b'ago.Geneticchangesovertime,basedoninterest. This study analyzed variables that may lifestyle and diet changes, have also inuencedinuence decisions by insurance companies the genetically inherited risk for MS. The ndingsto approve or deny prior authorizations for a were published in the journal Nature.prescribed therapy and what effect this action Thrower-So,wheredidMScomefromhad on disease activity. Half of the prior originally? Traditional thinking has been thatauthorizations were initially denied, and it geneticriskfactorsforMSoriginatedinwas very unlikely (98 percent) that a second Northern Europe around the British Isles. Thereview would result in a different decision. Orkney Islands off the coast of Scotland haveOral medications and infusions were denied some of the highest rates of MS globally atmore often than injections, and Medicaid had about 402/100,000 people. Compare that tohigher denials than commercial insurance. my home state of Georgia where the risk isThe delay in prior authorization for prescribed about 70/100,000. High prevalence areas intreatments increased the likelihood of disease the U.S., such as Minnesota, have a rate ofactivity, and most often, the patient would end around 200/100,000. up on the initially prescribed medication but only after the disease progressed. The article New genetic studies show that genes carryingwas published in The International Journal a risk for MS were imported to Northern Europeof MS Care. from Central Europe (the region around modernThrower- Research has given us more than Russia) in the Bronze Age (3300-2600 BC) in25 FDA-approved disease-modifying therapies the Yanmaya migration. to manage MS. A key to preventing long-term We know that MS results from a combinationdisability in MS is the introduction of an of environmental and genetic risk factors.appropriate DMT as quickly as possible during Multiple genes have been identified thatthe course of MS. Sadly, while medical research contribute to a higher risk for MS. Most ofhas given us more options, health insurance these genes play a role in immune regulation.carrier policies can present a signicant barrier While MS has a genetic component, it is nottoearlyandeffectivetherapy.Thisstudy a strong hereditary disease. If you have a rstfound that half of DMT prior authorization degree relative (parent, sibling, or child) withclaims were denied. These denials delayed MS, your lifetime risk for developing MS istreatment and were linked to a higher risk of around 2.5-3 percent. Most people with MSdisability. cannot identify a family member with MS.One of the ways that insurance carriers Environmental risk factors include exposuremay restrict care is with step edits. Imagine to common viruses, such as the Epstein-Barryour MS neurologist wants to start you on drug virus, and low vitamin D levels.Study: Insurance companies denyB as they feel this drug is the most appropriate half of the prior authorizationsfor your situation. However, your insurance carrier says you must try drug A before you A researcher at a Florida neurology cliniccan try drug B. Your insurance carrier has never conductedaretrospectivecross-sectionalseen you as a patient and has no expertise in study of 52 individuals recently diagnosedMS. Lets imagine your neurologist cannot get with MS to measure the link between durationdrug B approved and you are forced to try of prior authorization and other variables ofdrug A. You have a relapse on drug A. Each 45 msfocusmagazine.org'