Nancy Ross, PharmD, BCACP, MSCS, CSP describes treatment approach and patient navigation in an MS center of excellence.
Neil Minkoff, MD: How do you figure out if the patient should try drug A before they go to drug B or if you’re adamant drug B is right for them?
Nancy Ross, PharmD, BCACP, MSCS, CSP: Because we’re a center of excellence, it’s almost as if we don’t see the patient when they’re first diagnosed. Chances are they’ve been somewhere else. They’ve been to a local neurologist, the emergency department, or somewhere else. And someone along the line has told them, “You probably have multiple sclerosis, and you need to see a specialist.” By the time they get to us, they’ve already gotten their feet wet. If my physician then comes to me and says, “I want this patient on drug B,” then that’s the drug they need. I’m going to push absolutely for coverage of drug B, and we’ll continue to argue and do whatever we can, including appeal letters, second-level appeal letters and peer-to-peers to support our case.
Neil Minkoff, MD: How do you track patients to see how they’re doing with drug B to see if they need to go to drug C? How do you follow that up to provide not just the information necessary for their clinical care, but also for bean counters like me and Maria Lopes so we have to alter our thinking?
Nancy Ross, PharmD, BCACP, MSCS, CSP: I do ask for quite a bit of feedback. I will tell patients that this is a relatively new drug that has been out for 6, 9, or 12 months and we need feedback on how this medicine is affecting them in their daily lives. I tell patients that not every drug is for every person and not every drug is for every person at every stage in their life. Your disease and your symptoms may change. We need to be flexible with that and understand that we need to adjust your therapy accordingly. Although in 1993 we had a take it or leave it option, now, if this drug isn’t right for you, that’s fine. Don’t suffer. Let us know and we will work with you to make sure you can stay compliant on this medicine. I don’t want you at home suffering trying to irk out this medicine when we have other options.
Neil Minkoff, MD: Trying to brazen it out.
Nancy Ross, PharmD, BCACP, MSCS, CSP: Yes, exactly.
Neil Minkoff, MD: When patients are coming in on therapies that would not be your center’s choices, is that being driven by payer coverage, patient choice, or external prescribers? You may not know, but if you have any sense as to what’s driving those decisions, that would help us level set what we’re doing here.
Nancy Ross, PharmD, BCACP, MSCS, CSP: Typically, if a patient is seeing their local neurologist, their local neurologist might not see a huge volume of patients with multiple sclerosis. They’re not going to be as familiar with some of these high-level medications. They’re going to be very familiar with interferons, Copaxone, and even with Tecfidera, dimethyl fumarate, and those kinds of things because they’re a little less complicated. Tysabri, Ocrevus, Kesimpta, and Gilenya are a little more complicated. When Gilenya came out and it had all the cardiac warnings, local neurologists didn’t know what to do with it. They tend to use some of the more traditional agents because they’re more familiar with them. When the patient moves to a specialist, the specialist will say, “Yes, but look at the annualized relapse rates on these medications. We need to move you to something that’s more effective.”
Transcript edited for clarity.
Serum Neurofilament Light Changes Not Always Apparent in Active RRMS, Study Finds
May 8th 2024A prospective study found evidence of serum neurofilament light (sNfL) level increases in patients affected by active forms of relapsing-remitting multiple sclerosis (RRMS); however, these findings were not significant enough to suggest sNfL measurements replace clinical or MRI monitoring of disease activity.
Read More
Dr Kathy Zackowski Discusses the Importance of Rehabilitation Research and Trials in MS
April 26th 2024Kathy Zackowski, PhD, National MS Society, expresses the inherent value of quality rehabilitation trials for broadening clinical understandings of multiple sclerosis (MS) and bettering patient outcomes.
Read More
Distinguishing Biomarkers Identified in MS Outcomes
March 19th 2024Results from this cohort study found that levels of glial fibrillary acid protein, cerebral spinal fluid, and neurofilament heavy chain are distinguishable biomarkers that are associated with disease outcomes in multiple sclerosis (MS).
Read More
FDA Issues CRL for Glatiramer Acetate Depot for Relapsing Forms of MS
March 11th 2024The FDA has declined to approve glatiramer acetate (GA) depot in the treatment of relapsing types of multiple sclerosis (MS), issuing a complete response letter (CRL) for the long-acting, injectable form of GA.
Read More