Q&A: Strengthening Multiple Sclerosis Care Through Embedded Clinical Pharmacy Collaboration

In an interview with Pharmacy Times®, Aimee Banks, PharmD, BCPS, MSCS, discusses the expanding role of pharmacists in supporting patients with multiple sclerosis across the entire continuum of care. She explains how pharmacists help patients navigate complex treatment options by providing education on dosing, administration, side effects, and long-term safety, while also addressing adherence and monitoring challenges. Banks highlights access to care and cost as major barriers, emphasizing the importance of insurance navigation, prior authorizations, and connections to financial assistance programs. She underscores the value of frequent patient contact, proactive outreach, and use of dispensing and laboratory data to identify and address gaps in therapy. Banks also describes how pharmacists serve as critical liaisons within interdisciplinary MS care teams, improving patient and provider satisfaction and helping ensure treatment remains safe, appropriate, and effective over time.

Pharmacy Times: From a specialty pharmacy perspective, what are the biggest challenges patients with multiple sclerosis face when accessing and staying on therapy?

Aimee Banks, PharmD, BCPS, MSCS: Access is a huge barrier for MS patients and their treatment. One of the initial access challenges is access to health care in general. I work at an MS Center of Excellence, which is a neuroimmunology clinic at Vanderbilt. I work with neuroimmunologists who specialize in MS. One important piece is making sure patients are being seen by at least a specialized neurologist, if not one that specializes in MS care, to confirm the diagnosis and discuss treatment options.

When we talk about treatment specifically, the cost of care is a huge barrier for patients, even when a neurologist or MS specialist recommends a specific treatment they feel is medically necessary. Insurance companies do not always agree that it is the most appropriate treatment. Access to care from a payer perspective, as well as out-of-pocket costs, can be a huge barrier.

When I think about access, I think about the logistics, along with the education piece. We want to make sure patients understand their diagnosis and the treatment options, including not only the effectiveness of potential treatments but also the risks and safety concerns. Patient-centered, informed decision-making is a big part of this, but the financial piece remains a major challenge.

Our team works closely with providers, patients, financial assistance counselors, and available resources to help patients get medications approved through insurance or, if they are underinsured or uninsured, connect them with the appropriate foundation or program to access therapy. Being easily available in the clinic or pharmacy is very important for patients, and pharmacists play a significant role as a liaison between patients and providers, helping connect the dots around access.

Pharmacy Times: How does the specialty pharmacy team support adherence and monitoring for patients on MS disease-modifying therapies?

Banks: Frequent contact and being readily available is one of the biggest ways we can improve adherence and monitoring. We need to be asking the right questions when we speak to patients, and we need to make sure that our colleagues, whether pharmacy technicians, case managers, or care coordinators, are documenting appropriately and asking the right questions. Again, this goes back to education, educating patients on what to expect.

I emphasize to my team the importance of setting realistic expectations. We need to make sure patients understand what the potential daily side effects of a medication might be. They also need to have a good understanding of the potential long-term consequences or long-term adverse effects so they know when to reach out with specific questions.

We need to be proactively reaching out to patients to make sure they are taking their medication correctly. If we have access to dispensing data, we can use that to assess how frequently or regularly patients are getting their medication filled. If it looks like there may be gaps in therapy, we need to understand why.

Is it because patients are rationing their medication due to high cost? Have they reduced their dose because they perceive they are having a side effect? Or is it an intentional discontinuation or hold of treatment due to infection, lab abnormalities, or provider recommendations? Sometimes there are intentional nonadherence gaps, and sometimes there are unintentional gaps where patients alter their dosage or regimen on their own. The more contact we have and the more we ask the right questions, the more pharmacists can intervene and mitigate nonadherence and improve persistence.

Ensuring patients stay on therapy long-term or appropriately interrupt therapy when medically necessary is critical. If patients experience infections, lab abnormalities, or start a new medication with a significant drug interaction, we need to communicate with providers or appropriate team members to mitigate side effects or interactions. From a monitoring perspective, we are heavily involved in the clinic setting.

Pharmacists are the primary responsible parties for many patients who require frequent laboratory monitoring. Systems are in place to ensure outreach and adherence to safety monitoring schedules based on prescribing information or internal guidelines. Through close patient contact, pharmacists help ensure therapy remains appropriate, safe, and effective throughout the entire course of treatment.

Pharmacy Times: What role does collaboration between specialty pharmacists and neurology providers play in improving outcomes for patients with MS?

Banks: As I mentioned initially, we are the liaison between our patients and our providers or prescribers. Being available and in frequent, close contact with patients is really important.

Providers are constantly seeing patients in the clinic on very strict schedules, and they usually do not have the time to pick up the phone and call a patient about a complex issue. Fortunately, we have a little more flexibility in our schedules to be able to do that. We intentionally make ourselves easily accessible to patients, not only from a specialty pharmacy perspective, but also to patients in our clinic who may not be using our health system specialty pharmacy.

There is a lot of literature showing that pharmacists improve outcomes related to adherence and persistence. Pharmacists significantly increase patient-reported outcomes and patient satisfaction. When a pharmacist is embedded in a clinic or working closely and collaboratively with providers, patient satisfaction scores are significantly higher.

Provider satisfaction scores are also significantly higher when they have a pharmacist or medication expert on their team who can focus on areas of MS and its treatment that they may not spend the majority of their time on. We are an extremely interdisciplinary team at our MS center, and this collaboration is invaluable for patients. Patients are aware of and appreciate the collaboration and the easy access to their providers through the pharmacist, as well as the communication back to the patient.

We relay information to providers and then relay that information back to patients, helping ensure patients are referred for potential relapse screening or acute issues as needed. I am a strong advocate of clinical pharmacy practice in MS. Working on a collaborative, interdisciplinary team provides outcomes and benefits that are likely immeasurable and offers tremendous value for patients.