How UPMC's Integrated Model Supports Members With Multiple Sclerosis

In an interview with Pharmacy Times, Melissa Seifert, PharmD, a clinical pharmacy specialist on the care management team at UPMC Health Plan, explains that managed care pharmacists help connect the clinical and access sides of multiple sclerosis (MS) treatment, reviewing formulary coverage, prior authorization requirements, safety considerations, and patient-specific factors to support therapy selection. Access to real-time claims data allows pharmacists to identify gaps in therapy and proactively reach out to members to address barriers such as cost, adverse effects, or access issues.

Selecting the right disease-modifying therapy (DMT) involves weighing clinical factors, including age, disease duration, and relapse history, alongside safety and tolerability concerns such as comorbidities and drug-drug interactions. Practical considerations, including adherence history, storage requirements, transportation for clinic-administered therapies, and dexterity for self-injection, also factor into the decision, along with clear member education on the risks and benefits of each option.

Seifert notes that MS symptoms such as fatigue, memory changes, and mobility issues can complicate adherence, making it important for pharmacists to look at the whole person rather than the prescription alone. She points to UPMC's integrated network of providers and health plan services, including social work, health coaching, and rehabilitation therapies, as a strength in coordinating care, and emphasizes that earlier, individualized DMT initiation has been associated with fewer relapses and slower disability progression.

Services and care management resources may vary based on a member's benefit plan, eligibility, and individual circumstances.