A Personalized Approach to Specialty Drug Management

The healthcare landscape has shifted dramatically in the last 20 years. Along with increasing costs and complexity, we’ve also seen a rise in the prevalence of chronic conditions and a specialty pipeline that has grown exponentially to treat ultra-rare conditions and orphan diseases. Additionally, we are now able to harness the power of big data, pharmacogenomics, and gene databases for more targeted interventions. With the rise of the personal cellphone, the internet of things, and an “always on” culture, consumers crave convenience. As a result, we have innovations like home delivery and telemedicine and that’s just the beginning.

How has this rapid evolution reshaped the patient care journey?

Before this evolution, the US healthcare system was built to be reactive. Patients didn’t have access to advanced tools and technology; they were required to go to their doctor or local pharmacy to get care. Patients would:

  • Experience symptoms and make an appointment with a doctor (within the next week or so, depending on the doctor’s schedule)
  • Undergo general tests before the doctor would provide a generalized, disease-directed treatment plan (which was likely based on limited guidelines and practice and/or provider experiences)
  • Pick up medications at a traditional pharmacy (which requires travel and more time)
  • Schedule another appointment in a few weeks or months for a follow-up or more testing (with possible changes to the current treatment plan)

Now more than ever, patients want more control over their healthcare experience and outcomes. There’s a mindset shift from “patient” to “consumer” and a “population of 1” view versus traditional population health. We are at the cusp of a revolution that redefines how healthcare is delivered, where personalized care solutions are filling gaps in the old model.

Personalization in the new care delivery model

 In the new care delivery model, each individual can have a tailored treatment approach based on their condition and preferences. At Magellan Rx, we work cross-functionally across our industry, partnering to discover better and more efficient ways to drive down costs and improve the quality of care for our members. The more we can refine each individual’s treatment program with our total specialty solutions to better meet their physical, emotional, and lifestyle needs, the greater chance we have of reaching better outcomes at a lower overall cost.

Precision medicine and pharmacogenomics (see page 36 for more), gene therapies, and CAR-T can help with early diagnoses and more robust treatment and regimen planning.

  • At Magellan Rx, we also leverage the experience and expertise of more than 150 key opinion leaders across multiple disease states within our Expert Clinical Network (see page 16 for more) to help guide clinical recommendations for members with complex and hard-to-treat conditions.

Personalized care with patient-specific monitoring and follow-up using services like telemedicine, convenient access to clinics, concierge services, and one-on-one coaching can help improve adherence and lead to better outcomes.

  • With Magellan Rx Specialty Pharmacy, patients with certain complex conditions have access to the Magellan Rx Cares Led by specially-trained nurses and pharmacists, members are supported through their care journey with one-on-one coaching, educational materials, motivational interviewing, and more.

Technology now supports patients throughout the care journey: numerous apps and wrap-around support services for sleep, weight loss, and mental health; texting follow-ups; online support communities, and more!

  • At Magellan Rx, we are committed to providing our members with the latest tools and technology to improve their health, like on-demand medication videos and personalized adherence programs that leverage artificial intelligence to improve outcomes.

 Benefits from a personalized approach

Ultimately, it is our mission as a pharmacy benefit manager (PBM) to ensure our members, customers, and the providers within their networks have the tools necessary for personalized care to optimize these benefits across the care continuum.

  • Patients will experience increased engagement and satisfaction with quicker access to clinical care and real-time targeted treatments, leading to a better quality of life.
  • Payers will be able to provide value-based care with better patient adherence and outcomes and increased transparency.
  • Providers will have more resources and tools available for more robust clinical decision-making, leading to better care coordination and monitoring and, ultimately, more engaged patients.

What’s next?

Growth in this space right now is greater than ever before, meaning we should already be planning for what’s next. These are the future trends we can deploy in the now to give our customers next-generation, patient-focused PBM services:

For more on what Magellan Rx is doing to provide our customers and members with the tools they need to achieve better outcomes, watch our 2-minute video!

 

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