It’s hard to comprehend how much the world has changed since the beginning of the COVID-19 pandemic. It has turned our lives upside down in many ways, from school and business closures to quarantines and social isolation. With no clear end in sight, it is not surprising that many people are having difficulty getting used to the “new normal” that is far from what normal life once was.

Families face the challenges of online and home schooling, and the coming school year brings more uncertainty.  In addition, many people are experiencing financial strain from reduced working hours or job losses. Workers may have to work from home and adapt to an entirely new way of working, with little social interaction.  For some workers, juggling parental and domestic duties with the demands of work has been very stressful. Over time, chronic stress can lead to burnout.

Symptoms of burnout include feeling physically depleted, emotionally exhausted and negative about work.[1]

The signs of burnout are similar to those of depression. If left untreated, burnout can lead to physical illness and mental health problems, such as depression and anxiety. Here are some practical tips to manage burnout:

• Set boundaries between work and private life. If you work from home, set clearly defined working hours and a specific work area.
• Take breaks during the day and build transitions in your life between the start of work and the end of the working day. For example, making a transition to work can be as easy as getting a cup of coffee each day and logging into your computer at the same time. To end the day, practice a daily routine such as checking your emails, reviewing priority tasks for the next day and logging off your computer.
• Take your well-earned time off. Even if the pandemic kept you from going somewhere for vacation, a planned “staycation” will allow you to enjoy the well-deserved rest and relaxation. It is important to recharge; you will feel refreshed when you return to work.
• Don’t forget to socialize. When your colleagues start working from home, you may miss the casual social interactions had throughout the day. Like any skill, use it or lose it. Socialization in a time of pandemic takes effort to maintain.
• Make self-care a part of your daily routine. A healthy diet, getting enough sleep and maintaining an exercise schedule can help you cope with and reduce stress.
• Maintain consistent family routines. A regular routine can help all family members feel more focused and productive. If your child is at home learning online either full or part-time or you’re home-schooling, set consistent times for meals, schoolwork, other activities and bedtime.

Help is available. Your program is completely confidential and here to help you and your household members 24/7/365. No situation is too big or too small. Give us a call or visit your program website to get started.

[1] https://www.who.int/mental_health/evidence/burn-out/en/

Technological and scientific advancements have dramatically altered the treatment landscape in several disease states. These include orphan diseases and conditions that previously had no disease-modifying treatment options. These innovative therapies have also come with unprecedented costs, with some agents introduced at a price exceeding one million dollars for a single patient. Value-based purchasing arrangements (VBPs) have attempted to manage the initial cost of these agents. In a VBP, which is sometimes referred to as an outcome-based arrangement, the ultimate price that is paid for the drug is dependent on the clinical outcome. In addition to a plan’s traditional utilization management initiatives to maintain sustainability, this strategy aims to hold pharmaceutical manufacturers responsible for the result of their product. This is similar to other healthcare environments, such as when readmissions impact hospital reimbursement. Under VBPs, a pharmaceutical manufacturer would issue a reimbursement if their product failed to produce the desired clinical outcome. In addition, this strategy incentivizes the development of unique therapies that are more likely to have a clinically significant impact. Novel medications that improve outcomes would provide a greater healthcare value and could be priced higher in the market. Currently, volume is a large driver of cost, with discounts from pharmaceutical manufacturers often tied to the number of units dispensed. This is less helpful for niche-area pharmaceuticals and genuinely innovative treatments used for uncommon conditions.

Practical considerations of VBPs, such as a higher administrative burden (e.g., paperwork, electronic database access, automated retrieval of data), limit their application to all products. Since it can be expensive to measure outcomes in order to assess the worth of a product to an individual patient or plan, VBP concepts are most commonly applied only to the costliest medications. For instance, VBPs can have a significant impact on the pricing of agents like gene therapy or select oncology agents. Some of these agents can have a large clinical impact on disease progression, survival, or quality of life, but a drug may not have the same results in all patients. However, value-based or outcome-based pricing may provide an increased incentive to payers by decreasing their initial risk and providing more sustainable treatment coverage.

While there has been an increase in the use of VBPs by states, manufacturers, and other payers in order to control drug spending and tie patient outcomes to cost, uncertainty remains in developing novel VBPs. The Medicaid Drug Rebate Program (MDRP) created by Congress under the Omnibus Budget Reconciliation Act of 1990 ensures that Medicaid receives the lowest net price for a single source drug or innovator multiple source drug during the rebate period charged to any payer. Simply put, pricing net of all discounts, must be reported to Medicaid, and the best price would have to be offered to Medicaid as well. It is critical that Medicaid programs continue to receive the lowest price available for a single source drug or innovator multiple source drug.

On June 19, 2020, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule that is aimed at promoting VBP flexibility for a variety of payers, including Medicaid, with a goal of maintaining a best price for Medicaid. CMS notes that best price creates challenges related to the availability of VBP arrangements. For example, under existing best price rules, if an individual fails to achieve the specified clinical outcome under the VBP arrangement, the drug manufacturer may be required to provide a discount or otherwise may not be entitled to payment for that patient. Thus, the best price of that drug for purposes of the MDRP could become zero. This possibility has stunted the development and proliferation of VBPs. This new proposal from CMS, which includes other regulatory revisions as well (e.g., minimum standards for Drug Utilization Review [DUR] programs), could ultimately lower healthcare costs and potentially limit spending on treatments with limited value over time.

The ultimate goal of a VBP is for all parties to have a vested interest in the outcomes of drug therapy and to share the risk related to healthcare costs. Specifically, it calls on manufacturers to have more “skin in the game.” Moreover, the change to the Medicaid market could have potential savings applicable to a variety of market segments, impacting all Americans. Regardless of the final outcome or any changes made to the current draft prior to its possible rollout, the proposal demonstrates readiness from CMS to pivot prior strategies to mitigate rising drug prices.

As our country continues to navigate the coronavirus pandemic and social distancing, a new concern has emerged – avoiding and delaying medical help when necessary, also known as medical distancing. Maintaining physical and mental health during the current pandemic is essential. If you are feeling ill, need a routine medical check-up, or have severe feelings of anxiety or depression, please seek medical attention.

Stop Medical Distancing 

It’s important that you feel safe and get the care that you need, when you need it. Here are some helpful tips to safely receive medical attention while social distancing:

1.  Mask Up– The Centers for Disease Control and Prevention have asked all Americans to wear a cloth face covering to help prevent the spread of the coronavirus. Medical facilities require patients, staff, and providers to wear a mask to protect you and your community. Take part in the fight against the coronavirus by complying and wearing a mask, too.

2.  Distance Yourself– When you are waiting to be seen by your physician, ask if you can wait outside or in your car. If you have to stay inside, do your best to distance yourself from other patients, visitors, and staff. When returning home, avoid being in the presence of those most vulnerable to coronavirus.

3.  Sanitize– Medical facilities are regularly cleaning waiting areas and exam rooms between each patient. Hand washing and sanitizing your hands before and after your visit is a must to protect yourself and your family from getting sick. Keep hand sanitizer in easy-to-reach places so you don’t forget, such as your bag, purse, pocket, or in your car.

4.  Limit Visitors– To create a safe environment, many medical facilities have implemented restrictions and limitations on visitors. This helps protect you and other patients who are vulnerable to the coronavirus. Going to the doctor alone can be scary and intimidating – but it’s essential to limit friends of family members from going with you when it can be avoided.

5.  Go Digital– If you’re still not comfortable with face-to-face visits or don’t need to be physically seen by a doctor, you should optimize telemedicine or telehealth services. These are appropriate and efficient means of connecting with your provider in the comfort of your own home.

6.   Trust– Finally, trust your doctor and know that your safety is their number one priority. As the pandemic continues, medical facilities are adjusting the way they deliver health and enhancing their procedures and protocols.

Protecting yourself from the coronavirus does not need to get in the way of your overall health and well being. #Stopmedicaldistancing

By Varun Choudhary and Greg Dicharry

The impacts of suicide on population subsets

Suicide is a leading cause of death in the US.[1] It has become the hidden epidemic in our society that is spreading with the COVID-19 pandemic. Statistics show certain populations are more vulnerable than others. While a recent study shows that 11% of adults seriously contemplated suicide in June 2020, the same was disproportionately reported by young people aged 18 to 24 (26%), Hispanic people (19%), Black people (15%), unpaid caregivers for adults (31%) and essential workers (22%).[2]

Medical professionals have historically been at higher risk for suicide than those in most other professions.[3] Over 400 physicians a year commit suicide, yet the cause for such tragedy is not addressed.[4] A recent example was the suicide of Dr. Lorna Breen, the 49-year-old medical director of an emergency department in New York, who felt like she was drowning amid trying to save lives during the COVID pandemic. She had no history of mental illness and was considered an exemplary physician before succumbing to trauma of witnessing so much death.

Suicide has also been a silent killer within our military for several years, as troops dealing with trauma are unable to get the care they need. This was the case with the recent suicide of 34-year-old Master Sergeant Andrew Christian Marckesano, who had served six full tours in Afghanistan and was nicknamed the real “Captain America.” We must take a proactive approach to suicide prevention so we can help these heroes before they become tragic statistics.

Magellan’s approach to suicide prevention

Magellan is a national leader in suicide prevention and is addressing this health crisis that is devastating so many individuals, families and communities. We believe the first and foremost action that must be taken is to destigmatize the need to ask for help. There is still an ingrained culture in medicine and the military, as examples, that it is a weakness to address mental health needs. We need to build a culture of acceptance and promote the concept that reaching out is a strength, not a weakness. Changing this paradigm will take the effort of many mental health agencies and organizations.

Magellan is here to lead the initiative and use our expertise to bring awareness and training through a preventive model that pushes a zero-suicide approach. We were very successful in launching this campaign in Maricopa County, Arizona, and received international recognition for its effectiveness in reducing suicide. We are working with other organizations to promote this approach, so communities are aware of the signs and warnings of potential suicide, know how to engage suicidal individuals and are able to address the acute mental health needs of these individuals before they escalate.

In recent years, we have had the privilege of hosting a series of suicide prevention summits in Pennsylvania, Florida and Idaho. These events have brought together over 1,000 local and national leaders to exchange ideas, share successes and discuss solutions around the challenges we face together in addressing this crisis in our communities. In addition to this work, Magellan regularly supports local suicide prevention efforts in communities we serve, including sponsoring and participating in annual American Foundation for Suicide Prevention (AFSP) Out of the Darkness Walks around the country.

The Hope Rising for Suicide Prevention virtual summit, September 26, 2020

Most recently, we have established an internal suicide prevention innovations team to develop and implement a plan to enhance our suicide prevention efforts to create more awareness, training opportunities and support for our employees, members, providers, customers and the communities we serve.

Magellan is officially launching the initiative this month for National Suicide Prevention Awareness Month with the Hope Rising for Suicide Prevention virtual summit. This event is being planned and hosted in partnership with the nation’s leading suicide prevention organizations, including the National Suicide Prevention Lifeline, LivingWorks, American Association of Suicidology, Zero Suicide Institute, and numerous other national and international suicide prevention and mental wellness experts, lived experience advocates and people new to suicide prevention to share inspiration, information, wellness techniques and best practices.

This uplifting virtual event will empower attendees with the motivation, skills and resources needed to positively impact suicide prevention efforts in their communities.

Hope Rising for Suicide Prevention is just the beginning, as Magellan continues to create and support impactful suicide prevention initiatives that will help people find the hope and help they need to stay alive and thrive.

For more information about this and other Magellan events during Suicide Prevention Awareness Month, suicide prevention downloadable materials and more free resources, visit our suicide prevention website.

[1] https://www.cdc.gov/vitalsigns/suicide/

[2] https://www.cdc.gov/mmwr/volumes/69/wr/mm6932a1.htm.

[3] https://www.healthline.com/health/mental-health/healthcare-workers-suicide-covid-19#3

[4] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6526882/

There are an estimated 1.2 million people in the US living with HIV, and roughly 1 in 8 people are undiagnosed. The virus attacks your body’s immune system and weakens its ability to fight infections. When HIV is untreated, it can lead to acquired immunodeficiency syndrome (AIDS), and the body becomes even more at risk for opportunistic infections.

While antiretroviral therapy has been available to treat HIV-positive patients for some time now, certain antiretroviral medications are also FDA-approved to be taken daily to prevent the risk of becoming infected with HIV. This treatment, known as pre-exposure prophylaxis (PrEP), is intended for people who do not currently have HIV but are at risk for contracting HIV. Overall, PrEP has shown to reduce the risk of contracting HIV through sexual contact and injecting drugs by 99% and 74%.

The main goal of any PrEP treatment is to prevent the transmission of HIV to an uninfected person. There are multiple treatments available to help reduce the risk. Regardless of which medication a patient takes, these medications must be taken consistently every day as prescribed. It is also crucial to not skip or miss doses. Possible side effects from PrEP medications primarily include nausea, but in general, these medications are well-tolerated. Despite this, it is still important to tell a healthcare provider about any side effects experienced.

Advances in antiretroviral treatments have made it possible for patients to live healthy, vibrant lives. That said, patient management programs are very valuable to patients whose ability to take their medications as prescribed has direct impact on the long-term success of their treatment.

Telehealth services have been available for years to help remove geographical and other boundaries for people in rural and medically under-served areas; however, use has been limited. Driven by the COVID-19 pandemic, including shelter-in-place orders, social distancing, and federal agencies mandating use for certain programs, telehealth has grown exponentially since March.

While companies like Teladoc and MD Live have been operating telehealth platforms for nearly two decades, many platforms are dedicated only to physical health. Magellan Healthcare has maintained a telehealth network for behavioral health since 2014 and helps:

• Health plans offer a cost-effective alternative to traditional doctor visits, urgent care and the emergency room; provide access to valuable care that is convenient and available anytime and anywhere; expand existing programs and services focused on health and wellness; and attract new members by offering the modern convenience of an on-demand service.
• Employers improve employee access to healthcare; reduce tardiness and absenteeism; increase employee productivity; offer a competitive benefits package; improve employee satisfaction; and retain and attract the best employees.
• Members have more privacy; access a deep and specialized network; receive treatment before work, after work or on weekends; have more frequent touch points to improve compliance with treatment and avoid unnecessary hospitalizations; and avoid travel, lost time from work and weeks of waiting for an appointment.
• Providers reach out to members in remote areas or where specialties are needed; provide care to homebound members; provide behavioral health services from home, office or while traveling; reduce no-shows and cancellations; offer additional and/or non-standard appointment times; and expand the patient base and improve relationships with existing patients.

Although the benefits of telehealth are many, people may feel uncomfortable using services. That’s why Magellan Healthcare created a video called Telehealth: Get Care and Treatment Wherever You Are. This video can help people understand:

• How to schedule a telehealth visit
• What to do once a telehealth visit is scheduled
• How to get the most from telehealth

The more comfortable people are using telehealth for their behavioral healthcare, the more options they have available to them. This can lead to improved compliance and better health outcomes.

Watch the video here.

Prescription drug prices can be expensive. How can the average person save money on prescriptions in a quick, easy way? Pharmacy discount cards are available widely, but what are they and why should people use them? Here are five important things to know about pharmacy discount cards.

1. They can save you money!
   Pharmacy discount cards can be used to lower your costs on medications you need to fill that may not be covered by your employer’s health insurance plan. Using a discount card can save up to 80% off the cash price when you need to fill a non-covered drug. Comparing prices between your insurance and discount card is important to make sure you are not overpaying for your prescription. You should also check other pharmacies as prices do vary from chain to chain as well as independent pharmacy locations.

2. Using them won’t count toward insurance plan deductibles.
   Prescriptions filled using a discount card do not count toward your deductible or out-of-pocket maximum amounts. Discount card transactions fall outside of your health plan policy and should be used when a drug is not covered or if you are uninsured. Discount cards cannot be used in combination with insurance.

3. They are free to use.
   Most pharmacy discount cards do not require membership fees to use their cards, but some programs do require you to provide personal information. Make sure you review their privacy policy to ensure you are comfortable sharing information before using their services. The privacy policy is typically posted on their website.
4. No paperwork necessary.
   With pharmacy discount cards, there are no forms to fill out and no paperwork. When you present your discount card at the pharmacy, you are given the discounted prescription price at the counter and you pay the balance. There is no further obligation on your part to the discount card. You can use the card for future transactions, but typically there is no requirement to do so.

5. They work for pets, too!
   If you have pets, many discount cards extend their benefits to them as well. Many people fill their prescriptions at their veterinary office without realizing they may be overpaying. There are some prescriptions for your dog or cat that can only be filled by a vet, but many can be filled by your local pharmacy and usually at a much lower cost. You can ask your vet to write a prescription for your pet and have it filled at your neighborhood pharmacy. Make sure the vet includes their DEA number as most discount cards require this information to process the prescription.

There are many companies offering to save you money on your prescription drugs, which can sound too good to be true. Pharmacy discount card providers are only compensated when you fill a prescription using their card and the pharmacy benefits from your business. You get to save money on your prescription and improve or maintain your health of you or your loved ones.

The coronavirus disease 2019 (COVID-19) pandemic has taken a substantial toll on human life, not to mention our way of life. With over 14 million confirmed global cases and the death toll approaching 612,000, it is one of the most significant crises in recent history. In the United States (US), the country with the most cases and deaths, confirmed cases exceed 3.8 million and over 141,000 deaths have been reported as a result of this outbreak. As cases surge in certain parts of the country and the world, safe and effective vaccines and therapies are crucial to combatting this virus.  

Currently, there are no US Food and Drug Administration (FDA)-approved treatments or vaccines for SARS-CoV-2, the virus that causes COVID-19. Over 200 agents are being evaluated to treat the virus. These include new emerging molecular entities as well as approved drugs that are already available to treat other conditions and now being repurposed for COVID-19. According to the World Health Organization (WHO), 24 vaccine candidates have entered human trials and over 140 vaccine hopefuls are in preclinical evaluation.

Scientists around the world are working tirelessly to discover a vaccine for COVID-19. Vaccines candidates go through many stages of study. The average time to develop a vaccine ranges from 10 to 15 years. The Ebola vaccine, newly-minted in December 2019, only took about 6 years to be approved, whereas an HIV/AIDS vaccine has still not come to market after about 40 years. Given this pandemic’s magnitude, extraordinary measures from public and private stakeholders have been introduced to accelerate vaccine development.

COVID-19 has presented us with many challenges. Mitigation measures and safe and effective vaccines and treatments are key to restoring a new normalcy.