New Treatments Require New Approaches?

Dylan Landers-Nelsons's Perspective on Multiple Sclerosis (MS), Medical Marijuana, and What Employers Can Do About Them

A Business Group Staffer’s Perspective on Multiple Sclerosis (MS), Medical Marijuana, and What Employers Can Do About Them: At a recent visit to my psychologist’s office, I saw one of those waiting room magazines we all typically ignore these days now that smart phones are ubiquitous. This one, though, caught my eye because its cover highlights two topics I’ve recently helped create Business Group resources on: medical marijuana and multiple sclerosis. Also Jim Gaffigan… I didn’t expect to see him on an American Academy of Neurology’s patient-focused magazine. Solid marketing, neurologists.

Exciting New Treatments of Rare Diseases

As seen in my psychologist's waiting room...

Epilepsy and Marijuana: As someone with inherited epilepsy, I’ve long heard in the “epilepsy community” increasing excitement about research trials showing effectiveness of marijuana-derived medications for preventing seizures in children suffering from often-untreatable Lennox-Gastaut and Dravet syndromes. These trials used a form of modified marijuana that doesn’t have THC, the ingredient that creates a “high.” Last year, the FDA approved the first such pharmaceutical treatment in the U.S., which could transform the lives of these children and their parents. Our Employer Considerations for Medical Marijuana  lays out the evidence for and against medical marijuana, as well as considerations for drug testing, treatment for substance use disorder, and safety in the workplace.  

Multiple Sclerosis:I first wrote our employer guide on MS in 2015, but my colleagues recently gave it a much needed update. Multiple Sclerosis: New Evidence, New Treatments covers several new medications for MS and strategies for addressing ever-rising treatment costs. Particularly promising is a new class of drugs, including the very drug advertised on page 12 of the waiting room magazine I picked up, which is the first that treats the primary-progressive form of MS affecting 15% of people with the disease.

A Healthy Dose of Caution for Patients and Employers

The New Big Tobacco? Like many of you reading this, I have family and friends who have suffered from misuse of tobacco, alcohol, and opiates. As legalization of recreational and medical marijuana grows across the country and is increasingly commercialized, individuals and employers need to be vigilant that we’re not creating yet another “big tobacco” poised to profit off the suffering of millions.

  • Like alcohol, just because something is legal doesn’t make it entirely safe or immune to abuse, and employers can help with communications that educate employees and their families.
  • Individuals should consult with their medical providers about the very real risks of using THC-containing marijuana and potential medical benefits when used appropriately, just like they would for prescription opioids or an elective surgery.

Cost and Affordability.The meds I take for epilepsy cost me (pre-deductible) and my fully-insured health plan (post-deductible) about $1,000 per month. For people taking MS treatments, they and their employers are on the hook for several times more than that (average list prices are north of $60,000 a year.) There is still no cure for MS, so medications are taken over the course of a lifetime and employers must be aware of these costs, while keeping an eye toward affordability and adherence.

What Can Employers Do to Improve Outcomes and Mitigate Costs?

Multiple Sclerosis: Because of the complexity in determining MS diagnoses and the most effective course of treatment for individual patients, employers should consider the following:

  • Implement second-opinion services for confirming MS diagnosis.
  • Proceed with caution with respect to formulary determinations and utilization management, as gaps in treatment created by administrative hurdles can lead to preventable disease progression.
  • Provide supports for caregivers through flexible scheduling, employee assistance programs, and other services.

Marijuana: Employers must be careful to balance workplace and hiring policies that promote safety, align with company culture, and take into account growing state legalization and legitimate potential benefits of medical marijuana for some conditions.

  • Select a drug testing policy that is appropriate for your company and industry. Several approaches are outlined in the Business Group’s Medical Marijuana Issue Brief.
  • Employers with a significant presence in states that have newly legalized recreational marijuana should consider reiterating company policy regarding substance use and on-the-job safety.
  • Ask your pharmacy benefit manager how they plan to cover FDA-approved marijuana-derived treatments.