A recent stakeholder interchange from the Institute for Value-Based Medicine and The American Journal of Managed Care® convened thought leaders in both the clinical and managed care communities to discuss challenges, opportunities, and future directions in MS, with the goal of assisting stakeholders to optimize outcomes for patients. The interchange reviewed several evolving areas in the MS treatment and research landscape, including advances in pathology, and new emphases on neurological reserve and brain preservation, all of which may help shape efforts to improve benefits design relative to MS. This article is a summary of key points from the discussion.