For Multiple Sclerosis (MS) Awareness Month, Pharmacy Times interviewed Melinda Morgan, PharmD, Manager, Clinical Pharmacy, UPMC Health Plan at Pittsburgh, Pennsylvania, on MS and the pharmacist’s role within this space. She describes how crucial the pharmacist’s involvement is in MS care, and that they serve as valuable resources when it comes to educating patients, helping medication management and adherence, and providing holistic support for patients. Morgan notes that she is hopeful for upcoming clinical trials and advancements in MS care, particularly in progressive forms of the disease.
Key Takeaways
- Pharmacist's Role in Multiple Sclerosis (MS) Care: Pharmacists play a pivotal role in MS treatment by providing patient education, medication management, and coordination of care with health care providers. Their accessibility makes them valuable resources in addressing patient concerns and ensuring medication adherence while advocating for their patients' needs.
- Holistic Patient Approach: Treating MS requires a holistic approach that considers not only medication management but also lifestyle factors and social determinants of health. Pharmacists need to view patients holistically, understanding their challenges beyond medication adherence, such as transportation barriers and lifestyle choices, to optimize treatment outcomes.
- Future Directions in MS Treatment: There is optimism for the future of MS treatment, particularly in progressive forms of the disease. Ongoing discussions and potential clinical trials offer hope for the development of new therapies that could significantly impact the management of MS, broadening treatment options for patients.
Pharmacy Times: What is multiple sclerosis (MS), and what does it look like in everyday life?
Melinda Morgan: MS is a neurological condition that can impact so many facets of a patient's life. There are different forms of it—progressive, relapsing-remitting—and it can cause exacerbations that really impact everything from daily functioning, to their work at their job, every aspect of a patient's health.
Pharmacy Times: Can you describe the pharmacist’s role in the treatment of MS, and in what ways do they navigate the complexities of this condition?
Morgan: I think patient education can be huge in this setting. We've all heard the phrase for decades that pharmacists are the most accessible health care provider, so it's a great opportunity for pharmacists to step in, listen to the concerns of the patient or the caregiver that they might be having, and make sure that they know what all their medications are treating and any potential [adverse effects (AEs)] to watch for. We can also be a bridge to coordinate their care with their provider, so whether it's something simple, like requesting refills for them, or something more complex, like suggesting medication adjustments, we can help advocate for our patients.
Pharmacy Times: How do pharmacists collaborate with other health care professionals (eg, specialists, physicians, physical therapists) and insurance providers to help ensure patients are receiving the best care?
Morgan: Lately, we have an MS care management program at [UPMC Health Plan] that focuses on collaboration between our nurse care managers, our patients, social workers and our pharmacy teams to help address both member and caregiver needs related to medication questions, care access, and many other needs specific to MS. Specifically for my team in the pharmacy department, we outreach to patients telephonically and build relationships with these patients quite quickly. Sometimes we find that numbers disclose that they're experiencing AEs or new symptoms for the first time. Maybe they weren't totally transparent with their provider, or the question wasn't asked directly and they didn't think to bring it up during our appointment. We can help tease out if there's a particular medication that may be the culprit of this new symptom, or perhaps it's progressing another condition. We can help work with our providers to make suggestions for medication changes, adjustments, or loop them into additional resources such as asking their provider for referrals to physical or occupational therapy.
We also work really closely with our network pharmacies that are dispensing MS treatments to our members. Since they often have monthly contact with most of these patients, it's another opportunity to catch worsening symptoms or other social needs. We have established pathways for these pharmacies to refer into resources that we have available, like social workers or care managers, to look at the patient holistically. We've had instances where we were able to locate community resources for our members to get a ramp built for easier access to their home. So, it can be everything from social needs, medication needs, anything that we can help with.
Pharmacy Times: MS often presents with comorbidities, requiring the consideration of potential drug interactions and medication adherence. How do pharmacists address these challenges to optimize adherence and prevent adverse outcomes?
Morgan: In our role [at UPMC Health Plan], we're able to see medications that are being billed to the members insurance and we have guardrails in place to look for medication interactions specifically, which may come into play especially when members have multiple providers, different specialists, or may use multiple pharmacies. While we encourage patients to try to use 1 pharmacy to also help mitigate this risk, that doesn't always happen, and they may have different reasons they prefer different pharmacies. We also outreach to patients during transitions of care—such as hospital to home discharge—because we know that transitions are particularly risky in terms of confusion with medication changes, and we want to make sure that our patients are set up for success.
Lastly, we work with pharmacies that offer medication packaging also sometimes referred to as adherence packaging, where medications are organized into bubble or strip packaging for each dose of the day. This helps to take the guesswork out for the patient and their caregivers and helps keep their medications organized and on track and helps to promote adherence to their routine medicines.
Pharmacy Times: Is there anything important that pharmacists need to know when treating patients with MS?
Morgan: We need to think about these patients holistically, so taking into account all of their needs, including social determinants of health and outside factors that may influence their health needs. Patients that may have transportation barriers, for example, not only can't get to the pharmacy to refill their medicines, they may have had trouble getting to their routine medical appointments, Imaging, lab work, which can set off a whole cascade of events that impacts their ability to stay adherent. So, it's not just getting them to fill up a box for the medicines we need to look at the whole picture of what may be challenging for them to stay on track.
Pharmacy Times: Holistic methods are prominent within the health care space. What are some holistic approaches that patients with MS can incorporate into their treatment regimens?
Morgan: We sometimes refer to this as a “brain healthy lifestyle,” so, [we’re] looking at things like movement, physical activity, diet, nutrition, avoiding tobacco and not drinking alcohol in excess. The same healthy lifestyles that we promote for diagnoses like diabetes and cardiovascular disease, also apply to our patients with MS. So, [that includes] getting good sleep; staying physically active; and eating a diet with a wide variety of whole foods, fruits, and vegetables.
We also know that certain comorbidities are more common in patients with MS, so cerebrovascular disease, cardiovascular disease, other neurological conditions. And establishing these healthy behaviors can help, not only with protecting neurological reserve and maximizing brain health, but also potentially reducing the risk of some of these comorbidities. It's obviously important also to get those comorbidities treated appropriately by the provider, but these lifestyle modifications can be the first step.
Pharmacy Times:Are psychedelics currently being used in the MS space?
Morgan: It's not something that I'm personally super familiar with, I think the thing that I would caution is that there's not a lot of clinical trials and things looking at how these alternative treatments might interact with existing MS treatments that we know have been studied for safety and efficacy. So, it's something that patients definitely need to discuss with their provider at length before considering any of these alternative solutions.
Pharmacy Times: Is there anything coming up in the future, such as clinical trials or mew medications, that you are looking forward to or hopeful for?
Morgan: Yeah, I think there's some exciting discussions surrounding potential future treatment options for progressive MS specifically, which is a big deal because most of our existing therapies focus on the relapsing forms. Seeing some additional therapies come through for these progressive forms of MS will potentially change the landscape in the upcoming years.
Pharmacy Times: Any closing thoughts?
Morgan: I think overall just thinking of our patients, not just as a pharmacist with their medications, but really looking at the whole picture. Every social factor that might be influencing them can cascade and trickle down into how well their medications work for them. So just looking at the patient holistically.
