking a full time job to help pay for their care.
This provision ensures that they can continue coverage under their
parent’s policy.
Closing the Medicare Part D Coverage Gap: Disease Modifying Therapies for someone with MS can
cost as much as $4,000 per month, which is out of reach for the average
American; therefore, gradually closing the coverage gap has provided
financial relief for those who depend on Medicare for prescription
coverage.
Pathway for Biosimilars: The law provides a pathway for biosimilars which
provides some hope of lower cost therapies in the future. The FDA had
recently indicated it would not have pursued this pathway without the
legislative mandate therefore, it will continue to be developed–which is
good news for anyone who uses biologic therapies.

Background
Although
many people with MS have health care coverage, 70% of those with health
insurance still struggle with the cost of health care and 30% are forced to
spend less on food, heat, utilities and other necessities in order to afford
their health care. Those without access to private insurance and who do not
qualify for public programs are often priced out of the market, as individual
plans can be prohibitively expensive.

On
average, the financial impact of living with MS is $69,000 per year, and more
than half of this amount consists of direct health care costs. Unlike some
other diseases, MS is a lifelong illness–typically diagnosed between the ages
of 20 and 30s–prime career and family building years. Because of the high cost
and complications that can be associated with the disease, the National MS
Society has long supported many of the policies that were included in the law
just upheld by the Supreme Court.

With
guidance of people living with MS, the Society adopted a set of National
Health Care Reform Principles several years ago and, as an organization.
Our approach is to support legislation that is in line with those principles.
We intend to continue to work with Congress and the Administration in pursuit
of public policies that address the needs of those impacted by MS.

Contact
For
assistance with specific health insurance questions, people with MS, their
families or healthcare providers may speak with an MS Navigator by calling
1-800-344-4867 (FIGHT MS). You can find additional information on our website.