Accomplishments: CNMSC Drug Access Working Group Project

Background

In 2022, the Canadian Network of Multiple Sclerosis (MS) Clinics (CNMSC) launched an initiative aimed at improving access to MS medications for people living with MS (PLWMS) at both a national as well as a provincial level. MS Canada is a key partner in this initiative, helping to ensure that the voice of PLWMS is a consistent part of the dialogue with decision makers.

The project is sponsored through unrestricted grants from: Biogen Canada Inc., EMD Serono Inc., Novartis Pharmaceuticals Inc., Hoffman-LaRoche Limited, and Amgen. This funding provides support for the research, analysis, engagement, and project management requirements to ensure the success of this initiative.

What are the goals of the project?

The goals of the project are:

  • To provide timely MS clinician expert input and/or feedback to health technology assessment (HTA) bodies (i.e., CDA1 and/or INESSS2) regarding disease modifying therapy (DMT) approvals/use for PLWMS and related demyelinating disorders;
  • To advocate for alignment of provincial criteria re: DMT access; and
  • To improve access for children living with MS to DMTs across Canada.

What has been accomplished to date?

The work of this project has moved forward under three pillars, and the accomplishments associated with each thus far (i.e., to October 2024) are outlined below.

Pillar Areas of Focus Activities/Accomplishments
HTA-focused
activities
  • Input to CDA reviews and/or reports (e.g., first-line [1L] DMT review3 )
  • Co-creation of new processes with CDA
  • CNMSC feedback on CDA report re: 1L DMTs in highly-active disease (March 2024)
  • Responses to draft ravulizumab (Ultomiris) + inebilizumab (Uplizna) NMOSD recommendations (April 2024)
  • Engagement of CDA to have dimethyl fumarate and teriflunomide reviewed for use in RIS (April 2024)
    • CDA and provinces agreed to this review through the newly created Formulary Management Expert Committee (FMEC) process
    • CNMSC input submission to improve clinical relevance of project scope (Aug 2024)
  • CNMSC and MS Canada engagement with CDA re: 1L review to accelerate the implementation of recommendations by provincial payers
    • Appointment of CNMSC expert clinician to FMEC review team (Sept 2024)
    • CNMSC input submission to improve clinical relevance of project scope (Sept 2024)
Provincial
engagement
activities
  • Leverage learnings from Ontario MS initiative to modernize access criteria and improve access processes for MS medications in other provinces

Alberta

  • Oct 2023: Renewals approved for 24 m (up from 12m)
  • Aug 2024: Mayzent - removal of the T25W requirement at treatment initiation and at renewal; removal of the EDSS change requirements at renewal
  • On-going: alignment of Enspryng NMOSD criteria with other provinces

Saskatchewan

  • On-going: support with MS Canada of SK clinician to get renewals approved for 24m

Nova Scotia

  • Q1-2 2024: creation of practitioner team with MS Canada and rapidengagement of NS Pharmacare
  • Pending policy change: move to an initial 2-year approval and 5-yrenewal period

Quebec

  • On-going: Collaboration with MS Canada QC team re: raisingawareness re: 2024 McDonald criteria (when published); analysis ofpotential implications of new criteria for HTA bodies, provincial drugprograms, etc.
Pediatric access
activities
  • Pediatric WorkingGroup survey ofpediatric DMT accessand/or challengesacross Canada
  • Scoping review ofuptake of DMTs inchildren andadolescents with MS inCanada andInternationally
  • Publications in process:
    • Survey of pediatric DMT access and/or challenges acrossCanada
    • Scoping review of uptake of DMTs in children andadolescents with MS in Canada and Internationally
  • Poster presentations:
    • ACTRIMS (Feb 2024)
    • ECTRIMS (Sept 2024)
  • Development of decision-maker engagement strategy Early 2025

Policy impacts achieved

CDA:

In spring 2024, CNMSC engaged CDA to request the review of dimethyl fumarate and teriflunomide for use in Radiologically Isolated Syndrome (RIS) in CDA’s new Formulary Management Expert Committee (FMEC) process. CDA and participating jurisdictions have agreed to carry out this review, which represents the first time that a clinician group has approached CDA through its new non-sponsored review process.

Alberta:

Subsequent to CNMSC and MS Canada’s successful efforts to have Alberta Health extend renewal periods for DMTs as of October 1, 2023,4 the team undertook many months of engagement with and/or submissions to the drug plan and the Alberta Expert Committee to align the criteria for use for Mayzent with those in other Canadian jurisdictions.

Effective August 1, 2024,5Alberta Health has removed the following requirements from the Mayzent criteria for use:

  • removal of the T25W requirement at treatment initiation and at renewal
  • removal of the EDSS change requirements at renewal

Modernization of Mayzent’s criteria helps to ensure that they accurately reflect the available evidence, the approach to care, and equitable access for PLWMS in Alberta with those in other jurisdictions.

Nova Scotia:

CNMSC and MS Canada have worked collaboratively to establish an MS practitioner team in Nova Scotia to prioritize issues and lead engagement with representatives of the Nova Scotia Pharmacare program. Key outcomes of the first meeting of these groups included:

  • A commitment by NS Pharmacare to move towards 2-year initial approval periods, along with 5-year renewal periods for relevant DMTs.
  • Preliminary discussions on streamlining criteria for existing agents, improve the appeal processes, andaccess to highly active agents as 1L agents for select patients.
  • A commitment to on-going working group meetings.

Other Accomplishments

In addition to the specific accomplishments achieved for the 3 pillars of activity identified for the project, there have been several additional tangible outcomes as well as intangible benefits attained:

  • Stakeholder communications via on-going updates to CNMSC Drug Access Working Group Project website (see: https://cnmsc.ca/Home/DrugAccessWorkingGroupProject).
  • Engagement of a wide range of CNMSC members from across the country on medication access relatedissues.
  • Engagement of and creation of new relationships with key decision-makers within national as well asprovincial organizations.
  • Engagement with medication access decision makers is providing concrete opportunities to improve patientcare as well as showcase the expertise and research of CNMSC members across the country.

Continuing work under this initiative

In its second year, the Drug Access Working Group Project has continued to see both progress and impact on a number of fronts. Activities in the coming year will emphasize provincial and/or national decision-maker engagement, both directly and thorough future collaborative initiatives (e.g., with MS Canada, CDA, etc.) to raise the issue of timely and equitable MS medication access for all Canadians.

Project sponsors

If you have any questions about this project, please contact Michelle Eisner at CNMSC (meisner@brain.ubc.ca) and/or Dr. Judith Glennie the project manager (judith_glennie@on.aibn.com)
Biogen
Amgen
Roche
EMD Serono
Novartis