New Therapies

Multiple Sclerosis Medications in the VHA: Delivering Specialty, High-Cost, Pharmacy Care in a National System

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Introduction/Importance: Pharmacotherapy for multiple sclerosis has increased significantly since 1993 when the first disease modifying therapy was approved. The expansion of therapies has been accompanied with differences in adverse effect profiles, efficacy, and cost. The most recent therapies pose the challenge of balancing these issues while providing optimal care.

Observations: Several measures such as generic conversion and standardization of therapies can be employed to control costs of therapy. The safety and efficacy of these agents can be monitored by implementation of criteria for use and/or medication utilization evaluations.

Conclusions: A formulary management system encompasses methodologies to evaluate the relevant clinical and medical literature and includes a systematic approach for selecting medications for different diseases, conditions, and patients. Formulary systems often contain prescribing guidelines and clinical recommendations that assist health care professionals with providing high quality, value-based care for patients.



Prior to the first approved disease modifying therapy (DMT) in the 1990s, treatment approaches for multiple sclerosis (MS) were not well understood. The discovery that MS was an immune mediated inflammatory disease paved the way for the treatments we know today. In 1993, interferon β‐1b became the first DMT for MS approved by the US Food and Drug Administration (FDA). Approvals for interferon β‐1a as well as glatiramer acetate (GA) soon followed. Today, we consider these the mildest immunosuppressant DMTs; however, their success verified that suppressing the immune system had a positive effect on the MS disease process.

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