Multiple Sclerosis

Living with Multiple Sclerosis and maintaining overall well-being involves more than drug treatment. Our patient therapy management program offers high-quality integrated services that deliver optimal clinical outcomes, superior financial assistance and outstanding patient service. The system is designed to provide medication access, individualized care, and maximize adherence. We are committed to offering comprehensive MS care by: reducing the frequency/severity of exacerbations, promoting function/independence, managing adverse effects, and giving emotional support. At Pharmacy Advantage we strive to transform lives and communities through health and wellness, one patient at a time.

About the disease

Multiple sclerosis (MS) is a condition that affects the brain, spinal cord and/or the nerves that control the eyes. The exact cause of MS is unknown, but some research suggests that a person's own immune (defense) system may attack the lining of the central nerves.

There are cells in the body that are activated by foreign material. A chain of events then is started to defend the body. This defense action causes scar tissue to form and interrupts messages between nerve fibers.

This interruption causes the symptoms that are seen in MS. The disease ranges from very mild and intermittent to steadily progressive. Some people have few attacks and little, if any, disability accumulating over time.

Symptoms of the Disease

Symptoms of MS may be mild or severe, of long duration or short, and may appear in various combinations, depending on the area of the nervous system affected. Complete or partial remission of symptoms, especially in the early stages of the disease, occurs in approximately 70 percent of MS patients.

The initial symptom of MS is often blurred or double vision, red-green color distortion, or even blindness in one eye. Inexplicably, visual problems tend to clear up in the later stages of MS. Inflammatory problems of the optic nerve may be diagnosed as retrobulbaror optic neuritis. Fifty-five percent of MS patients will have an attack of optic neuritis at some time or other and it will be the first symptom of MS in approximately 15 percent. This has led to general recognition of optic neuritis as an early sign of MS, especially if tests also reveal abnormalities in the patient's spinal fluid.

Most MS patients experience muscle weakness in their extremities and difficulty with coordination and balance at some time during the course of the disease. These symptoms may be severe enough to impair walking or even standing. In the worst cases, MS can produce partial or complete paralysis. Spasticity-the involuntary increased tone of muscles leading to stiffness and spasms-is common, as is fatigue. Fatigue may be triggered by physical exertion and improve with rest, or it may take the form of a constant and persistent tiredness.

Most people with MS also exhibit paresthesias, transitory abnormal sensory feelings such as numbness, prickling or "pins and needles" sensations; uncommonly, some may also experience pain. Loss of sensation sometimes occurs. Speech impediments, tremors, and dizziness are other frequent complaints. Occasionally, people with MS have hearing loss. Approximately half of all people with MS experience cognitive impairments such as difficulties with concentration, attention, memory, and poor judgment, but such symptoms are usually mild and are frequently overlooked. In fact, they are often detectable only through comprehensive testing. Patients themselves may be unaware of their cognitive loss; it is often a family member or friend who first notices a deficit. Such impairments are usually mild, rarely disabling, and intellectual and language abilities are generally spared.

Cognitive symptoms occur when lesions develop in brain areas responsible for information processing. These deficits tend to become more apparent as the information to be processed becomes more complex. Fatigue may also add to processing difficulties. Scientists do not yet know whether altered cognition in MS reflects problems with information acquisition, retrieval, or a combination of both. Types of memory problems may differ, depending on the individual's disease course (relapsing-remitting, primary-progressive, etc.), but there does not appear to be any direct correlation between duration of illness and severity of cognitive dysfunction.

Source: National Institutes of Health

Causes of the disease

To understand what is happening when a person has MS, it is first necessary to know a little about how the healthy immune system works. The immune system - a complex network of specialized cells and organs - defends the body against attacks by "foreign" invaders such as bacteria, viruses, fungi and parasites. It does this by seeking out and destroying the interlopers as they enter the body. Substances capable of triggering an immune response are called antigens.

T cells, so named because they are processed in the thymus, appear to play a particularly important role in MS. They travel widely and continuously throughout the body patrolling for foreign invaders. In order to recognize and respond to each specific antigen, each T cell's surface carries special receptor molecules for particular antigens.

Helper T cells are essential for activating the body's defenses against foreign substances. Yet another subset of regulatory T cells acts to turn off, or suppress, various immune system cells when their job is done. Killer T cells, on the other hand, directly attack diseased or damaged body cells by binding to them and bombarding them with lethal chemicals called cytokines. Since T cells can attack cells directly, they must be able to discriminate between "self" cells (those of the body) and "non-self" cells (foreign invaders). To enable the immune system to distinguish the self, each body cell carries identifying molecules on its surface. T cells likely to react against the self are usually eliminated before leaving the thymus; the remaining T cells recognize the molecular markers and coexist peaceably with body tissues in a state of self-tolerance.

In autoimmune diseases such as MS, the detente between the immune system and the body is disrupted when the immune system seems to wrongly identify self as non-self and declares war on the part of the body (myelin) it no longer recognizes. Through intensive research efforts, scientists are unraveling the complex secrets of the malfunctioning immune system of patients with MS.

Investigators are also looking for abnormalities or malfunctions in the blood/brain barrier, a protective membrane that controls the passage of substances from the blood into the central nervous system. It is possible that, in MS, components of the immune system get through the barrier and cause nervous system damage.

Scientists have studied a number of infectious agents (such as viruses) that have been suspected of causing MS, but have been unable to implicate any one particular agent. Viral infections are usually accompanied by inflammation and the production of gamma interferon, a naturally occurring body chemical that has been shown to worsen the clinical course of MS. It is possible that the immune response to viral infections may themselves precipitate an MS attack. There seems to be little doubt that something in the environment is involved in triggering MS.

In addition, increasing scientific evidence suggests that genetics may play a role in determining a person's susceptibility to MS. Some populations, such as Gypsies, Eskimos, and Bantus, never get MS. Native Indians of North and South America, the Japanese, and other Asian peoples have very low incidence rates. It is unclear whether this is due mostly to genetic or environmental factors.

In the population at large, the chance of developing MS is less than a tenth of one percent. However, if one person in a family has MS, that person's first-degree relatives-parents, children, and siblings-have a one to three percent chance of getting the disease.

Further indications that more than one gene is involved in MS susceptibility comes from studies of families in which more than one member has MS. Several research teams found that people with MS inherit certain regions on individual genes more frequently than people without MS. Of particular interest is the human leukocyte antigen (HLA) or major histocompatibility complex region on chromosome 6. HLAs are genetically determined proteins that influence the immune system.

These studies strengthen the theory that MS is the result of a number of factors rather than a single gene or other agent. Development of MS is likely to be influenced by the interactions of a number of genes, each of which (individually) has only a modest effect. Additional studies are needed to specifically pinpoint which genes are involved, determine their function and learn how each gene's interactions with other genes and with the environment make an individual susceptible to MS. In addition to leading to better ways to diagnose MS, such studies should yield clues to the underlying causes of MS and, eventually, to better treatments or a way to prevent the disease.

Source: National Institutes of Health

Multiple Sclerosis Treatment and Medications

Scientists continue their extensive efforts to create new and better MS symptom treatment therapies. There is as yet no cure for MS. Many patients do well with no therapy at all, especially since many medications have serious side effects and some carry significant risks. Naturally occurring or spontaneous remissions make it difficult to determine therapeutic effects of experimental treatments; however, the emerging evidence that MRIs can chart the development of lesions is already helping scientists evaluate new MS symptom treatment therapies.

In the past, the principal medications physicians used for MS symptom treatment were steroids possessing anti-inflammatory properties. No strong evidence exists to support the use of these drugs to treat progressive forms of MS. Also, there is some indication that steroids may be more appropriate for people with movement, rather than sensory, symptoms.

While steroids do not affect the course of MS over time, they can reduce the duration and severity of attacks in some patients. The mechanism behind this effect is not known; one study suggests the medications work by restoring the effectiveness of the blood/brain barrier. Because steroids can produce numerous adverse side effects (acne, weight gain, seizures, psychosis), they are not recommended for long-term use as an MS symptom treatment.

One of the most promising MS symptom treatment research areas involves naturally occurring antiviral proteins known as interferons. Three forms of beta interferon (Avonex, Betaseron, Extavia and Rebif) have now been approved by the Food and Drug Administration for relapsing-remitting MS symptom treatment. Beta interferon has been shown to reduce the number of exacerbations and may slow the progression of physical disability. When attacks do occur, they tend to be shorter and less severe. In addition, MRI scans suggest that beta interferon can decrease myelin destruction.

Investigators speculate that the effects of beta interferon may be due to the drug's ability to correct an MS-related deficiency of certain white blood cells that suppress the immune system and/or its ability to inhibit gamma interferon, a substance believed to be involved in MS attacks. Alpha interferon is also being studied as a possible treatment for MS. Common side effects of interferons include fever, chills, sweating, muscle aches, fatigue, depression and injection site reactions.

In addition to beta interferon, the FDA has approved a synthetic form of protein called copolymer I for the treatment of relapsing-remitting MS. This product is available under the name Copaxone® (glatiramer acetate). Copolymer I has few side effects, and studies indicate that the agent can reduce the relapse rate by almost one third when used as an MS symptom treatment.

Scientists continue their extensive efforts to create new and better MS symptom treatment therapies for MS. Goals of therapy are threefold: to improve recovery from attacks, to prevent or lessen the number of relapses, and to halt disease progression.

Source: Amended National Institutes of Health

Biologic Response Modifiers ("Biologics")

  • Ampyra
  • Aubagio
  • Avonex
  • Copaxone
  • Extavia
  • Gilenya
  • Rebif
  • Tecfidera
  • Tysabri

The information on this site is intended to provide useful health and wellness information and is not intended to be used in lieu of medical advice from a qualified physician. If you are having health issues and concerns, contact a licensed physician or healthcare professional for diagnosis and treatment. For questions or concerns regarding your medications please contact your pharmacist.

Biologic Response Modifiers ("Biologics")

  • Ampyra
  • Aubagio
  • Avonex
  • Copaxone
  • Extavia
  • Gilenya
  • Rebif
  • Tecfidera
  • Tysabri

The information on this site is intended to provide useful health and wellness information and is not intended to be used in lieu of medical advice from a qualified physician. If you are having health issues and concerns, contact a licensed physician or healthcare professional for diagnosis and treatment. For questions or concerns regarding your medications please contact your pharmacist.

Patient Enrollment Form

Use the online Enrollment Form to order your prescriptions from Pharmacy Advantage and enroll in our Mail Order program. Mail your original prescriptions to:
Pharmacy Advantage Corporate HQ
Attn: New Member Enrollment
735 John R. Road, Suite 150
Troy, MI 48083

The information on this site is intended to provide useful health and wellness information and is not intended to be used in lieu of medical advice from a qualified physician. If you are having health issues and concerns, contact a licensed physician or healthcare professional for diagnosis and treatment. For questions or concerns regarding your medications please contact your pharmacist.

MS Injection Medication Request Form

MS IV Medication Request Form

MS Oral Medication Request Form

General Medication Request Form

Physician Order Form

Prior Authorization Form

The information on this site is intended to provide useful health and wellness information and is not intended to be used in lieu of medical advice from a qualified physician. If you are having health issues and concerns, contact a licensed physician or healthcare professional for diagnosis and treatment. For questions or concerns regarding your medications please contact your pharmacist.

Financial Assistance:

The staff at Pharmacy Advantage understands that prescription drugs can be expensive, especially for specialty medications. We are committed to helping our patients find ways to get the specialty medications they need, at prices they can manage. Pharmacy Advantage is dedicated to finding patient funding whenever possible in order to eliminate interruptions in therapy due to concerns over drug costs.

There are patient assistance programs for people who meet any of the following criteria:

  • Have insurance with a high co-pay
  • Incur a high deductible
  • Have Medicare or are eligible for Medicare
  • Have no prescription drug coverage and live on a limited income
  • Have lost their job

Many of our patients are currently enrolled in a co-pay assistance program and our clinical staff members would like to assist them in finding the program that best fits their needs. In order to receive assistance each program does have certain criteria that need to be met. The clinical staff at Pharmacy Advantage is happy to work with you in order to assist in completing the necessary steps.

If they are not currently enrolled and would like to discuss their options, please contact the clinical department at (800) 456-2112 extension 5, Monday thru Friday from 8:00 a.m. to 5:30 p.m.

Programs from Multiple Sclerosis Drug Manufacturers

The following is a list of some drug manufacturers that offer financial assistance programs for people living with Multiple Sclerosis who cannot afford to buy the medications they have been prescribed. You are encouraged to call these manufacturers directly for more information on these programs. If you need financial assistance for a drug not listed here, please contact one of our pharmacists.

Drug Name Manufacturer Telephone Number:

Drug Name Manufacturer Phone Number
Ampyra Acorda Therapeutics 888-881-1918
Aubagio Genzyme 855-676-6326
Avonex Biogen Idec 800-456-2255
Copaxone Teva Neuroscience 800-887-8100
Extavia Novartis 866-398-2842
Gilenya Novartis 800-445-3692
Rebif Serono: MS Lifelines 8877-447-3243
Tecfidera Biogen Idec. 1-800-456-2255
Tysabri Biogen Idec. 1-800-456-2255

The information on this site is intended to provide useful health and wellness information and is not intended to be used in lieu of medical advice from a qualified physician. If you are having health issues and concerns, contact a licensed physician or healthcare professional for diagnosis and treatment. For questions or concerns regarding your medications please contact your pharmacist.