Multiple sclerosis (MS) is a chronic neurological disease associated with significant health inequities due to the economic burden it imposes on patients and healthcare systems, largely attributed to its high cost disease modifying treatments (DMTs). In many intances, providers are not aware that DMT efficacy is not tied to cost, but is tied to access. Furthermore, clinicians serving in safety-net settings often lack understanding of which DMTs are accessible, and how to link pharmacy programs that serve these vulnerable populations.

The development of the MS EP factored real-life practice including pre-assessment findings noting variability in provider’s DMT practice patterns, overutilization of non-formulary high cost DMTs, and lack of accessibility. Elements from the Kaiser Permanente MS care model which considers disease activity and rituximab when choosing DMT was integrated. The EP was used to educate general neurologists, primary care physicians and improve system assessment of DMT dispensation under a 340B program. We used audit and feedback from diverse stakeholders; neurologists, pharmacy and leadership. Internal dispensation patterns of high cost DMTs through pharmacy were generated across four safety net hospitals.

The implementation of the EP decreased provider practice pattern variability and increased accessibility to high efficacy DMTs for those patients at high risk of disability progression. An incremental cost-savings of $4.1 million+/year was generated over 3 years (sample of 128 patients).