{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T18:14:35Z","timestamp":1789496075295,"version":"build-2803163510"},"reference-count":37,"publisher":"American Medical Association (AMA)","issue":"8","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"Importance<\/jats:title>Narrow formularies can be used to increase rebates and manage the use of costly drug therapies in the US.<\/jats:p><\/jats:sec>Objective<\/jats:title>To examine the association between the breadth of formulary coverage for multiple sclerosis (MS) disease-modifying therapies (DMTs) and MS relapse.<\/jats:p><\/jats:sec>Design, Setting, and Participants<\/jats:title>This retrospective cohort study analyzed 100% Medicare administrative data from 2018 to 2022. The data analysis was conducted from August 1, 2024, to January 30, 2025. Beneficiaries with stand-alone prescription drug plans (PDPs) and Medicare Advantage Prescription Drug plans (MA-PDs) were followed for at least 5 quarters (baseline,\u2009quarters 1-4; follow-up,\u2009quarter 5). Calendar periods reflected formulary decision-making. Beneficiaries in the same Medicare Part D plan during baseline and follow-up, with relapsing-remitting MS, and with MS DMT use during baseline were included.<\/jats:p><\/jats:sec>Exposures<\/jats:title>Formulary breadth was low coverage if the 4-quarter moving average of MS DMT drug or class coverage was below the median by plan type and quarter; it was considered high coverage if the average was above the median.<\/jats:p><\/jats:sec>Main Outcome and Measures<\/jats:title>The primary outcome was MS relapse, including inpatient or outpatient treatment for MS. Multivariable logistic regressions were estimated separately for PDPs and MA-PDs, controlling for patient and plan characteristics and clustering for repeated observations by beneficiary.<\/jats:p><\/jats:sec>Results<\/jats:title>The claims analysis included 50\u202f162 unique beneficiaries in PDPs (mean [SD] age, 58.5 [12.1] years; 74.9% female) and 34\u202f708 in MA-PDs (mean [SD] age, 58.2 [10.3] years; 77.2% female). Oral or injectable MS DMTs were frequently excluded from coverage (&amp;gt;50% excluded in 2022: PDPs,\u200911 of 15 DMTs; MA-PD, 9 of 15 DMTs). The MS relapse rate was greater for low- vs high-coverage PDPs (10.6% vs 9.5%; odds ratio [OR],\u20090.88 [95% CI, 0.84-0.92]) and MA-PDs (7.8% vs 6.9; OR, 0.88 [95% CI, 0.85-0.91]). In multivariable analyses, broader formulary coverage during baseline was associated with less MS relapse during follow-up (PDP: adjusted OR,\u20090.93 [95% CI, 0.90-0.96] for drugs and 0.94 [95% CI, 0.91-0.97] for classes; MA-PD: adjusted OR, 0.88 [95% CI, 0.83-0.94] for drugs and 0.92 [95% CI, 0.86-0.98] for classes).<\/jats:p><\/jats:sec>Conclusions and Relevance<\/jats:title>In this cohort study of Medicare data, broader formulary coverage was associated with an 8% to 12% lower odds of MS relapse in MA-PDs and a 6% to 9% lower odds in PDPs. Formulary coverage and restrictions should be tailored for patient need, not just management of costs and use.<\/jats:p><\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2025.25155","type":"journal-article","created":{"date-parts":[[2025,8,1]],"date-time":"2025-08-01T15:30:39Z","timestamp":1754062239000},"page":"e2525155","source":"Crossref","is-referenced-by-count":6,"title":["Formulary Restrictions and Relapse Episodes in Persons With Relapsing-Remitting Multiple Sclerosis"],"prefix":"10.1001","volume":"8","author":[{"given":"Barbara","family":"Blaylock","sequence":"first","affiliation":[{"name":"Blaylock Health Economics LLC, Reno, Nevada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karen","family":"Van Nuys","sequence":"additional","affiliation":[{"name":"Leonard D. 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