For many patients, receiving an organ transplant may feel like the end of a painful, stressful journey. In fact, the transplant serves as the starting point of a new chapter of life which will require lifelong management. There are many factors that can impact an individual’s health after an organ transplant. Leading a healthy, vibrant life requires commitment from patients, caregivers, and providers.

The main goal of any post-transplant treatment is to prevent organ rejection by the body. To help reduce the risk, there are a variety of treatments available. These drugs, often called immunosuppressants or anti-rejection medications, help the body to shield the newly-transplanted organ from the body’s immune system. In doing so, these drugs help to minimize the risk of transplant rejection.

It is very important that these medications are taken consistently every day as prescribed. It is also crucial to not skip or miss doses. Coordination with the transplant team is a must before making any changes to these medications or how they are taken. Even though some of these medications may be associated with side effects, they can be managed. It is crucial to tell a healthcare provider about any side effects experienced.

Possible side effects from transplant medications include:

• High blood pressure
• Weight gain
• New-onset diabetes
• High cholesterol
• Increased risk of bone disease
• Kidney disease
• Increased risk of infection

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

Care is core to every service we deliver and everything we do at Magellan Health. Through our work, we are listening, learning and using our collective insight to make a difference in the lives of those we serve.

Wyoming’s High Fidelity Wraparound program is just one of many examples where Magellan team members, who have lived through similar experiences, are returning the favor and providing the care and concern they consider themselves fortunate to have also personally received.

High Fidelity Wraparound is a voluntary planning and care coordination process for children and young adults (ages 4-20) with complex behavioral health conditions. High Fidelity Wraparound’s community-based solutions and planning process bring people together from different areas of a family’s life to form a team. The team, led by a Family Care Coordinator, creates steps to help youth stay in their homes, schools and communities.

Through collaboration with the Wyoming Department of Health, Division of Healthcare Financing (Medicaid), Magellan serves as the Care Management Entity for the High Fidelity Wraparound program, setting the rules and providing training for everyone involved in the process.

One of Magellan’s certified Family Care Coordinators, a person responsible for managing a High Fidelity Wraparound team, recalls the story of a recent family she worked with. “In December, the family’s generator went out and without power they had to leave their home. As a result, the family had to move which was highly disruptive and caused a lot of tension within the family as their culture is centered on independence. In addition, it was upsetting to a young member of the family as the unfamiliar environment became very troubling.”

Living away from home negatively impacted progress the youth was making before having to move. Relationships were being affected and everything for this youth became more difficult. The family requested help to get back to their property through Magellan of Wyoming. Their Family Care Coordinator said, “When we found out our flex funds were approved to help get them home, [mom] cried and I did as well. This family finally felt hope, and there could now be a clear plan to help them move back home.”

Tammy Cooley, senior operations director at Magellan Healthcare of Wyoming, said, “We are honored to provide a means for a family to get back to their home, and keep their youth with them. Sometimes, we see families in situations where youth cannot remain at home. When we can fill a need and keep a youth safely at home because it’s the right thing to do, we will do that. The work we do, at the very core, is about the success of youth and families being able to meet their needs in positive ways.”

What are social connections?

Social connections are the relationships you have with the people around you. They may be close, like family, friends, and coworkers, or more distant, like people you know casually. They can be as close as next door or so far away that you only connect with them by telephone or through the Internet.

Your network of relationships may be big or small. One or two close family members or friends may be all you need to feel supported and valued. Whether your circle is big or small, the important thing is that you are there for each other.

Why are social connections important?

Resilience, the ability to bounce back after stressful situations, is strengthened when you give and receive support. Building positive relationships with people can make a difference in how resilient you are. Try to connect with people who have a positive outlook and can make you laugh and help you. The more positive your relationships are, the better you’ll be able to face life’s challenges.

The support you get from your social connections can add to your feelings of meaning and purpose in life. These, in turn, add to your resilience. Happy, resilient people tend to be more connected to the people around them. Resilient people know that they can depend on the strength of their family and friends when the going gets tough.

Remember that giving support is just as important as getting support. You count on your social connections for support, but they also count on you. Ask others about their families, jobs, and interests, and help them when you can. Don’t always focus on your challenges or talk about yourself. Know when it’s time to listen or just enjoy your friends’ company. Giving support to others builds the social bonds that help make you resilient.

 How can you make more social connections?

There are many ways you can start building positive relationships:

• Invite a friend who makes you laugh, and go to a funny movie.
• Send an encouraging email or text message to someone who’s going through a hard time.
• Look for a faith community that shares your views. It may also have its own organized social groups.
• Call a food bank or hospital and ask about their volunteer programs.You can also connect with people through social media on the Internet. Many people interact more freely with people they can’t see face-to-face. Online forums about specific interests can be a good choice for people who cannot leave their homes or are shy or self-conscious.

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When the whole family is involved in physical activities together, children learn that being active is fun and makes you feel good. And busy parents can combine family time with exercise time.

Try these tips for getting everyone in the family up and moving together:

Getting started

• As a family, make a list of activities you’d like to do together.
• Make sure the activities are things everyone can do and enjoy.
• Keep a family physical activity log, or hang a calendar on the wall.
• Try to plan one or two family activities a week. For ideas, see the suggestions below.
• Once a month, plan something special that involves being active, like a trip to the zoo, a day hike, or camping.
• Use a safe backpack, stroller, or bike trailer so that smaller children can be included in family activities.

Walking

When family schedules get really busy, going for a walk may be the easiest thing you can do together.

• Start with short walks that everyone in the family can do. Add more distance gradually. Younger children can ride a bike or a tricycle. You can pull a wagon in case little ones get tired.
• Scavenger hunts can keep children from being bored on a walk. Keep in mind a list of “treasures” they can find, such as a red leaf, a blue house, a black dog, or an out-of-state license plate.
• Use a phone app or get pedometers, and work on increasing the number of steps you take on your family walks. Start with a goal of 10,000 steps a day.
• Register the whole family in a family fun run/walk in your community. If the event is for charity, have your family walk through your neighborhood to collect pledges.

Outdoor activities

• Go for a bike ride.
• Join your children in old-fashioned games like hopscotch, tag, jump rope, and hide-and-seek.
• Get involved in family-friendly sports like skiing, skating, swimming, and tennis.
• Play a daily family basketball game in the driveway or at a playground.
• Take up miniature golf or flying-disc golf.
• Fly a kite.
• Pick up trash at a local park.

Indoor and rainy-day activities

• Have a family dance night. Share dances from each generation, and teach each other to do them. Or learn folk dances.
• Create a new dance or exercise routine to a favorite song. Have a different child choose the song each week.
• Go to the mall, and count how many laps you can walk as a family.
• Have a hula hoop contest.
• Set up a fun obstacle course in the basement, garage, or spare room.

General rules

• Limit TV, video games, and computer time.
• Don’t use food as a reward for meeting activity goals.
• Make physical activity a priority. Don’t let things get in the way of family activity time.

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Note: The excerpt is from “How Work-Life Flow Is Shaping Success at Magellan”, first published here.

“People work best when they are happy and have the space to think and consider, to rest and recharge. Working shouldn’t mean missing out on some of those key family moments or having to struggle with responsibilities due to stress and exhaustion.

Working remotely means that there’s fewer interruptions, leading to greater productivity, happy customers and a happy team. That helps our customer satisfaction, our recruitment, our retention, and our bottom line. Our work-life flow is truly shaping our success. […]

[…]we’re proud to be at the forefront of offering flexible work options that allow work and life to flow for our professionals. So, naturally, we are honored to be named on the 2019 list of 100 Top Companies with Remote Jobs in 2019 by FlexJobs!“

Read more here…

One of the greatest challenges in managed care is staying up-to-date on the constantly evolving healthcare landscape. This can be especially overwhelming for high cost, complex specialty disease states. Payers are often faced with making difficult coverage decisions for hundreds of disease states as they also juggle prioritizing daily job tasks, such as managing drug spend, developing clinical programs and policies, and implementing member engagement strategies. In face of this challenge, payers have reported difficulties handling drug requests for complex treatments, particularly for off-label use for specialty drugs in high cost, rare disease categories, which are poorly understood and have limited clinical guidelines.

To address this unmet need, some payers seek the assistance of key opinion leaders (KOLs), also known as thought leaders. KOLs are considered experts in their respective fields, are regularly sought out by their colleagues for opinions or advice, are early adopters of new treatments or procedures, establish best practice protocols for patient care, and many managed care organizations depend on them to better understand specific disease states and new therapies.

As part of its value-based approach to medical and pharmacy benefit management, Magellan Rx Management has developed an Expert Clinical Network (ECN) of local, national, and world-renowned experts and has access to more than 120 key thought leaders in several disease categories, including rare disease such as hereditary angioedema, hemophilia, oncology, and more. These experts assist clients with challenging prior authorization case reviews, peer-to-peer discussions, drug policy development, and formulary guidance. Ultimately, the ECN offers health plans and providers the opportunity to make a more informed decision that leads to positive patient outcomes.

One case study from the ECN program was for a request from a client to review a complex prior authorization case. The request was for prophylaxis therapy in a patient who was currently using Firazyr for angioedema. The KOL provided an evidence-based recommendation based on patient’s medical history and current burden of disease. The KOL did not believe the patient was an appropriate candidate for prophylaxis therapy which resulted in the patient being referred to a center of excellence for additional evaluation and a potential cost avoidance of $44,000 per month.

As payers are faced with making difficult clinical coverage decisions for hundreds of disease states, assistance from a KOL can help in the reduction of inappropriate medication use, while offering the highest value and quality of care in disease management. To learn more download a copy of our MRx Report.

Specialty drug spend made up 41% of all drug spend ($318 billion) for the United States and European countries in 2017(1). New projections show specialty drugs will contribute to ALL of 2018 total drug spend growth due to a combination of explosive pharmacy trend in the specialty drug arena as well as declines in traditional medications(1). With thousands of specialty products in the pipeline expected to drive a significant portion of future medication costs and inflationary trends,(2) specialty growth has exceeded that of traditional drugs for the tenth consecutive year(1). Not only does specialty pharmacy trend continue to soar, these medications are now being created with remarkable biotechnology and gene-altering techniques to treat the most complex, high-cost healthcare conditions such as cancer, rheumatoid arthritis, and unique rare diseases.

Many of these specialty medications are billed under the medical benefit, which makes management even more challenging when considering complex medical benefit structures, numerous places of service, varied payment models, bundled claims, and complicated data.  Payers also cite several management concerns: determining the value of specialty drugs, ensuring clinically appropriate use, and responding to the specialty pipeline(3).

Spend trend and growing payer concerns emphasize the importance of developing strategies to stay ahead of the trend and pipeline. 

The Magellan Rx Management Medical Pharmacy Trend Report , in its ninth edition, includes a comprehensive view of medical pharmacy trends in claims data, including all major lines of business (commercial, Medicare, and Medicaid). According to the report, the 5-year pharmacy trend for specialty drugs on the medical benefit is 68%, 22%, and 17% (4) for Commercial, Medicare, and Medicaid lines of business, respectively. Driven by inflation, utilization, drug mix, and shifts in site of service, medical benefit drug spend has been identified as allowed amounts of $29.97 per-member-per-month (PMPM) for Commercial members, with Medicare PMPM allowed amounts of $52.19 (an increase of 18 and 12 percent, respectively, over the last year)(4). Yet visibility into this spend has been generally limited, given the management challenges addressed above.

It is critical for payers to stay current with evolving management strategies and marketplace conditions impacting medical pharmacy utilization and spend, especially as these specialty drug costs continue to be a leading driver of overall pharmacy trends. At Magellan Rx, we understand medical benefit drug spend, pharmacy trend, pipeline, and impact—all of which is imperative to formulating innovative, effective solutions for managing specialty drug costs. Get a more detailed analysis on the latest in pharmacy trends by signing up for our free webinar on March 14 at 1:00 pm Eastern.

1. IQVIA Institute 2018 and Beyond: Outlook and Turning Points. March 2018. Available at: https://www.iqvia.com/-/media/iqvia/pdfs/institute-reports/2018-and-beyond-outlook-and-turning-points.pdf
2. Commercial Specialty Medication Research: 2016 Benchmark Projections, Milliman Research Report. December 2015. Available at: http://us.milliman.com/uploadedFiles/insight/2016/commercial-specialty-medication-research.pdf
3. EMD Serono. Specialty Drug Digest 14th Edition. 2018
4. Magellan Rx Management. Medical Pharmacy Trend Report. 9th Edition. 2019. Available at: https://www1.magellanrx.com/magellan-rx/publications/medical-pharmacy-trend-report.aspx

By Sam Srivastava and Mostafa Kamal

This week, the federal government took a significant step forward in helping address the opioid epidemic with the signing of the nation’s first comprehensive opioid legislation.

The Substance Use Disorder Prevention that Promotes Opioid Recovery and Treatment (SUPPORT) for Patients and Communities Act addresses a broad range of Medicare, Medicaid, public health and law -enforcement issues and aims to advance the recovery landscape for individuals living with opioid use disorder (OUD) and other substance use disorders (SUDs).

As longstanding advocates for access to mental health and substance use disorder treatment and services, we’re deeply appreciative of the bicameral, bipartisan work of the Congress to successfully drive this critical effort forward. The legislation contains a number of impactful policies we at Magellan Health, and many others, have pushed for, including those recommended in our testimony to Congress this past spring. These critical policies promote clinically appropriate opioid prescribing, support opioid misuse prevention, and enhance access to evidence-based treatment and recovery services.

The signing of this law marks a significant milestone and step in the right direction, and we believe there are several ways it has the potential to address some of the day-to-day challenges of the nation’s opioid epidemic. Three key areas stand out.

Safer prescribing patterns. The SUPPORT for Patients and Communities Act encourages the use of safe and effective alternatives to opioids for pain management, which – in addition to clinically appropriate prescribing practices – are key in breaking the cycle of prescription opioid misuse. These include the establishment of grant programs incentivizing the use of non-pharmacological opioid alternatives, the required implementation of safety limits for opioid prescriptions, new electronic prescribing requirements in Medicare, and beneficiary screening requirements in initial Medicare prevention exams, to name a few.

Our experience demonstrates the power of these and other safe-prescribing interventions—such as the Centers for Disease Control and Prevention’s prescribing guidelines, which Magellan has already implemented—to reduce opioid misuse rates.

Americans consume 80 percent of all opioid painkillers produced worldwide—and the risk of addiction after just four or five days of treatment is high. Opioid prescribing rates have decreased in recent years thanks to nationwide efforts to ramp up provider education. Yet the supply of prescription opioids remains high – approximately 66.5 opioid prescriptions for every 100 Americans in 2016 – reflecting the work still needing to be done.

By exploring alternative therapies to pain management, including non-pharmacological digital therapies, we can eliminate the risk of opioid misuse and addiction, and also equip individuals living with chronic pain with the tools and resources needed to live healthier, more vibrant lives.

Boosted access to evidence-based treatment. One of the most effective, evidence-based treatments for OUD is medication-assisted treatment (MAT)—considered the gold standard for reducing the risk of overdose and death. When combined with psychosocial interventions, like cognitive behavioral therapy and contingency management, and recovery supports, including peer and family, MAT empowers the recovery journey while building resiliency.

Increasing access to MAT is critical to promoting recovery and preventing relapse. Today, while 900,000 U.S. physicians prescribe opioids, fewer than 35,000 physicians are certified to prescribe buprenorphine, one of three medications approved to treat opioid addiction.  Even fewer of these actually participate in prescribing MAT and, as a result, access to care is often limited or stigmatized. The SUPPORT for Patients and Communities Act expands providers’ ability to prescribe MAT, including by expanding eligibility for certification to new provider types. With stigma also playing a role in the lack of widespread adoption of MAT, this provision is a solid and necessary step toward expanding access to treatment.

Reaching underserved communities. The SUPPORT for Patients and Communities Act facilitates telehealth options for OUD treatment. In communities with limited resources for one-on-one OUD recovery support, telehealth services or a combination of virtual and in-office services provide the basis for the most evidence-based, person-centered and well-rounded approach to treatment. The package also authorizes pilot programs to provide temporary housing services for individuals recovering from OUD. We believe this is crucial to supporting those living with OUD and other SUDs, especially in rural and underserved communities, return to healthy and vibrant lives.

 The SUPPORT for Patients and Communities Act provides practical policy solutions necessary for addressing this national crisis. From expanded treatment options, to more effective care coordination, to improved prescription drug monitoring programs used to enhance detection and prevention of opioid misuse in real time, this legislation is an important step in the right direction.

We applaud Congress and the Administration on this bipartisan effort and important law, which will have a deep and lasting impact on health for generations to come.

 About the authors:

Sam Srivastava is Chief Executive Officer of Magellan Healthcare, and Mostafa Kamal is Chief Executive Officer of Magellan Rx Management.