As Accessible Providers, Pharmacists Address Inequities in Multiple Sclerosis Care

In an interview with Pharmacy Times, Jenelle Montgomery, PharmD, CPP, discussed how pharmacists can help patients with multiple sclerosis (MS) navigate their complex medication regimens, as well as how pharmacists can address inequities in patient care in MS. In addition to racial inequities in access to care, Montgomery said socioeconomic challenges are very common for the specialty medications necessary in MS.

Q: MS care and management can be quite complex. What pharmacologic approaches are typically used?

Jenelle Montgomery, PharmD, CPP: So, the main medications that you see for multiple sclerosis are disease modifying therapies, or DMTs. So, these medications help prevent new lesions from occurring, [and] patients having new symptoms from those new lesions. So, we have quite a few medications now that are available for patients in various forms—oral medications, self-injections, and infusions.

And then also, in a different bucket, we have medications for symptoms. You can see a lot of symptoms due to the lesions that the patients have, so they might have pain or numbness and tingling, they can have sexual dysfunction, bladder and bowel dysfunction. So, we have medications that kind of target those areas, even down to patients having gait problems, there's a medication for that. So, there's quite a few options for patients for that symptom management.

Q: What are some of the challenges pharmacists commonly encounter in MS care?

Jenelle Montgomery, PharmD, CPP: Yeah, so we have quite a few challenges that can come up for pharmacists related to MS medication—also symptom medications, but mostly our disease modifying therapies. So, one of them is access to medications. For example, people being able to afford medications and the disease modifying therapies are very expensive, so patients often need either copay programs to help with the costs, sometimes financial assistance programs, so that's a big challenge. Also, we want to make sure that patients are adherent to their medications so that they’ll help prevent relapses from happening or any disability from happening. So, making sure patients are on medications is very important for pharmacists, as well. Also, polypharmacy, so patients having a long list of medications that can kind of easily happen with MS depending on what the patient's symptoms are. So, we want to make sure we're not over-prescribing medications and making sure that patients really are taking the medications they need to manage their MS and make sure they're stable moving forward.

Q: How do health care inequities manifest in MS specifically?

Jenelle Montgomery, PharmD, CPP: Racial inequities is a kind of big factor, so we see, in particular, African American patients and Hispanic patients that have more morbidity and mortality related to multiple sclerosis. So, we want to make sure that we're targeting those patients and making sure they're getting access to a neurologist and to high-efficacy medications early. We also have inequities in terms of locations, so patients who are in rural populations, we want to think about how are they going to get their MRIs? How are they going to get access to a neurologist? And then also just kind of social inequities. So financial assistance I talked about, so patients who don't have the financial resources for these medications and making sure that we're asking those questions and getting the medications they need in an affordable manner.

Q: How can pharmacists play an active role in addressing these inequities?

Jenelle Montgomery, PharmD, CPP: Yeah, that's a good question. Pharmacists are a great resource for these inequities, so I'm kind of going back to the financial piece of it. Just making sure you're asking the question, are they able to afford their medications? What resources do we need? Do we need to bring in our support services program for the different manufacturers? Do patients have access to a copay card? So, pharmacists know about a lot of those financial opportunities that are available for patients. Another thing is, you know, pharmacists kind of build a great deal of trust with patients, so when we're looking at different racial groups, for example, a lot of patients will call us later after their visits and we have these long-term relationships with patients. So, I think that's a really good kind of way to make sure they're coming back for their visits and continuing on their medications. Another factor that's helpful is having a pharmacist in support groups for patients. So, these patients that need additional support, have other patients that they collaborate with, perhaps that's a place for pharmacists to kind of join in and provide those additional resources to a larger group.