Making MS treatment more affordable in Nepal

The addition of MS treatments to the WHO’s Essential Medicines List (EML) in 2023 is making a difference in countries like Nepal. Access to MS treatments in Nepal has previously been limited but things are changing thanks to the efforts of the MS Society of Nepal. Rituximab, a high-efficacy MS treatment, is now subsidised under the national insurance scheme, supported in part by its inclusion on the WHO Essential Medicines List. This achievement highlights how global advocacy efforts can empower local communities to secure better MS treatment options. Discover how advocacy in Nepal is changing lives and how you can advocate for better access to MS treatments.

Nepal is a lower-middle income country in Asia, with an average monthly household income of approximately $250 USD. At present, there is no accurate data on the number of people living with MS in the country.

Dr Avinash Chandra

The MS Society of Nepal (MSSN) was founded and led by its President, Dr Avinash Chandra, a neurologist from the Bir Hospital and Annapurna Neurological Institute in Kathmandu. The Society brings together healthcare professionals and people affected by MS from across the country and aims to support MS research and improve the well-being of those living with MS.

In Nepal, there is no entire population-wide health coverage. People use private provision or if that is unaffordable then they rely on a means-tested state safety net, which caps the cost of their healthcare. In some districts, the poorest section of the population has access to $1000 USD per person per year to cover all their health needs; everyone else must pay health costs out of pocket.

The only on-label disease-modifying therapy (DMT) for MS available in Nepal is interferon. Rituximab, mycophenolate mofetil and azathioprine are available off-label. Previously, interferon had to be imported, costing $600 USD for one injection. Dr Chandra noted that fewer than 10 people with MS in the whole country could afford this. Even when an Indian-manufactured version of interferon became available for $100 USD per injection, this was still too expensive for most people with MS in Nepal, as the injections must be taken 2 to 3 times a week.

Dr Chandra realised that rituximab could be a cost-efficient alternative, because whilst each infusion cost $600-800 USD, people only needed infusions twice a year. About six years ago, when he began treating people with MS with rituximab, he noticed they also experienced improved health outcomes from using this high efficacy DMT.

The Government Hospital (Bir Hospital) in Kathmandu, where Dr Chandra works, is located alongside the Ministry of Health and is directly under its command. Starting in 2022, Dr Chandra met regularly with government health officials to raise awareness of MS – an unfamiliar disease for many people. By explaining the chronic nature of MS and the importance of using DMTs to reduce progression and disability, Dr Chandra could make the case for why the government should invest in treating this condition.

In 2023, rituximab, cladribine and glatiramer acetate were added to the World Health Organization’s (WHO) Essential Medicine’s List, thanks to the efforts of MSIF and many collaborators around the world. You can read more about this important milestone here: https://www.msif.org/essential-medicines/

Thanks to this stamp of approval from the WHO, Dr Chandra had the extra evidence needed to demonstrate the importance of making treatments accessible for people with MS, in particular rituximab. In late 2024, the Ministry of Health agreed that rituximab would be eligible for government subsidy, for people treated through the state insurance scheme, reducing its price from $600-800 USD to $250 USD per infusion.

At MSIF, we are pleased to see that the listing of rituximab on the WHO Essential Medicines List was able to support the advocacy efforts of MSSN, and we congratulate them on their success in widening access to treatment for people with MS in Nepal.If you are interested in advocacy to improve access to MS treatments, explore our website with tips and case studies here: https://www.msif.org/access-to-ms-healthcare/