What You Should Know:

MS Disease Modifying Treatment Therapy Formulary Change at the VA

Though PVA seldom advocates with the VA regarding contracting, the concerns about impact to PVA members were significant enough that PVA leadership, CEO Carl Blake, Chief Policy Officer Heather Ansley, and Director of Research and Education and MS Committee liaison Cheryl Vines met with the Deputy Chief Consultant of Pharmacy Benefits Management Jennifer Martin, PharmD, BCPP to address these concerns. While we were not able to impact the formulary contract, we were able to impact the process, especially in educating both patients and providers about their options regarding the new formulary medication, Briumvi. Dr. Martin agreed that PBM would develop an educational letter for both Veterans with MS and their VA health care providers. This is not commonly provided with formulary changes.

The letter below, will be sent from each VA Hospital to Veterans who receive DMT treatment. You should receive this from your hospital in the next few weeks, before the formulary policy takes effect in late June or early July, 2024. If you do not receive the letter, you should contact Pharmacy Services at the hospital where you receive your care. Please note, this formulary policy will not impact Veterans with primary progressive MS, as it has not been found effective for this type of MS.

We urge you to advocate for yourself to assure you get the treatment that you need.

The letter you should receive is below:

Dear Veteran, This letter is to inform you of new information about VA pharmacy coverage of anti-CD20 monoclonal antibodies for relapsing forms of multiple sclerosis (MS). Anti-CD20 antibodies currently used for MS include: ocrelizumab (OCREVUS®), ofatumumab (KESIMPTA®), rituximab including biosimilars (RITUXAN®, RUXIENCE®), and ublituximab (BRIUMVI®). When there are multiple medications in the same class (meaning the main way they work is the same), VA may select one medication to have on formulary. Ublituximab-xiiy (BRIUMVI®) is the formulary option for most people starting anti-CD20 antibody therapy for relapsing forms of MS. This letter answers some commonly asked questions and provides recommendations about how to discuss this information with your healthcare team.

Will I need to switch to ublituximab if I am already on a different MS medication?

No. This will not require you to change from the medication you are
currently taking to ublituximab.  As always, your MS provider may
discuss trying an anti-CD20 antibody or a different medication if
medically necessary.

Will I have to try an anti-CD20 antibody in order to try any other medication for MS?

No. What medication you start for your MS is a decision that you and
your MS provider make together. VA will not require that you try an anti-
CD20 antibody first before other medications.

Will I need to switch to ublituximab if I am already on a different MS medication?

No. This will not require you to change from the medication you are
currently taking to ublituximab.  As always, your MS provider may
discuss trying an anti-CD20 antibody or a different medication if
medically necessary.

What if my healthcare provider decides I should start an anti-CD20 antibody, but there is a reason I can’t use ublituximab?

You and your MS provider should discuss the details of any medication
you start to determine if it is right for you. If you both decide an anti-
CD20 antibody is right for you, but there is a reason that you are not a
good candidate for ublituximab; your MS provider may consider an
alternative.

If I have been diagnosed with Primary Progressive MS (PPMS), how does this affect me?

Not all anti-CD20 antibodies have been proven to work in PPMS. The
preferred agent will affect people starting an anti-CD20 antibody with
relapsing forms of MS only. Relapsing forms of MS include relapsing-
remitting MS (RRMS), active secondary progressive MS (active SPMS),
and clinically isolated syndrome (CIS).

The goal of the [insert VA Site Name] is to provide you with the best possible results from your medication. If you have questions or concerns regarding this, please contact the [insert VA Site Name] (8:30 a.m. – 5:00 p.m., Monday through Friday) at [insert site phone number & toll-free numbers]. When the VA operator answers, please request outpatient pharmacy at extension [insert outpatient pharmacy extension].