OBJECTIVES: There are currently several pharmaceutical options for multiple sclerosis (MS), some introduced  recently and some more coming in the future. They are characterized by different modes of action, schemes of administration and, ultimately, costs. MS resources management is thus complex and rely on proper interaction between stakeholders – hospital pharmacists, MS department heads, hospital top management, local health representatives, heads of regional pharmaceutical policy. This is particularly true in Italy, a federal and delocalised setting comprising local, provincial, regional, and national decision makers. The aim of this work was to design a tool to explore the financial implications and ultimately align decision makers. Informed choices might save resources and support the adoption of innovative treatments, thus contributing to overall sustainability and equity in patient access. METHODS: We developed a dynamic user-friendly tool in Microsoft Excel® with VBA® macros. The flow of the analysis is stepwise and comprises, on top of adherence, variables usually excluded from standard budget impact such as intra- and inter-class switches, potential wash out period, as well as drop-out rates. All variables can be modified or excluded by users since default values can be restored at any time. The tool is open and can accommodate future treatments. RESULTS:  The tool assesses the financial impact of alternative choices  in a comprehensive manner since results can be displayed with the desired level of detail – cumulative or annual, overall or by treatment line and/or cost item. CONCLUSIONS: This is an example of how to match the required level of information to specific end-users, encouraging both discussion and decision making in the best interest of patients. This  is a prerequisite in multifaceted realities like Italy but it could assist in many other settings where stakeholders need to align to each other in order to  forecasts accurately budget allocation.