OBJECTIVES: During 2007-2011 Multiple Sclerosis (MS) was the only category that experienced triple digit growth in sales, leading to doubling of their sales from $3.4 billion in 2007 to $7 billion in 2011. This has led to change in payer coverage and utilization of branded MS products. This study was undertaken to understand current trends in sales, access and utilization management for MS products in the United States. METHODS: Sales data for MS branded products was analyzed using IMS Health 2007-2011 data. Access and utilization management trends were analyzed using preferred drug list and coverage policies of top US health plans. Primary discussions were conducted with pharmacy and medical directors to understand new trends in coverage of MS products RESULTS: More than half (approximately 59%) of the branded MS products are covered by health plans as non-preferred products or at Tier 3/4 . Significant majority (84%) of these products were covered with prior authorization or pre-certification criteria. Quantity limits were used by 34% of the plans. Use of step therapy or progression prescription is not currently common and was found in only 5% of the plans. In this sample (n=37), only one plan (<5%) had formulary exclusion for an MS product. Payer designated specialty pharmacies are increasingly being used by various health plans. Compared to 2007, payer coverage of MS products shows significant increase in use of PA (40% in 2007 versus 84% in 2012). Payers express high concern for rapidly growing MS category and report use of more utilization management approaches to control spending.  CONCLUSIONS: MS products are facing more aggressive utilization management. Patient access for new MS therapies could be limited due to non-preferred status, high co-pay or strict PA criteria.