The group continues discussion about patient communication needs, and Sarah Anderson, PharmD, shares resources that the National MS Society offers to both patients and providers. [WATCH TIME: 9 minutes]
WATCH TIME: 9 minutes
The treatment paradigm for multiple sclerosis (MS) has come a long way since the early years of ABCR agents, with a therapeutic arsenal of disease-modifying therapies now numbering in the 20s. Yet, with all of the change that advances in pharmaceutical development have brought, there are still novel approaches being introduced—and perhaps the biggest recent introduction is biosimilars.
With the FDA approval of the first of these new products for MS in the fall of 2023, the era of biosimilar treatments has begun, and in this new era is a new challenge: education and awareness of these options, for both patients and clinicians.
In collaboration with the National MS Society, NeurologyLive® hosted a Roundtable Discussion focusing on this step forward for MS treatment, the changes that it will bring to care and the healthcare system as a whole, and the resources for the field to stay up to date on their use. Featured in the discussion are Jeffrey Cohen, MD, an MS specialist and director of Cleveland Clinic’s Mellen Center for Multiple Sclerosis Treatment and Research; Alicyn Magruder, PharmD, BCACP, MSCS, a clinical pharmacist at Mizzou Specialty Pharmacy within the Neurology and Sleep Disorders Clinic; and Sarah Anderson, PharmD, NBC-HWC, a pharmacist and director of Clinical Content and Resources on the Clinical Innovation and Strategy Team at the National Multiple Sclerosis Society.
Transcript below. Edited for clarity.
Matt Hoffman: How ‘in the weeds’ do you find yourself getting [in patient education conversations] and do you find that it’s valuable? Because I can imagine, we talk a lot about when it comes to the clinical care of patients with MS—particularly with newly diagnosed patients or patients who are going to initiate treatment—that there's a lot of information to take in, there's a lot of learning about the disease and understanding what's going on. When it comes to the insurance side, that's another whole mountain of information.
Do you find that it's often more helpful to give them extensive information on, “this is kind of how this system works, why it works”? And do you cover again—we have one approved and maybe more, hopefully, coming down the road—that the hope is long-term, those cost savings will translate to the patient? Do you find that you often have to get to that extensive conversation, or that that level of patient education is usually required?
Alicyn Magruder, PharmD, BCACP, MSCS: You have to meet the patient where they're at. So you have the patients for whom any more extra information, especially newly diagnosed patients—I don't need to give them all that. But you have people that spend a lot of time on MS forums, they hear other patients’ experiences, and you have to think of the bias on those forums. A lot of times, people aren't always sharing the best times, they're sharing their frustrations. And so, if I have a patient that's been on one of these forums, or feels very educated about why they want a certain medication or why they want brand name, that's when I offer that extensive, “let's think through this” conversation. But if a patient's overwhelmed by everything else, they don't need to. They just need to understand that we're doing our best to get what's accessible to you through your insurance or through the drug company.
The one nice thing about the MS market currently is that for most drugs, regardless of what your insurance covers, if you're in the appropriate state that allows the free drug programs and copay cards, I can get you the drug. And so, because of those branded settings, where we have free drug options from the companies, and that market can change. So even with teriflunomide, and fingolimod, that has changed over the last year. I can't promise that I can get that drug, when a year ago I could.
But as far as education on the insurance side, it's meeting the patient where they're at with how educated they are already and how much information they've gotten from MS forums or other groups. We want to make sure that we're addressing what concerns that they've seen online or in a group setting, as well.
Matt Hoffman: Dr. Cohen, you mentioned earlier, obviously, there are instances where you might appeal a payor’s request to switch to one of these agents. I'm curious for you what might be a situation where that's a consideration? Are there any kind of unique or immediate perhaps red flags, so to speak, that might be something to you that triggers a conversation with a patient that, “This is something we can definitely try to appeal,” or is it a case by case usually?
Jeff Cohen, MD: Well, it's case by case. We spent quite a lot of time and a lot of person hours on prior authorization and appeals and so forth. We've gotten fairly adept, when we really think a patient needs to be on a particular medication, to getting it. Ultimately, it does require a lot of effort sometimes. But it becomes more of an issue, as Alycin was saying, when someone's already been on a medication, is doing fine, and they don't want to mess with a good thing. If they're really expressing concerns about changing, that's someone that I would go to bat for, even if I think, medically, it probably would be acceptable. Because if they're already convinced that they're not going to do well, they probably won't do well.
Alicyn Magruder, PharmD, BCACP, MSCS: I agree with that statement. They'll find something wrong if they have the belief that it won't go well. I also I do the appeals for our department, so I go to bat for those patients that are just convinced that it's not going to work, but then also I look for sensitivities to other medications in the past. Somebody with a long history of either allergy or drug histories, anybody that's had an anaphylactic reaction to a medication, especially in an infusion. I might be more likely to try to appeal that by just noting that they're stable and we know that they are doing well because we can't always control the inactive ingredients of switching.
There are more patients in the MS population that seem like they're very concerned about a switch, because “Oh, I've had a switch in the past, and that didn't go well.” And so, if they've already had that experience in the past, then they there might be predisposed to it for one, but also, if they don't think that they're going to do well, I think they'll find something that makes them think that they're not doing well as well.
Sarah Anderson, PharmD, NBC-HWC: Yes, the nocebo effect is a real thing, which is the term used for this, if you go in with preconceived expectations that it's not going to go well then you typically do or outcomes.
Matt Hoffman: Yeah, of course. In that process, the goal there would be then to provide the resources that you have, just with your knowledge base and understanding of this process of how they're approved, and how the insurance side of things works. But Dr. Anderson, on the the advocacy side—where are some of those resources that perhaps we could point clinicians or patients to, to kind of help navigate that process? Especially now that again, we've been talking about biosimilars as this step into the future, but it's here now. So, where are some of the things, the resources, we can provide for them to really help them educate themselves, so they can prepare themselves for that potential reality or just even for that conversation with their clinician?
Sarah Anderson, PharmD, NBC-HWC: Thanks for asking that. The National MS Society, on our website, we have a web page dedicated to generic and biosimilars, understanding how they're approved, understanding what makes them different from their originator product, how are they similar to the originator products, etc. We also have an FAQ online specific to generics and biosimilars, as well. In addition, we've done an “Ask An MS Expert Program” webinar program with Dr. Jiwon Oh, based in Toronto, on the topic of generics and biosimilars that went live a month or so ago, so that link is posted online on our website as well. I wrote a “5 Things to Know About Biosimilars” blog for our Momentum Magazine, which is both in print and available online. We have a news bulletin specific to the natalizumab biosimilar that was recently FDA-approved in the last month or so, and that's also available online.
And then in addition to all of that, we also have information on patient assistance programs and a guide to prescription financial assistance. So, for any DMT that anyone is on, we do have links to any programs that are available through manufacturers, as well as other programs out there like Needy Meds, Good RX, the Mark Cuban Drug Plus company, etc. So, lots of resources out there for people to research as it relates to cost, as well.
And then also specific to providers, we are just finalizing an article for the NeurologyLive MS issue that will be going out in November in your print publication entitled, “Acceptance of and Access to Biosimilars and Generics: the MS Treatment Landscape and Patient Engagement,” so looking forward for that article to be coming out shortly for that NeurologyLive audience to be able to consume.
Matt Hoffman: Yeah, we're also very excited to to get that up for for the provider and patient community.