Secondary Progressive Multiple Sclerosis: Patient Impact and Coverage Implications for New Therapies EP8

Secondary progressive multiple sclerosis (SPMS) is an advanced form of multiple sclerosis (MS) thought to be caused by neurodegeneration within the central nervous system and involves steadily increasing neurologic dysfunction and disability without clear recovery or stability periods. (1,2) It develops from relapsing remitting multiple sclerosis (RRMS), typically 10 to 15 years after a diagnosis of MS. (3) Among patients with RRMS, up to 80% may progress to SPMS within 20 years. Additionally, among those who do not receive disease-modifying therapies for MS, 33% progress to SPMS within eight years. (2)

Treatment of SPMS is associated with many challenges, perhaps most significantly the historical lack of treatment options developed specifically for the condition. The therapeutic armamentarium has evolved significantly since 2019, however, with the approval of 2 oral therapies with indications for the treatment of SPMS. Additionally, many therapies already approved for RRMS have seen their labels broadened to include SPMS. Given these recent and significant shifts, health plans are challenged with selecting appropriate therapies for coverage for SPMS while offsetting the broadly escalating costs of MS treatment. (4)