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January 30, 2019

The Complexities of Multiple Sclerosis: How a High-Touch Specialty Pharmacy Delivers Improved Outcomes for Patients and Plan Sponsors

Multiple Sclerosis (MS) is an unpredictable, chronic disease that attacks the central nervous system, damaging nerve fibers and often leading to progressive disability. According to the National Multiple Sclerosis Society, prevalence of MS has reached close to 1 million people in the U.S.[1] The cause is unknown and diagnosis is complex as it is often determined after ruling out several other conditions first, making it important to ensure the patient actually has MS before embarking on expensive treatments. The disease is characterized by four distinct forms and manifests differently from patient to patient. The form, progression, severity and specific symptoms of MS, such as fatigue, vision loss, numbness and poor balance, can vary widely among patients, requiring individualized treatment.

According to the National MS Society, about 85% of people are initially diagnosed with a form of MS referred to as relapsing-remitting MS (RRMS). This is a course of the disease with clearly defined attacks, or exacerbations, of new or increasing neurological symptoms, followed by periods of remission. During remission, symptoms may or may not disappear. Some symptoms may continue and become permanent. The frequency of relapses, the severity of symptoms experienced and the length of the gap between attacks are unpredictable.[2] 

Medications available today to help MS patients are considered “disease-modifying” therapies. While they do not promise a cure, the 15 FDA-approved agents, all considered specialty medications, are options for the RRMS patient. Unfortunately, there are few options for the other forms of MS. Goals of treatment include a reduction in the number of exacerbations a patient experiences, which ultimately could delay disease progression. These therapies are available as tablets, self-injectables, or physician-administered infusions, and come with a hefty price tag, costing payers and their members over $60,000 annually per patient.[3] Because each patient reacts differently to treatments, it is important that payers offer a broad formulary that gives patients options to find a treatment that provides optimal outcomes.

The MS Roller Coaster: Adherence Factors Continue to Take MS Patients Off Track

The varying stages of relapse-remission make it difficult for MS patients to remain vigilant to their drug regimen, yet continuous use of these therapies has proven to decrease relapse rates and reduce disability progression. Lack of adherence could lead to relapses and further progression of the disease. Reducing relapses is a key part of slowing progression of the disease and adherence is crucial.

Many find taking disease-modifying medication over a long period of time challenging, and face obstacles to adherence such as:

  • A lack of symptoms: Because the symptoms of MS come and go, with an absence of symptoms, MS patients often don’t feel it’s necessary to continue taking the medications.
  • Persistence of symptoms: When a patient continues to have a MS symptom while taking the medication, they may feel it’s not working, and simply discontinue the treatment.
  • Needle phobia and injection fatigue: Some of the available medications are given by self-injection, which can pose an adherence risk for patients with needle fear or a dislike of injections. Injection site reaction can also cause those who have been using injectable medication for many years to tire of the routine and skip doses.
  • Side effects: Some MS patients have found that they feel worse while taking the medication rather than better and, therefore, stop taking the drugs as prescribed.
  • Affordability: Treatment can be very expensive, leading some MS patients to skip or split doses.

The Complexity of MS Requires Expert Clinical Experience and Individualized Pharmacy Care

Research shows that patients who understand their treatment options and are confident in managing their care cost 8% less to treat.[4] Because medications are often new and patient reactions are sometimes unknown, the specialty pharmacy’s involvement is critical to helping patients navigate hurdles to adherence and stay on their drug regimen to avoid or delay disease progression.

There are unique drivers for various specialty medication classes and each specialty pharmacy manages these classes differently, some having better expertise in certain classes than others. Because every MS story is unique, therapeutic care requires a proactive, hands-on pharmacy approach that is not only disease or drug specific, but requires an experience tailored to each patient. Therefore, working with a specialty pharmacy that has particular expertise with the disease MS, its treatments, side effects and challenges can help monitor the patient’s response to treatment, ensure safety and adherence, and help reduce future relapses.

EnvisionPharmacies Achieves a 92% Adherence Measure and Keeps Majority of MS Patients Relapse Free for a Year

Clinical research and real-world evidence has shown that the average MS patient will experience at least one relapse per year, costing about $13,000 per exacerbation. Under EnvisionSpecialty’s care model, 92% of patients are adhering to their medications, which has resulted in a decrease in relapses to less than one per year for the majority of patients.

Based on industry best practices, our MS care model centers on care and compassion, patient advocacy, knowledge of the available treatments and their side effects, delivering high-touch care that results in improved adherence, site of care optimization, reduction in inappropriate discontinuations and other cost saving measures that improve patient health. Our team, led by a Multiple Sclerosis Certified Specialist (MSCS), works with patients before the first dose, ensuring their commitment, understanding and readiness for therapy. We provide continuous communication and monitoring throughout treatment, tracking treatment response and disease activity with our proprietary Multiple Sclerosis Disease Activity (MS-DA) tool, which is used to adjust the patient’s care plan as needed for the most effective treatment. We also connect patients with copay assistance through our SpecialtyBridge program to help make medications more affordable and improve adherence.

EnvisionSpecialty provides payers confidence that their MS members are fully supported, as well as provides the appropriate amount of reporting and condition support to demonstrate results. 

[1] Luxner, Larry. (2017, November 20). Nearly 1 Million Americans Have Multiple Sclerosis, NMSS Prevalence Study Finds. multiplesclerosisnewstoday.com.

[2] National Multiple Sclerosis Society. (2017, September 14). Managing Relapses. Retrieved from National Multiple Sclerosis Society: www.nationalmssociety.org

[3] Tobias, E. (2017, January 13). MS Drug Treatment Costs Start the Year Headed Up. multiplesclerosisnewstoday.com.

[4] World Health Organization. (2003). Adherence to Long-Term Therapies: Evidence for Action. Geneva: World Health Organization. 

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