Formulary, Adherence, and Whole-Person Support in Multiple Sclerosis Care

Melissa Seifert, PharmD, a clinical pharmacy specialist on the care management team at UPMC Health Plan with 13 years of pharmacy experience, discusses the role of pharmacists in supporting members with multiple sclerosis (MS), from evaluating formulary coverage and safety considerations during therapy selection to using real-time claims data to identify and resolve gaps in treatment. She also addresses the clinical and practical factors that shape disease-modifying therapy (DMT) selection, common barriers to adherence, and how UPMC's integrated health system model supports coordinated, whole-person care.

Pharmacy Times: Can you introduce yourself?

Melissa Seifert, PharmD: My name is Melissa Seifert. I'm a clinical pharmacy specialist on the care management team at UPMC Health Plan, and I've been a pharmacist for 13 years. I have experience working in
independent retail, specialty pharmacy, and now managed care.

Pharmacy Times: What role does a clinical pharmacy specialist play in the ongoing management of MS patients, particularly around therapy selection, monitoring, and adherence support?

Seifert: I think that managed care pharmacists play a really important role in helping connect the clinical side of MS treatment with increasing accessibility to therapy, helping members stay on their medications. With so many treatment options available, clinical pharmacists in the managed care setting can support providers and care teams by looking at things like formulary coverage, prior authorization requirements, safety considerations, and patient-specific factors that may impact which therapy is the best fit.

We can also help with ongoing monitoring by making sure prescriber offices are aware of recommended labs, screenings, or follow-up needs. And an advantage that we have in the health plan setting is access to real-time claims data. So when gaps in therapy occur, we can reach out to the member to assess for any barriers, such as cost, [adverse effects] (AEs), or access issues, and help the member to rectify those barriers in real time.

Pharmacy Times: With so many disease-modifying therapies (DMTs) now available, what factors go into choosing the right one for an individual patient?

Seifert: There are so many factors that can influence what is best for a particular member. So, there's clinical factors such as age, disease duration, and relapse history. We also need to think about safety and tolerability. So, comorbid conditions that could affect their risk for [AEs], family planning considerations, as well as other medications they are taking so we can check for any contraindications or drug-drug interactions.

And then in addition to the clinical factors, we also need to think practically about any factors that may impact a member's adherence to a prescribed medication. So, for example, if someone has a history of nonadherence, a twice-daily oral medication may not be the best option. If someone travels frequently for work, we need to consider storage requirements such as refrigeration, and then if a medication requires administration in a clinic, transportation can become a major factor. Also, if a member is planning to self-inject at home, we need to consider things like dexterity.

Member education is essential, too. Pharmacists can provide members with a clear understanding of the risks and benefits of the options available so they can make an informed decision together with their prescriber and choose a therapy that fits with their clinical needs and their day-to-day life.

Pharmacy Times: What are some of the biggest challenges patients face in adhering to their MS treatment regimens, and how are those being addressed?

Seifert: One of the biggest challenges with adherence in MS is that the disease affects so many parts of a member's daily life. Symptoms like memory changes, fatigue, depression, anxiety, pain, vision changes, numbness, or mobility issues can make it difficult to remember doses, self-administer injections, fill a pill box, or get to an infusion center. I think the best way to address this is to look at the whole person, not just the prescription. By asking the right questions, pharmacists can identify barriers early, help manage symptoms that affect quality of life, and connect members with resources like financial assistance, care coordination, social work, or health coaching. And as pharmacists, the support we provide to our members must be individualized because each person's needs are different and can change over time.

Pharmacy Times: How has the shift toward earlier, more aggressive treatment approaches changed outcomes for patients?

Seifert: I think the shift toward earlier and—when appropriate—more aggressive treatment has significantly impacted patient outcomes in a positive way. Starting DMT earlier has been associated with fewer and less severe relapses, a reduction in MRI activity, less inflammation in the central nervous system, and slower disability progression. It may also delay conversion from relapsing remitting MS to secondary progressive MS. Over the past decade, having more approved treatment options has also allowed therapy selection to become much more individualized. Providers can think about each patient's clinical and lifestyle factors to choose a treatment strategy that gives them the best chance of maintaining function and quality of life over time.

Pharmacy Times: How does UPMC stand out in the MS space? Is there anything you are doing differently than other institutions or health systems?

Seifert: UPMC is really well-positioned in the MS space because of our integrated health system with our network of providers and our health plan. For members with complex chronic conditions like MS, coordination of care is incredibly important. Having an integrated system may help improve communication across specialists, streamline processes, support more consistent care, and make it easier to connect members with the services they need. Our pharmacists ask about social determinants of health during member calls, so if a member identifies a need, we can connect them quickly with a case manager, social worker, or health coach.

Another strength is that we can help connect members not only with neurologists and other specialists but also with supportive services like physical therapy, occupational therapy, and speech therapy. Our team can work 1-on-1 with members on lifestyle changes such as nutrition, exercise, stress management, and smoking cessation, which are all part of a holistic approach to managing MS.

Pharmacy Times: What do you see as the biggest unmet needs in MS care today, and where do you hope the field is headed in the future?

Seifert: I think that one of the biggest challenges in MS care today is being able to effectively measure and treat the full range of symptoms that affect our members' quality of life, specifically the subtle changes that occur in a member's ability to perform their activities of daily life. Some changes may seem small from week to week, but over 6 months or a year, they can add up to significant progression.

Pharmacists are often referred to as the most accessible health care provider. By speaking with members routinely, we can help to recognize these subtle changes that are occurring with our members and then work with their provider to make recommendations on adjustments to their treatment and make appropriate referrals they may need to get them assistance.

Pharmacy Times: Any final or closing thoughts?

Seifert: I think that a takeaway message would be that MS care is about more
than choosing a medication, it's about supporting the whole person so they can maintain function, independence, and quality of life for as long as possible. And I think pharmacists in managed care are in a unique position to help bridge clinical care, medication access, and adherence support for those living with MS.