title: Managed approaches to multiple sclerosis in special populations.
abstract: BACKGROUND
  Multiple sclerosis (MS) is a chronic demyelinating disorder of the  central nervous system that is classified as an immune-mediated inflammatory  disease. In managed care, patients with MS can be managed through care  coordination that engages an interprofessional approach to a comprehensive  spectrum of preventive, medical, rehabilitative, cognitive, and long-term health  care services. In addition, the management paradigm for MS is currently in a  stage of rapid evolution, with a number of new agents, including more oral  drugs, expected to become available in the near future. Pharmacy and therapeutic  committees may soon be faced with evaluating a hierarchy of new scientific data  to differentiate the safety and efficacy of these new agents. Decisions will  need to be made regarding the utility of these potential new agents among  existing therapies with longer-term safety and efficacy data available in the  scientific literature. For those MS patients managed under Medicaid, formulary  and medication management decisions may be further impacted by psychosocial,  cultural, educational, attitudinal, and/or economic factors that may be unique  to the Medicaid population. The need to maximize immediate and long-term  resource utilization is usually an important consideration when managing a  Medicaid population. There is also an increasing focus on quality measures and  quality outcomes by the Centers for Medicare and Medicaid Services. Many managed  care professionals can be involved in establishing quality measures and quality  improvement processes to effectively appropriate and manage the resources  required for Medicaid patients with MS. As a result, medication and medical  management of this special population can involve a comprehensive approach by  managed care professionals. For purposes of this article, the term "special  populations" applies to patients with MS who are managed under Medicaid plans.
  
  
  OBJECTIVE
  To review (a) particular challenges managed care organizations  (MCOs) encounter when managing special populations of Medicaid patients with MS,  (b) recent efficacy and safety data for oral therapies for relapsing forms of  MS, (c) costs of current MS therapies, and (d) potential strategies for managed  care to improve care of their MS patient population and optimize clinical and  economic outcomes.
  
  
  METHODS
  Review of recent published literature, abstracts  related to MS presented at major medical conferences, and recommendations from  key organizations including the U.S. Department of Health and Human Services and  the National Multiple Sclerosis Society.
  
  
  CONCLUSIONS
  The health economics of MS are  a central issue for MCOs managing Medicaid patient populations. Additional  challenges include the anticipated expansion of the marketplace to include  several new oral agents and the lack of consensus guidelines for management of  patients with MS. The benefit-risk profile of new agents will need to be  considered in the context of established first-line parenteral drugs. Management  of patients with MS should include an individualized approach for each patient  as part of a shared decision-making process. In the overall management of  special patient populations, case management and collaborative practice models  in managed care may help to ensure that critical benchmarks are achieved.
authors: Gateway Health Plan, 600 Grant St, Fl 41, Pittsburgh, PA 15219, USA. ksperandeo@gatewayhealthplan.com
authors: Kara
authors: K
authors: Sperandeo
authors: Lisa
authors: L
authors: Nogrady
authors: Kathleen
authors: K
authors: Moreo
authors: Chris R
authors: CR
authors: Prostko
mesh_terms: D019090:Case Management; D016527:Drug Costs; D006801:Humans; D008329:Managed Care Programs; D008484:Medicaid; D009103:Multiple Sclerosis / Q000188:drug therapy* / Q000191:economics; D014481:United States