Already in the first quarter of 2019, two new Multiple Sclerosis (MS) medications were approved by the Food and Drug Administration (FDA) and there are many more on the horizon for approval. MS is a complicated disease that impacts approximately 1 million people in the U.S. and affects every patient differently. It attacks the central nervous system, damaging nerve fibers, causing varied symptom exacerbations and leading to progressive disability. While there is no cure for this condition, there have been substantial treatment advances in the last 20 years, known as disease-modifying therapies (DMTs). DMTs help limit the number of exacerbations and delay disease progression for the most common form of the illness, relapsing-remitting MS (RRMS). However, there are a number of hurdles to treatment success and with the growing number of therapies, payers need to understand the expensive treatment options in order to make a visible impact on member outcomes and cost management.
The MS Treatment Options Continue to Increase
Multiple sclerosis patient care has come a long way since the first cortisone treatments in the early 1950s. While a true cure might be over a decade away, the current and near-future treatment landscape is thriving, as pharmaceutical companies continue to invest in the development of new treatment options. In addition to a growing number of oral and infusion alternatives, there is a focus on indications beyond RRMS, such as clinically isolated syndrome and secondary progressive MS.
Secondary Progressive MS (SPMS) is a stage that follows RRMS and is characterized by a worsening of neurologic function and accumulated disability over time. Before the development of DMTs, studies indicated that half of RRMS patients would progress to SPMS within 10 years and by 25 years, 90% would transition to SPMS. While experts agree that DMTs have an impact on the progression of MS, it is too soon to tell to what extent they delay the transition to SPMS. However, the increasing development of treatment options continues to give hope to patients around the world.
EnvisionSpecialty monitors the growing drug pipeline, keeping our clients informed of new medications being developed. Our pharmacists stay abreast of the latest treatments and potential side effects, and work with patients to understand their disease and therapy options.
Evaluating the Treatment Options
The majority of DMTs are injectable or infusion treatments, which can be difficult for patients with a fear of needles or can lead to injection fatigue. In fact, one study found that approximately 50% of patients discontinued injectable disease-modifying therapies within the first year. In September 2010, the first oral DMT was approved by the FDA, providing another option for the needle averse or when side effects or other complications prevent the continuation of injection therapy. As of March 2019, there are now five oral MS treatment options available. A study by the International Journal of MS Care, found that patients strongly prefer daily oral administration. While some patients may like the comfort of an oral medication, others may find it inconvenient to take a daily dose instead of a less frequent injection.
EnvisionSpecialty works with patients to evaluate treatment options, taking into consideration dosing convenience, impacts to daily life and other barriers to adherence.
Understanding Medical Versus Prescription Benefits
New-to-market therapies for MS continue to expand the options for route of administration, as well as dosing frequency. Neurologists are starting to escalate treatment to infusion options earlier for high-risk patients. When a patient receives infusion treatment, the cost of the drug often transitions to the medical instead of the prescription benefit. When a medication is covered under the medical benefit, total cost of treatment can be more challenging to assess when factoring in infusion site-of-care and provider professional services, in addition to the cost of the drug.
This increased use of infusion therapies in the treatment of MS patients is being reflected in 2018 pharmacy benefit management (PBM) trend reports, which indicate a decrease in MS utilizers because the treatment is under the medical benefit instead of the pharmacy benefit. This results in a positive drug spend trend, but may not fully represent costs associated with MS care. Another factor that is influencing a more stable MS trend in spend is the expanding use of generic MS medications that were introduced into the market in 2017 and 2018.
EnvisionSpecialty works with payers to help determine a cost effective plan to managing MS drug spend. We also help patients maximize external financial support programs for their treatment.
Listening to the MS Patient Voice Sheds a Light on Their Invisible Symptoms, Leading to Improved Outcomes
EnvisionSpecialty starts working with MS patients before the first dose is shipped, setting a foundation to ensure the best possible treatment outcomes. Our care team, staffed with multiple pharmacists that are MS certified specialists, spends an average of 24 minutes with a patient before starting therapy to get a full understanding of their personal journey with the disease. Listening to the patient’s voice at the beginning of care and throughout their therapy, by utilizing various assessments and screenings, assures that their concerns are indeed highly visible to the pharmacist. This hands-on approach ensures the patient’s engagement and commitment, which supports improved understanding and readiness for properly utilizing their medications. Our patient-centric communication, which includes focused listening and monitoring, results in improved adherence, reduction in inappropriate discontinuations and other cost saving measures.
In addition, EnvisionSpecialty has developed a proprietary Multiple Sclerosis Disease Activity algorithm that helps the pharmacist better identify the unique elements of each patients’ disease and guides pharmacist monitoring of the MS patient. Patients with moderate to high disease activity are monitored more closely than patients with low activity and stable disease with no indicator of active progression. This is one of many unique assessment and patient monitoring steps taken by the pharmacists to give clear visibility into the patient’s symptoms and their response to therapy. Our visibly different approach to MS treatment results in improved outcomes for MS patients while providing payers with the confidence that their members are fully supported and receiving the appropriate therapy.
 Luxner, Larry (2017). Nearly 1 Million Americans Have Multiple Sclerosis, NMSS Prevalence Study Finds. November 20, 2017. Multiplesclerosisnewstoday.com
 National Multiple Sclerosis Society. Secondary progressive MS (SPMS). Retrieved from National Multiple Sclerosis Society https://www.nationalmssociety.org/What-is-MS/Types-of-MS/Secondary-progressive-MS.
 Dargahi, N, et al (2017). Multiple Sclerosis: Immunopathology and Treatment Update. Brain Sciences, July 2017; 7(7): 78.
 Multiple Sclerosis Association of America. Long-Term Treatments for Multiple Sclerosis. https://mymsaa.org/ms-information/treatments/long-term/
 Wilson, L, et al (2015). Patient Preferences for Attributes of Multiple Sclerosis Disease-Modifying Therapies. International Journal of MS Care.
 2018 Drug Trend Report, Express Scripts.