When it comes to the complexity of diagnosis and treatment regimens, few conditions rival multiple sclerosis (MS).
MS is one of the most common disabling neurological diseases of young adults with symptom onset generally occurring between the ages of 20 to 40 years.
On top of the challenges inherent to diagnosing multiple sclerosis, physicians must also navigate a constantly evolving treatment landscape. With an ever-expanding array of disease modifying therapies, finding the right treatment for each patient is difficult.
Support for neurology providers and their patients
Understanding the unique complexity associated with MS and other neurological disorders and treatments, Optum® Specialty Pharmacy has developed a new model of care — the Optum® Neurology Center of Excellence — starting with a focus on MS.
The Neurology Center of Excellence provides clinical expertise to help physicians manage care for their patients living with MS. The care model applies the combined experience and knowledge from our MS-certified pharmacists to help physicians make informed treatment decisions.
In addition to our clinical expertise, the Neurology Center of Excellence model is designed to help physicians spend more time providing the highest level of care possible to their patients by removing administrative barriers.
The Optum Specialty Pharmacy provider support teams are familiar with the complexities of MS and can support your practice. For example, our dedicated manufacturer support team works directly with manufacturers to make sure prescriptions are processed quickly so patients get the therapy they need without delays.
Likewise, our appeals team is staffed by specialized nurses who write customized letters of appeal, regardless of formulary restrictions, to help patients get on the MS medications that work best for them.
Given the progressive nature of MS, adherence to treatment is a vital element of positive outcomes. Based on analytics informed by years of collected clinical data, we can spot potential signs of non-adherence and then target specific interventions to help patients stay on track.
“We know providers don't have a lot of time these days — they need specialized support,” says Holly Ouellette, an MS-certified pharmacist who helped develop the Center of Excellence model and established the Specialty Appeals program. “The Optum Neurology Center of Excellence was developed with that in mind. With the launch of the first Center of Excellence model focusing on MS, we are assisting health care staff, providers and patients in a multitude of ways.”
Removing barriers to neurological treatment
While the Center of Excellence model helps physicians focus on their patients, it also eases the health journey of people living with neurological disorders. The ultimate goal is improving access to affordable care.
Ouellette recalls a recent example of how Optum Specialty Pharmacy worked proactively to remove barriers for a patient: After suffering side effects with two existing MS medications, a patient was denied a newly prescribed medication.
After the denial, the patient stopped taking all medications and was experiencing worsening MS symptoms as a result. Optum Specialty Pharmacy nurses quickly drafted a letter of appeal for the patient’s provider to sign and submit to the payor. And although the new medication was approved, the copay was more than $1,000. Our team then worked with the patient to apply a copay card, which brought the copay down to $0.
“Because of our proactive efforts, the patient was able to restart therapy quickly,” Ouellette said. “The provider accepted help with the appeal letter and in just one week, the medication was in the patient’s hands.”
A holistic care model that puts patients first
From patient onboarding to ongoing management, Optum Specialty Pharmacy focuses on a person’s physical and financial health. Our goal is to simplify the complicated, fragmented health care system and make it work better for everyone.
Optum Specialty Pharmacy engages patients through award-winning and nationally accredited digital tools designed to help them manage their MS treatments and stay adherent. The suite includes:
- Virtual visits: Through our first-to-market virtual visits, patients can meet face-to-face with our highly trained pharmacists via webcam from the comfort of their own home. They get visual training on how to inject medications as well as condition and therapy counseling. These visits can be scheduled through a Care Advocate. On-demand virtual visits through the patient portal are not currently available.
- Video series: Our personalized video series is sent to patients by email or text. The videos offer condition and treatment information, suggestions for adherence and side effect management, lifestyle tips, patient testimonials, advice from our clinicians and much more.
- Texting programs: Our comprehensive text messaging programs improve patient adherence and make it easier for patients to refill their medications. These programs include medication reminders, refill notifications including Schedule My Fill,* personalized clinical assessments and educational outreach.
- Specialty patient portal and mobile app: Nationally accredited patient portal and mobile app allow patients to securely request refills, check order and shipping status, check prescription history, review information on conditions and medications and schedule on-demand virtual visits.
Keeping an eye on the future of MS treatment
As new MS treatments and therapies enter the market, options for treating and managing multiple sclerosis will continue to advance. We’ll have our finger on the pulse of these new medications. We can help actively assess and help manage these new medication trends. Additionally, as the trend of value-based care accelerates, providers can depend on us to deliver a new set of tools to help support better patient outcomes, not only in MS but for all complex conditions. The Center of Excellence model is built to help deliver precisely the care patients need while eliminating challenges to access and affordability.