Best Practices for Specialty Pharmacy Management of Multiple Sclerosis

Just over 900,000 people in the U.S. live with multiple sclerosis (MS), according to a study funded by the National Multiple Sclerosis Society and, by some estimates, the average lifetime medical cost is $4.1 million. This disease has the second highest all-cause medical cost for those with chronic conditions. Getting patients into treatment quickly, and keeping them on treatment, is important to decrease the chances of the disease worsening but also to keep costs and healthcare utilization down.

“Patients should stay on their therapy indefinitely, as long as their condition hasn’t changed,” said William Trombatt, Pharm.D., CSP, manager of clinical programs manager of clinical programs for specialty and home delivery pharmacy for AllianceRx Walgreens Prime at the 4th Annual Pharmacy Benefit Management Institute Specialty Rx Forum, which was held virtually on October 16. Those adhering to MS treatments are 42% less likely to relapse, require 52% fewer hospitalizations, and have fewer outpatient visits as well. Not surprisingly, this has a correlating impact on utilization costs.

The need for a “higher touch” program is important for patients with MS, said Trombatt’s colleague and co-presenter at the meeting, James Adams, chief information officer for AllianceRx Walgreens Prime. Patients can’t just walk into a regular pharmacy to quickly fill a prescription as many people with other condition can do, he noted. “There’s a tremendous amount of coordination between the pharmacy, doctor and insurance company before the patient is even approved for the medication,” said Adams. For the patient, that includes co-pay discussions, insurance coverage and scheduling shipments to their house.

A good pharmacy benefit management program for MS includes clinical management to educate the patient on the initial and subsequent fills, along with discussions about the medication and their disease, how to administer medication, managing adverse effects and symptoms, and conducting a fatigue and depression screening, said Adams. “This is where the specialty pharmacist has an opportunity to stretch their legs as experts,” he added. Following up with the patient after therapy begins can address any adherence issues like side effect management, building patient trust in the process, Adams told the forum attendees.

The monthly refills are an opportunity to deepen the relationship with the patient while not overwhelming them with the same information, Adams said. The pharmacy should understand, he said, that “the refill process doesn’t necessarily get easier for the patients, as they often need to call the specialty pharmacy to again coordinate payment and delivery, and to complete clinical assessments.” Adams said. Online clinical assessments have been successful at AllianceRx Walgreens Prime, according to Adams, who said 75% of their patients are eligible to complete their refill information online and almost all of those who use this method don’t require pharmacist intervention.

The difference shows for patients who are considered well managed versus those who are less managed, according to a study done by Walgreens. That study showed that better managed patients had adherence levels of just over 75% compared with just 45% for those who were less managed. “These programs make a difference,” Adams said.