OBJECTIVES: To evaluate the management of Spanish patients with multiple sclerosis (MS), to assess the unmet needs at the hospital pharmacy and the treatment adherence fulfilled by MS patients treated with disease-modifying therapies (DMT). METHODS: Non-interventional and multicenter study that recruited 237 patients with relapsing-remitting MS (RRMS) or secondary progressive MS (SPMS) treated with DMT. Pharmacists completed a questionnaire on management actions and unmet needs. Adherence was assessed using an adaptation of the Morisky-Green test. RESULTS: Mean age of patients was 40.1±9.4 years (65.8% women). Average time from diagnosis was 7.5±5.6 years, 95.4% RRMS, 61.2% with no relapses during last year. Most patients presented EDSS grade 0-2.5 (62.4%). Overall patient adherence was 77.1%. Treatment adherence was significantly higher among patients with no relapses (82.9% vs 67.4%, p<0.05) and among those ≥40 years (85.1% vs 68.3%, p<0.05). 21.1% of pharmacists do not have adequate educational materials and in 16% of cases there was no adequate space to assure confidentiality. Specific protocol to monitor adverse events exists only in 21% of pharmacies and to monitor adherence in 32%. Pharmacists emphasized as major unmet needs: educational material, adherence training, staff and workload. According to main needs, there was a trend towards lower adherence at hospitals with higher workload (68.6% vs 80.2%; p=0.167) and with lack of educational materials (75.2% vs 84.6%; p=0.435). There were no adherence differences depending on the existence of available space for training (76.9% vs 78.6%; p=0.890) or between gender (84.1% men vs. 73.6% women; p=0.195). In 2 out of 10 cases (19.8%), a discrepancy exists between pharmacist perception on adherence and Morisky-Green evaluation. CONCLUSIONS: An improvement of educational materials and operational protocols regarding workload is a requirement at hospital pharmacies to provide adequate follow-up and to ensure adherence by MS patients in Spain.