An MS Academic Center Experience with Ocrelizumab and Implications for Increasing Staffing Needs

Background: Multiple sclerosis (MS) is an autoimmune disease affecting the central nervous system with multiple potential disease modifying therapies (DMT). These therapies often have complex processes for getting them initiated. These processes take an increasing amount of time and resources from practitioners and MS clinics. Formulary restrictions, specialty pharmacy processes and the approval processes are creating significant financial pressures on practices.

Objectives: We analyzed the timeframe of starting ocrelizumab from when the referral was made to patient getting infused in a small sample of our patients, who were changing their treatment course due to progression of disease secondary to MRI changes and/or clinical progression of symptoms or newly diagnosed with MS needing to start a DMT. 

Methods: To complete this analysis, we performed a chart review on 30 of our patients who were prescribed ocrelizumab since the launch of the medication in April 2017 through November 30th. We examined the range of time as well as the average length of time between the date ocrelizumab was ordered and the date the patient was first infused. We also calculated the amount of work, per patient, required by the practice. We included all Medicare and commercial insurance plans. 

Results: Out of 30 patients, there were 13 patients with progressive forms of MS and 17 patients with relapsing forms of MS. It took on average 53 days from when a referral was placed for ocrelizumab to when the patient was infused; with a range of 15 days- 192 days. There were 8 patients with Medicare and 22 patients with commercial insurance plan. All required a prior-authorization from the insurance company which on average takes 12 minutes to complete. Six patients had the medication initially denied and an appeal was done to get the drug approved. Data relative to total resources required will be presented.

Conclusions: MS is complex disease and currently uses large amount of resources and staffing for care coordination. Disease modifying therapies are the mainstay of treatment to help slow the progression of MS and prevent future relapses. Ocrelizumab was FDA approved this year for relapsing and progressive forms of MS. All insurers are requiring prior-authorizations to be completed and on average takes 53 days to get a patient infused with ocrelizumab, thus further complicating the care coordination for MS patients. MS centers are investing additional time and resources which could result in the need for new staff or changes in current work flow to better meet the demands of coordinating DMT for MS patients.