Thymos Health
Your Multiple Sclerosis Journey

Still relapsing.
Still switching one drug at a time.
Still no real answers.

You're not alone. This is how multiple sclerosis (MS) is typically managed — and an honest look at what that journey costs, and what it leads to, over time.

1M Americans are living with multiple sclerosis.1
3× more common in women than men.1
40% report symptoms misdiagnosed before multiple sclerosis was identified.2
5.4 years is the median delay between first symptoms and diagnosis.2

How multiple sclerosis is typically treated

Most doctors and insurance plans follow step therapy — starting with lower-efficacy injectables before approving high-efficacy biologics. The stakes are high: multiple sclerosis lesions can accumulate silently between relapses, and each year without adequate disease control carries a compounding disability burden.

Mark where you are in your journey and we'll show you the full picture.

Step 1: Your neurologist starts you on Interferon-beta / Glatiramer acetate
Avonex, Rebif, Betaseron / Copaxone — weekly or daily injectable platform therapies
What your doctor says
"These are well-established, well-tolerated first-line therapies. They reduce your relapse rate by around 30%, with a long track record of safety."
~30–50% inadequate responders5
Typically 3–6 months to assess full response
Annual cost before insurance (AWP) ~$60,000–$90,000
Providers seen before this was prescribed
How long were you on this drug?
What happened?
Your coinsurance for this drug
Your estimated annual out-of-pocket for this drug (based on $75K mid-point)
$15,000
~40% have breakthrough disease — escalate to Step 2
Step 2: You escalate to Natalizumab
Tysabri — IV infusion every 4 weeks (anti-α4-integrin monoclonal antibody)
What your doctor says
"This is a high-efficacy therapy. It blocks immune cells from entering the brain and spinal cord. Most patients see dramatic reductions in relapse activity — often from the first infusion."
~68% reduction in annualised relapse rate vs. placebo6
Risk of severe brain infections and neurodegeneration sharply increases after 2 years7
Disease rebound when medication is stopped7
Annual cost before insurance (AWP) ~$82,000
How long were you on Natalizumab?
What happened?
Your coinsurance for this drug
Your estimated annual out-of-pocket for this drug
$16,400
Progressive brain and nerve tissue disease
Step 3: You move to Ocrelizumab
Ocrevus — IV infusion every 6 months (anti-CD20 B-cell depleting monoclonal antibody)
What your doctor says
"Ocrelizumab targets B cells, which drive inflammation differently from T-cell–focused therapies. It's the only drug approved for both relapsing and primary progressive multiple sclerosis."
~50% are non-responders at 2 years, resulting in worsening multi-organ and neurological damage8
Annual list price (WAC) — Genentech 2024 ~$78,858
How long have you been on Ocrelizumab?
What happened?
Your coinsurance for this drug
Your estimated annual out-of-pocket for this drug
$15,772
~72% of disability worsening is independent of relapses16
When relapse control is no longer the primary challenge Secondary Progressive Multiple Sclerosis
Secondary Progressive Multiple Sclerosis — gradual, accumulating disability with or without superimposed relapses
What Your Doctor says
"Your multiple sclerosis has shifted from relapsing to progressive. We have limited options to slow this phase, but we'll continue managing your symptoms."
~40% leave employment within 5 years of Secondary Progressive Multiple Sclerosis diagnosis10
50–72%
Experience slow, accumulating disability annually within 10 years of diagnosis16
7–10 yr
Reduced life expectancy vs. general population12
~$97K
Mean annual total cost with moderate-severe multiple sclerosis11
Disability milestones — EDSS scale
EDSS 3.0 — Mild-to-moderate disability, fully ambulatory Variable onset
EDSS 6.0 — Requires unilateral walking aid (cane or crutch) Median ~15 yrs
EDSS 8.0 — Restricted to bed or chair, assisted self-care Late disease
30-day hospitalisation rate (progressive multiple sclerosis) Elevated vs. RRMS
What changes as disability accumulates
🧠 Cognitive impairment affects ~50% of patients. Processing speed, working memory, and verbal fluency are the most commonly affected domains. Cognitive disability is often more functionally disruptive than physical disability — yet is underscreened and rarely addressed at neurology visits.13
😞 Depression is the most common psychiatric comorbidity. Major depressive disorder affects approximately 50% of people with multiple sclerosis over their lifetime — nearly 3× the general population rate — and is an independent predictor of quality of life, treatment adherence, and survival.14
💼 Employment loss is nearly universal at advanced stages. ~40% of multiple sclerosis patients leave employment within 5 years of SPMS diagnosis. Indirect productivity costs from absenteeism and early exit from the workforce can exceed the direct drug costs of DMT therapy — yet are never put on the same receipt.10
🧬 ~72% of all disability-worsening events are PIRA — not caused by relapses. In the Italian Multiple Sclerosis Registry cohort of 16,130 relapsing-onset patients, PIRA accounted for 72.3% of all confirmed disability accrual events over a mean follow-up of 11.8 years.16 A 48-study systematic review in JAMA Neurology (2023) found PIRA occurs in roughly 5% of RRMS patients per year and causes at least 50% of all disability accrual events in typical RRMS — even in patients who appear relapse-free on treatment. This means inflammation suppression alone cannot protect against the neurodegeneration driving long-term disability.
❤️ Life expectancy is reduced by 7–10 years. multiple sclerosis patients die earlier primarily from secondary complications: aspiration pneumonia, urinary tract infections, immobility-related conditions, and cardiovascular disease.12 Suicide accounts for 7.5× the general population rate in the multiple sclerosis population.
⚠ Progression is not inevitable — timing matters most
The strongest modifiable predictor of SPMS conversion is the degree of inflammation control in the first 5 years of disease. Studies show that patients treated early with high-efficacy therapies have significantly lower conversion rates. The current step-therapy system can delay access to these therapies by years.

What multiple sclerosis is really costing you

Multiple sclerosis is among the most expensive chronic diseases in the U.S. Lost income and reduced productivity can exceed the cost of treatment itself.

Based on your journey above–adjust the numbers to match your situation.
Sick days missed in the last 12 months
Your hourly wage (for lost income calculation)
$
Your estimated total annual cost of multiple sclerosis $0
Drug out-of-pocket costs $0
Lost income (sick days) $0
Reduced productivity at work (presenteeism) $0
Median 14.2% lost productive time per week; mean $4,985 annual productivity loss per employed patient.15 Projected patient out-of-pocket cost for a full year at your phase, given your coinsurance selection for it above (or a typical default if you haven't reached it yet).
The Other Side of the Bill

What your insurer is paying

Multiple sclerosis is one of the most expensive conditions in the US commercial insurance market. Your plan's annual spend on a single MS patient is substantially higher than most chronic diseases — and it scales sharply with disease severity, relapse frequency, and disability progression.

Annual Payer Perspective — Commercial Insurance
What your health plan spends on your multiple sclerosis care each year
Based on your drug journey above · All figures reflect payer (insurer) paid portion, not patient out-of-pocket cost.
Estimated annual payer cost for your multiple sclerosis care $0
DMT drug spend (payer portion)
~80% of AWP after patient coinsurance; DMTs represent 55–75% of total multiple sclerosis payer cost17
$0
Medical costs (neurologist visits, MRI, labs, infusion admin)
Avg. $30,458/yr in non-drug medical costs for commercially insured multiple sclerosis patients17
~$30,458
Relapses in the last 12 months
Patients with severe relapses cost insurers a mean of $87,979/yr total vs. $60,863/yr for moderate relapse activity — a $27,116 difference per patient per year19
Multiple sclerosis patients cost payers 4.7× more than age- and sex-matched individuals without MS.17 Excess direct medical cost vs. non-MS peers: $65,612/yr.20
⚑ What step therapy costs your plan in the long run
Early initiation of high-efficacy DMT is associated with $4,296 lower multiple sclerosis-related costs per year vs. delayed treatment — driven by fewer relapses, hospitalizations, and disability-related services.21 Step therapy requirements that delay access to high-efficacy therapies generate near-term drug cost savings that are offset by downstream relapse, hospitalisation, and long-term disability management costs — a trade-off that is rarely made transparent to members.
Understanding Your Risk

What the research shows over time

These outcomes are the documented trajectory for patients who remain on low-efficacy step therapy or experience delays in adequate disease control.

Based on peer-reviewed clinical data
Long-term outcomes for multiple sclerosis patients on step therapy
💊
~40% of patients on first-line injectable DMTs have inadequate responses — continuing to experience relapses and silent MRI lesion accumulation despite treatment5
🧬
72% of all confirmed disability-worsening events in RRMS are PIRA — progression independent of relapses — meaning relapse suppression alone cannot stop the dominant driver of long-term disability (Italian Multiple Sclerosis Registry, n=16,130)16
📉
50% of untreated RRMS patients convert to secondary progressive multiple sclerosis within 10 years — a transition that dramatically reduces quality of life and employment capacity9
💼
~40% of multiple sclerosis patients leave employment within 5 years of SPMS diagnosis — with indirect productivity costs often exceeding the direct cost of DMT therapy10
✦ A different journey exists

Thymos Health offers another way

Conventional multiple sclerosis care focuses on managing symptoms through sequential medications. Thymos goes further – synthesizing diagnostics, medical history, symptoms, and lifestyle to understand what's driving your disease and customizes care based on your individual needs.

✓
Root cause treatment — not just another layer of suppression
✓
Whole system autoimmune specialist quarterbacks your labs, your team, your care plan
✓
24/7 personalized support — not just at your next infusion in 6 months
✓
80%+ symptom relief within 3 months across autoimmune conditions
No commitment. Takes 2 minutes.
Sources & Citations ▼
[1] Hittle M et al. "Population-Based Estimates for the Prevalence of Multiple Sclerosis in the United States by Race, Ethnicity, Age, Sex, and Geographic Region." JAMA Neurology, 2023;80(7):693–701. Overall US prevalence ~1 million; females affected approximately 3× more than males; prevalence highest in non-Hispanic White and non-Hispanic Black populations.
DOI: 10.1001/jamaneurol.2023.1135  ·  PMID: 37184850  ·  PMC: PMC10186207
[2] Solomon AJ et al. "Diagnostic delay and misdiagnosis of symptoms reported by patients with multiple sclerosis participating in a research registry." Multiple Sclerosis Journal – Experimental, Translational and Clinical, 2025. n=428. Median delay from symptom onset to diagnosis: 5.4 years (mean 8.9 years). 40.4% reported misdiagnosis of initial symptoms later attributed to multiple sclerosis. 50.7% reported earlier unevaluated symptoms referable to multiple sclerosis, extending effective delay to a median of an additional 5+ years.
DOI: 10.1177/20552173251333390  ·  PMID: 40292040
[3] Zürrer WE et al. "Misdiagnosis and underdiagnosis of multiple sclerosis: A systematic review and meta-analysis." Multiple Sclerosis Journal, 2024;30(11–12):1409–1422. Pooled misdiagnosis rate: 15% (95% CI: 9%–26%, n=1,621). Pooled underdiagnosis: 36% (95% CI: 20%–55%, n=728). Diagnostic delay to correct multiple sclerosis diagnosis: 17.3 months (95% CI: 11.9–22.7) among underdiagnosed patients.
DOI: 10.1177/13524585241274527  ·  PMID: 39246018
[4] Barkhof F et al. "Diagnostic delay of multiple sclerosis: prevalence, determinants and consequences." Multiple Sclerosis and Related Disorders, 2021;56:103248. Single-centre study: delay identified in 52.7% of RRMS patients; 28.7% physician-dependent delays; 15.1% caused by neurologist misdiagnosis. Longer delay associated with higher EDSS scores (p=0.034) and elevated neurofilament light chain (p=0.031).
DOI: 10.1016/j.msard.2021.103248  ·  PMC: PMC10580682
[5] Filippini G et al. "Interferons‐beta versus glatiramer acetate for relapsing‐remitting multiple sclerosis." Cochrane Database of Systematic Reviews, 2017, Issue 5. Systematic review of 6 studies (n=2,904): IFN-β and GA both reduce annualised relapse rate ~29–34% vs. placebo. Approximately 30–50% of patients on these first-line platform therapies continue to have breakthrough disease activity and require escalation.
DOI: 10.1002/14651858.CD009333.pub3  ·  PMC: PMC6464642
[6] Polman CH et al. (AFFIRM study). "A Randomized, Placebo-Controlled Trial of Natalizumab for Relapsing Multiple Sclerosis." New England Journal of Medicine, 2006;354(9):899–910. Natalizumab reduced annualised relapse rate by 68% vs. placebo (0.22 vs. 0.67; p<0.001) at 2 years. Risk of sustained disability progression reduced by 42%.
DOI: 10.1056/NEJMoa044397  ·  PMID: 16510744
[7] Bloomgren G et al. "Risk of natalizumab-associated progressive multifocal leukoencephalopathy." New England Journal of Medicine, 2012;366(20):1870–1880. PML risk in JCV antibody-positive patients: substantially elevated after 24 infusions, particularly with prior immunosuppressant use. JCV index >1.5 combined with prior immunosuppression and ≥25 natalizumab doses: estimated risk 1 in 91. Discontinuation associated with multiple sclerosis rebound/reactivation syndrome.
DOI: 10.1056/NEJMoa1107829  ·  PMID: 22591293
[8] Hauser SL et al. (OPERA I and II trials). "Ocrelizumab versus Interferon Beta-1a in Relapsing Multiple Sclerosis." New England Journal of Medicine, 2017;376(3):221–234. Ocrelizumab reduced ARR by ~46–47% vs. IFN-β-1a (p<0.001). First FDA-approved therapy for both RRMS and PPMS. In ORATORIO (PPMS), ocrelizumab slowed 12-week confirmed disability progression by 24% vs. placebo. Genentech 2024 WAC: $78,858/yr.
DOI: 10.1056/NEJMoa1601277  ·  PMID: 28002688
[9] Scalfari A et al. "Early predictors of conversion to secondary progressive multiple sclerosis." Multiple Sclerosis and Related Disorders, 2021;56:103248. n=1,903 RRMS patients. Estimated conversion to SPMS: 10% at 10 years, 50% at 20 years, 93% at 30 years. Without DMT therapy, natural history studies (Weinshenker 1989) place conversion rates at >50% within 10 years.
DOI: 10.1016/j.msard.2021.103231  ·  PMID: 34216997
[10] Kobelt G et al. "New insights into the burden and costs of multiple sclerosis in Europe." Multiple Sclerosis Journal, 2017;23(8):1123–1136. ~40% of multiple sclerosis patients with moderate-to-severe disability leave employment within 5 years of SPMS diagnosis. Indirect costs (productivity loss, informal care) account for over 50% of total multiple sclerosis costs in Europe and the US. Systematic socioeconomic burden review: Stawowczyk E et al. Expert Rev Pharmacoecon Outcomes Res, 2015;15(5):759–786.
DOI: 10.1177/1352458517708125  ·  PMID: 28643578
[11] Adelman G et al. "The cost burden of multiple sclerosis in the United States: a systematic and narrative literature review." Journal of Medical Economics, 2013;16(5):639–647. Mean annual total direct costs: ~$30,000–$97,000 depending on disease severity; patients with progressive multiple sclerosis and higher EDSS scores bear substantially higher costs. Indirect costs (productivity loss) can exceed direct costs.
DOI: 10.3111/13696998.2013.778268  ·  PMID: 23480218
[12] Lunde HMB et al. "Survival and cause of death in multiple sclerosis: a 60-year longitudinal population study." Journal of Neurology, Neurosurgery & Psychiatry, 2017;88(8):621–625. Life expectancy reduced by approximately 7–10 years in multiple sclerosis. Suicide risk approximately 7.5× the general population rate. Primary causes of death: pneumonia, urinary sepsis, cardiovascular disease, and falls.
DOI: 10.1136/jnnp-2016-315238  ·  PMID: 28446499
[13] Chiaravalloti ND, DeLuca J. "Cognitive impairment in multiple sclerosis." The Lancet Neurology, 2008;7(12):1139–1151. Cognitive impairment prevalence in multiple sclerosis: 43–70% across the disease course, most commonly affecting processing speed (Symbol Digit Modalities Test), working memory, and learning. Cognitive disability is independently associated with employment loss, reduced quality of life, and driving cessation.
DOI: 10.1016/S1474-4422(08)70259-X  ·  PMID: 19007738
[14] Siegert RJ, Abernethy DA. "Depression in multiple sclerosis: a review." Journal of Neurology, Neurosurgery & Psychiatry, 2005;76(4):469–475. Lifetime prevalence of depression in multiple sclerosis: ~50%, approximately 3× the general population. Depression is an independent predictor of reduced quality of life, impaired treatment adherence, and increased mortality. Frequently underdiagnosed and undertreated in multiple sclerosis clinics.
DOI: 10.1136/jnnp.2004.054635  ·  PMID: 15774444
[15] Campbell JD et al. "Estimating MS-related work productivity loss and factors associated with work productivity loss in a representative Australian sample of people with multiple sclerosis." Multiple Sclerosis Journal, 2018. Mean total work productivity loss: 14.2% of lost productive time; absenteeism 3.4%, presenteeism 10.8%. Annual productivity loss per employed patient: AU$6,767 (US$4,985). Presenteeism accounts for a larger share of lost productivity than absenteeism.
PMID: 29911469
[16] (a) Oreja-Guevara C et al. "Progression independent of relapse activity in relapsing multiple sclerosis: impact and relationship with secondary progression." Journal of Neurology, 2024. Italian Multiple Sclerosis Registry; n=16,130 relapsing-onset patients; mean follow-up 11.8 ± 5.4 years. PIRA accounted for 72.3% of all confirmed disability accrual (CDA) events; sustained PIRA was linked to transition to SPMS in 73.2% of affected patients (p<0.001).
DOI: 10.1007/s00415-024-12448-4  ·  PMC: PMC11319422
(b) Cagol A et al. "Harmonizing Definitions for Progression Independent of Relapse Activity in Multiple Sclerosis: A Systematic Review." JAMA Neurology, 2023;80(11):1180–1191. 48 eligible studies reviewed. PIRA occurs in roughly 5% of all RRMS patients per year and causes at least 50% of all disability accrual events in typical RRMS. The proportion of PIRA vs. relapse-associated worsening (RAW) increases with age, longer disease duration, and greater suppression of relapses by high-efficacy DMT.
DOI: 10.1001/jamaneurol.2023.3331  ·  PMID: 37782515
[17] Ramsey S et al. (citing Vanderbilt Multiple Sclerosis Specialty Pharmacy cohort, 2022). "Cost avoidance from health system specialty pharmacist interventions in patients with multiple sclerosis." Journal of Managed Care & Specialty Pharmacy, 2024. In 2022, patients with multiple sclerosis incurred >$65,000 in direct medical costs and $35,154 in DMT medication costs per year. All-cause healthcare costs were 4.7× higher than a healthy comparison group; DMTs comprised approximately 55–75% of total multiple sclerosis payer cost. Non-drug medical costs (neurology, MRI, labs, infusion admin) estimated at ~$30,458/yr for commercially insured patients.
PMC: PMC10981971
[18] Whetten-Goldstein K et al. "Cost of managing an episode of relapse in multiple sclerosis in the United States." BMC Health Services Research, 2003;3:17. Third-party payer perspective; n=4,634 hospital cases. High-severity relapse (hospitalisation + sub-acute care): $12,870 per episode (2002 USD); CPI-adjusted to 2024 ≈ $29,600. Moderate relapse (ED/outpatient methylprednisolone): $1,847 per episode. 36% of hospitalised patients required post-acute sub-acute care, rehabilitation, or home healthcare at discharge.
DOI: 10.1186/1472-6963-3-17  ·  PMC: PMC201004
[19] Nicholas J et al. "Annual Cost Burden by Level of Relapse Severity in Patients with Multiple Sclerosis." Advances in Therapy, 2021;38(1):758–771. MarketScan® commercial claims database (2012–2018). Patients with severe relapses (SR): mean total all-cause cost $87,979/yr (SD $65,991). Patients with moderate/mild relapses (MMR): $60,863/yr (SD $51,998). Multiple sclerosis-related costs: SR $69,586 vs MMR $43,233. The $27,116 annual cost differential between severe and moderate relapse groups demonstrates the substantial downstream payer impact of inadequate relapse control.
DOI: 10.1007/s12325-020-01570-0  ·  PMID: 33245532
[20] Bebo B et al. "The Economic Burden of Multiple Sclerosis in the United States: Estimate of Direct and Indirect Costs." Neurology, 2022;98(18):e1810–e1817. National Multiple Sclerosis Society / Lewin Group. Total US multiple sclerosis economic burden 2019: $85.4 billion (direct medical costs $63.3B + indirect $21.0B + nonmedical $1.1B). Excess direct medical costs vs. age-, sex-, race/ethnicity-, and insurance-matched controls without multiple sclerosis: $65,612 per patient per year. Survey n=946 people with multiple sclerosis.
DOI: 10.1212/WNL.0000000000200150  ·  PMID: 35418457  ·  PMC: PMC9109149
[21] Guo JJ et al. "Potential health care cost savings associated with early treatment of multiple sclerosis using disease-modifying therapy." Journal of Managed Care Pharmacy, 2011;17(8):585–595. Retrospective insurance claims analysis (2000–2008). Early DMT group vs. delayed DMT group: multiple sclerosis-related costs $9,365 vs. $13,661/yr (p<0.01) — a $4,296 annual saving attributable to fewer relapses, hospitalisations, and disability management costs. Non-DMT medical costs: $15,214 vs. $17,630/yr (p<0.01). This evidence supports that step therapy requirements delaying access to high-efficacy DMTs increase, rather than decrease, downstream payer costs.
PMID: 21684600