Overcoming Access, Cost Barriers in MS: Andrew Wolf, MD

As the costs of multiple sclerosis (MS) treatments continue to rise, it is important to address the widening gaps in access to care, particularly in rural and western regions, where limited specialist availability and insurance barriers make it harder for patients to benefit from modern disease-modifying therapies, says Andrew Wolf, MD, assistant professor of neurology, University of Colorado Anschutz.

This transcript was lightly edited for clarity; captions were auto-generated.

Transcript

Can you provide some key trends or statistics of the current health burden of MS?

As far as the burdens from MS, we like to frame that in a couple different ways. So one is, of course, how is the disease directly impacting patients clinically? Are they having more inpatient stays due to things like MS attacks or relapses? Are they having more disability accumulate through things like progression or just worsening of symptoms? And then also, to look at things like cost? From the latter standpoint, especially as we look forward and have new multiple sclerosis drugs approved, especially as we get into 2026, the cost of disease-modifying therapies, or DMTs, for MS patients continues to rise.

I think that has been an important trend, even for drugs that have been out on the market in some cases for many years. Fortunately, though, we are getting some benefit where we also see that the relapse rates overall for treated MS patients and the rates of having more disability and moving to something called secondary progressive MS have declined just with the use of the more modern therapies. So, some positives and then some things to keep an eye on.

What are some of the biggest gaps in care for patients with MS that should be addressed?

As far as gaps for MS care, again, there are a couple different things that we like to think about. I think one that I tend to focus on a lot, just being here at the University of Colorado, is geographic access to care disparities. And so, there are only small numbers of neurologists who are subspecialists, who are fellowship trained, and who have the capacity to really effectively manage MS patients with all these medications, and they're often very concentrated at academic medical centers, which are typically going to be in larger metropolitan areas.

This presents a lot of challenges, especially in the western US, where patients are often spread far apart. Personally, I have patients in New Mexico, Wyoming, Colorado, Nebraska, and Kansas, so [it's a] pretty large region. We have been able to leverage telehealth to help bridge this gap to some extent. But if you look at treatment patterns and access patterns, this geographic disparity seems to be a big issue. Similarly, for patients with different insurance and socioeconomic status of other means, it's often not as easy to access or to afford high-quality disease-modifying therapies.