Pharmacists at the Forefront of Multiple Sclerosis Care: Clinical Decision-Making, Polypharmacy, and the Expanding Role in Research

In an interview with Pharmacy Times, Collin Jakubecz, PharmD, clinical pharmacy specialist, multiple sclerosis and neuroimmunology, from the University Hospitals Cleveland Medical Center in Ohio, alongside Kiranpal Singh Sangha, PharmD, clinical pharmacy specialist from the University of Cincinnati Academic Health Center in Ohio, and Nancy Le, PharmD, neurology pharmacist team lead from the University of Iowa Health Care, explored the multifaceted role of pharmacists in optimizing care for patients living with multiple sclerosis (MS).

If the patient's not willing to take an injectable, they really want to take an oral, and I start them on an injectable, they're not going to take the medicine. So we want to make sure that the patient is taking the medicine that they want to take and that they're going to be adherent to.—Nancy Le, PharmD

As part of National Multiple Sclerosis Awareness Month 2026—themed “MS Unseen”—the panel underscored that pharmacists are uniquely positioned to identify not only the visible hallmarks of MS, such as motor weakness, optic neuritis, and gait impairment, but also the often-overlooked symptoms, including fatigue, cognitive decline, nerve pain, and emotional burden that profoundly affect patient quality of life.

The experts provided a comprehensive overview of the current MS treatment landscape, spanning self-injectable agents such as interferon beta products and ofatumumab, oral therapies including fumarates and sphingosine-1-phosphate (S1P) modulators, and high-efficacy intravenous infusions such as natalizumab and anti-CD20 agents. Each class carries distinct safety considerations—from the teratogenicity of teriflunomide and bradycardia risk with S1P modulators to the serious risk of progressive multifocal leukoencephalopathy with natalizumab—making pharmacist involvement in counseling and monitoring critical to patient safety.

Polypharmacy emerged as a central concern, with prevalence estimates in MS patients ranging from 14% to 67.5%. The panel emphasized that pharmacists are well positioned to conduct medication reconciliation, identify drug interactions, review the appropriateness of as-needed medications, and facilitate communication with prescribers to reduce unnecessary medication burden and associated costs.

Shared clinical decision-making was also highlighted as a domain in which pharmacists provide measurable value—addressing patient hesitancy at diagnosis, accounting for comorbidities and lifestyle factors in selecting disease-modifying therapy, and navigating insurance access and patient assistance programs. The discussion extended to the growing research contributions of pharmacists, including pharmacovigilance reporting, retrospective studies, and collaborative manuscript development investigating safety outcomes in patients receiving anti-CD20 therapies.

The panel also addressed neuromyelitis optica spectrum disorder, highlighting 4 FDA-approved therapies for aquaporin-4 antibody–positive patients and the risk of meningococcal infection associated with complement inhibitors. The discussion concluded with recognition of pharmacy technicians as essential members of the care team, particularly in facilitating prior authorizations and financial assistance programs for specialty medications.