(64) Managed care approaches to address unmet patient needs in multiple sclerosis (MS): AMCP Market Insights Program

Background: : Multiple Sclerosis (MS) is a chronic, immune-mediated disease characterized by substantial heterogeneity in clinical presentation, progression, and treatment response. Despite therapeutic advances, many patients experience ongoing disease activity and disability, underscoring persistent unmet needs. Managed care organizations play a critical role in improving access to effective treatments, optimizing disease management, and supporting value-based care strategies to address these gaps.

Objective: : Identify unmet patient needs in MS, review disease pathogenesis and evolving subtypes, examine advances in therapies targeting MS biology and disability, and highlight payer perspectives on treatment value, endpoints, and the move toward biologically based diagnosis.

Methods: : A multidisciplinary roundtable was convened by AMCP in December 2024, bringing together 10 participants, including health plans, integrated delivery networks, PBMs, an insurance brokerage firm, an MS patient organization, and a neurology specialist. The program included live polling to capture quantitative feedback and facilitated discussions to gather qualitative insights.

Results: : Polling among 10 participants identified top unmet needs in MS: preventing disability (80%); affordable treatments, access to specialists, and timely use of effective therapies (70% each); and disparities in communities of color and social determinants of health, along with timely diagnosis (60% each). All respondents agreed on the importance of addressing disability progression not related specifically to relapses and early detection, supporting use of the 2024 McDonald criteria. Participants emphasized the need for real-world evidence, updated guidelines, and early use of high-efficacy disease modifying therapy (DMT). Key challenges included care fragmentation, lack of comparative data, need for standardized diagnostics and ICD-10 codes, and improved budget predictability tools. Participants expressed cautious optimism about Bruton's tyrosine kinase (BTK) inhibitors, viewing them as a novel approach with potential to address unmet needs, particularly in progressive MS.

Conclusions: : These AMCP Market Insights program findings underscored the need for earlier diagnosis, timely access to high-efficacy therapies, and updated guidelines to improve MS outcomes. Payer and clinical stakeholders expressed cautious optimism about emerging therapies like BTK inhibitors. Collaborative, evidence-based approaches will be essential for managed care organizations to address persistent unmet needs and enhance care for individuals living with MS.

Sponsorship:: Sanofi