To identify factors delaying drug enrollment and initiation of infusion disease modifying therapies (DMTs) for multiple sclerosis (MS) patients.

Timely treatment is an important factor in reducing relapse rate and disability progression in MS patients. Unfortunately, treatment is often delayed for infusion medications, some of which are our most effective medications, and patients are put at risk due to factors such as complex and lengthy enrollment processes, insurance approvals, and clerical delays.

Patients were identified as those initiating enrollment into ocrelizumab or natalizumab therapies through the University of Florida’s MS Center. The enrollment process was tracked through the patient’s medical record as enrollment documents, insurance forms, referrals, and other required documents were signed, completed, faxed, and uploaded.

Preliminary data shows that 19 patients enrolled in these medications since January 2019. Six have received treatment as of October 2019. Of these 6, the average time from enrollment submission to treatment initiation was 56 days, and ranged 5-135 days. For the 13 patients without treatment initiation, the average interval from enrollment to October 2019 was 83 days, ranging 4-175 days. Overall, 11 quantifiable delays were identified, resulting in 17 recorded contacts. Of the 11 delays, 45.5% were insurance-related, 36.4% were clerical, and 18.1% were patient-related. The average delay took 24.6 days to resolve, with an average of 30.4 days, 9.25 days, and 41 days per delay respectively. Of the 17-recorded contacts, 41% were insurance-related, 47% regarded clerical errors, and 12% were due to poor patient compliance.

Early analyses suggest that insurance-related delays were the largest barrier to treatment initiation, indicating that implementing a standard operating procedure for addressing insurance inquires might be beneficial. Moreover, data shows that while clerical errors were common, they were quickly resolved. Poor patient compliance, though rare, had the most enduring effect on treatment initiation.