Magellan Rx Management hosted the 15^th annual Specialty Summit on August 21-23 in New York City with a day-and-a-half of sessions on the industry’s most complex pharmacy challenges and a focus on breakthrough treatments like CAR-T and gene therapy.

A highlight for the audience of 500 was a session on CAR-T, an immunotherapy that is pushing the boundaries of cancer treatment in both children and adults. Dr. Bruce Levine, Professor in Cancer Gene Therapy at the University of Pennsylvania, is a pioneer in this field and presented successful results from the first pediatric patient treated with engineered T-cell therapy—including a surprise appearance from that patient.  Now 13-years-old, she walked across the stage with her parents and shared her dream of being a movie director when she grows up!

Dr. Andrew Scharenberg of Casebia Therapeutics talked through the complexity of gene therapies, including the incredible CRISPR/Cas9 molecular surgery technique that modifies the patient’s own genome to restore ‘normal’ function and, essentially, cure the disease. Colleagues Dr. Jeffrey Trent of TGen and Dr. Joseph Mikhael of TGen and the International Myeloma Foundation shared the stage to discuss mind-blowing advances in personalized medicine that are transforming the lives of children with rare, previously undiagnosed diseases.

Diving deeper into specific categories, Dr. Saira Jan of Horizon BCBS of New Jersey highlighted opportunities to improve quality of care, lower the total cost of care, and enhance member experience through an integrated model of managing autoimmune therapies. Michelle Rice from the Hemophilia Foundation discussed similar strategies for hemophilia treatment, including how advocacy groups, providers, and payers can work together to deliver more effective care.

Several lively panel discussions with industry experts from Amgen, SelectHealth, Mercer, IQVIA, AmerisourceBergen, Pfizer, Barclays, BCBS of Tennessee, Medica, Health New England and Security Health unpacked industry challenges and the continuing evolution of care delivery. Sessions focused on value-based partnerships, overcoming specialty barriers in Medicaid and managing medical pharmacy trend, as well as the impacts and lessons learned from the introduction of biosimilars; through expert insights and real-word examples, attendees walked away with action-oriented solutions for better management strategies and patient care.

Two standout speakers were Mark Johnston of Amazon Web Services (AWS) who reviewed the culture, philosophy, and vision that is driving Amazon’s incredible pace of innovation and how AWS is helping to reshape the foundation of the healthcare industry. An inspiring keynote by Dr. Victor Strecher gave the audience a crash-course on honing your individual life purpose to motivate you through your work, personal ambitions, and family/community goals.

At Magellan Rx, we are passionate about connecting our clients and industry partners to the people, tools, and information needed to make the best decisions for the populations they serve. Our purpose is to help people live more healthy, vibrant lives and take better control of their health. As pioneers in specialty pharmacy management, we are proud of this heritage and develop the Specialty Summit agenda each year with those values in mind. Mark your calendars and join us next year in NYC on August 26-28, 2019 as we host another exciting event packed with timely insights and emerging trends in the evolving specialty market.

In honor of World Hemophilia Day, Magellan Rx Management has released results from the first six months of its hemophilia management program launched in collaboration with Health New England, a non-profit health plan serving the commercial, Medicaid and Medicare markets.

Hemophilia is a rare genetic bleeding disorder, for which treatment is expensive and difficult to manage. The average annual cost per member with severe hemophilia can exceed $250,000, and may be upward of $1 million for members who have developed inhibitors. Personalized care programs for patients with hemophilia aim to reduce unnecessary costs while improving the overall quality of care.

“As April 17 is World Hemophilia Day, we’re excited to bring hemophilia care into the spotlight and highlight the early results achieved with Health New England through our hemophilia management program,” said Haita Makanji, vice president, clinical specialty solutions at Magellan Rx Management. “Through personalized interventions, we’re able to better determine the individual member needs and coordinate across key stakeholders to deliver a truly personalized care program that ensures members with hemophilia receive best-in-class care and achieve optimal outcomes.”

Since launching the hemophilia management program in August 2017, Magellan Rx Management and Health New England have standardized care across various stakeholders without compromising patient outcomes, resulting in:

• Optimized doses through assay management or pharmacokinetic (PK) testing in 50 percent of members
• Reduced average assay dispensed in prophylaxis patients from 5 percent to 1 percent, reducing the potential for waste
• No breakthrough bleeding reported from members who had a dose reduction

“In the past eight months of collaboration with Magellan, we’ve achieved our goals of ensuring high quality of care for members with hemophilia while minimizing potential waste created through excess dispensing and inappropriate dosing,” said Andrew J. Colby, R.Ph, MBA, Health New England’s pharmacy director. “By announcing our hemophilia management program results on World Hemophilia Day, we hope to raise the profile of this condition and look to continue to make strides in standardizing best treatment practices to benefit members across the country.”

The hemophilia management program aims to enhance overall quality and personalization of hemophilia care by coordinating with prescribers, members and pharmacies while reducing unnecessary costs. Key elements include:

• Helping payers analyze information related to member bleed history and hemophilia treatment patterns.
• Standardizing dispensing and optimal dose protocols to promote best practices and improve transparency in hemophilia care.
• Updating policies to encourage individualized treatment regimens based on member-specific metabolic factors.

As we look back on 2017, it was a year of many milestones on the United States (U.S.) drug approvals front. With 46 novel drugs receiving Food and Drug Administration (FDA) approval, it reached a 21-year high and more than doubled novel drug approvals in 2016. This count does not even include a number of biologics, vaccines, cell-based therapies, and the first ever, direct gene therapy for a hereditary disease.

Among the historic clinical highlights of 2017 was the landmark approval of two CAR-T therapies, tisagenlecleucel (Kymriah™) and axicabtagene ciloleucel (Yescarta™), for select types of leukemia and lymphomas, respectively. CAR-T or chimeric antigen receptor-T (CAR-T cell), is a multiplex process where a patient’s T cells are harvested, genetically modified, and infused back into the same patient to fight cancer cells. 

The role of specialty pharmacies in the invoicing construct for these costly CAR-T therapies is a fascinating component of these new treatment modalities. As illustrated in the CAR-T Invoicing Flowchart, the product is shipped directly from the manufacturing facilities to the certified hospital or treatment facilities. Once the certified hospitals take ownership of the product, they bill the payers who, in turn, pay the certified hospitals. The specialty pharmacies serve as the billing wholesaler between the manufacturers and the certified hospitals to invoice the hospitals and, ultimately, deliver payment to manufacturers. In this unique model, the specialty pharmacy does not handle the drug; rather, it serves as the invoicing clearinghouse between manufacturers and certified hospitals. Hence, there is no interaction between the specialty pharmacy and payers.

Specialty pharmacies are at the epicenter of care for patients with complex conditions. As a high-touch resource, they operate in a clinical environment that leverages specialty pharmacies’ services to dispense, distribute, provide monitoring, case management, adherence programs, reimbursement, and a number of other services particularly for patients with complex and rare diseases. In the CAR-T invoicing construct, the specialty pharmacy takes on the exclusive role of shepherding the invoice.

As we look ahead, future complex therapies will present a new paradigm for all stakeholders including prescribers, pharmacies, payers, patients, hospitals, and regulators. Specialty pharmacies, as an invoicing liaison, may be yet another facet in the evolution towards the next frontier – Specialty Pharmacy 2.0.

Every day in the news we hear about the devastating impact of the opioid crisis across the country. While we need to confront this complicated crisis, we also need to examine the larger issue of substance use disorders (SUD) that impact millions of Americans.

This past September, I had the honor to represent Magellan Health at the first meeting of the Substance Use Disorder Treatment Task Force, founded by Shatterproof. The mission of the task force is, “To fundamentally improve substance use disorder treatment in the United States, in terms of both quality and patient outcomes.” It also addresses the underlying cause of our country’s current substance use crisis, and lack of access to quality and evidence-based treatment. The task force has been created to expand access to quality treatment for the estimated 21 million Americans with SUD.

This task force is unique in that it convenes public and private healthcare companies, advocates and former government officials to take the lead in developing a tactical plan with measurable goals for payers to follow and implement. I am proud to be joined by so many colleagues and experts across the industry.

Our first focus is to implement the recommendations outlined in the November 2016 Surgeon General’s Report on Alcohol, Drugs, and Health. Secondly, we will utilize methods outlined in a 2006 report from the Institute of Medicine which recommends the need for a group of government regulators, accrediting organizations, consumer representatives, providers and purchasers to come together to develop a common, continually improving set of quality measures, specifically for mental health and substance use disorders.

The work of this task force aligns nicely with our efforts at Magellan, helping lead individuals to healthy, vibrant lives. Working with individuals with SUD, from both the behavioral health and the pharmacy benefits management perspective, we are in a unique position to help address these issues. I believe we can make significant contributions on this task force and for the benefit of our customers, members and providers with whom we work.

“We are often asked in interviews what our most memorable experience has been as a pharmacist,” said Marc. “I used to have a go-to story I thought was amazing, but now that story has been replaced.”
Marc Ream
Clinical Pharmacist, Magellan Rx

This month, we’re celebrating our amazing pharmacists and the work they do to impact members at virtually every point along the patient-care continuum. Today we’re sharing a story from clinical pharmacist Marc Ream, who partnered with the commercial pharmacy team to go above and beyond the call of duty for a family in need.

Although he did not know it then, when Marc Ream took a call late on a Friday afternoon, he was about to experience what would become the most rewarding moment in his career as a pharmacist.

The call came from a mother with an urgent request for an oncology drug approval for her 10-year-old daughter, Jane.* Jane, who lives with Leukemia, needed a specific medication that is relatively rare and not easily accessible. The family was leaving on their long-awaited vacation the next day, so they needed the medication that same day. Marc quickly realized that  getting this medication to the member quickly would require collaboration with the prescribing oncologist, as well as with multiple parties including the health plan, account managers, technicians, pharmacists, physicians and the dispensing pharmacy.

Marc quickly went to work, placing a call to the prescribing oncologist to gather a comprehensive history on the young girl, as well as the necessary clinical rationale to make the approval. Typically, once a medication is clinically approved, the pharmacist’s job is complete and the prescription can be filled by a local pharmacy. However, this particular oncology drug was classified as a limited-distribution medication, typically dispensed only through mail-order facilities. Realizing that the family would not have time to wait, Marc contacted a specialty pharmacy in the area to try to come up with a quicker solution.

He reached out to the pharmacy’s lead oncology pharmacist and confirmed that the medication was in stock, and they conferenced in Jane’s physician to place the order.  Marc worked with the oncology pharmacist to schedule delivery of the medication to the family. When they called the mother to tell her the good news, they could hear the emotion and gratitude in her voice. Thanks to the swift and diligent work of many, Jane and her family were off on their dream vacation with this important medication in hand.

Thank you to Marc Ream and the commercial pharmacy team for this empowering story that shows just how passionate and committed we are to leading humanity to healthy, more vibrant lives.

*Details around the specific circumstances of this story have been changed to protect the identities of both Jane (not her real name) and her family.

Privacy is a funny thing, and peoples’ choices about privacy when technology is involved is often hard to explain. We don’t think twice about letting companies track what we like and don’t; what we search for and when we search; the photos we like and the ones we don’t; our shopping patterns and our wish lists; where we go and when; and now, we welcome full-time listening devices into our homes. I often wonder if these listening devices would find their way into our kitchens if they looked more like a reel-to-reel recording device versus a cute little modern orb with fancy LEDs.

Despite how comfortable we are with technology in some parts of our lives, there seems to be a line that many won’t cross. For some reason, discussing our finances while the orb is listening is okay, but using technology to help us manage our healthcare strikes some people as going too far.

This line is moving, albeit slowly.

There are real challenges in advancing technology in healthcare. But most importantly, we need to allow consumers to choose how they want to see their health information.

Texting is common in healthcare today, but it is inefficient, and often, confusing. Most healthcare-related texts contain either redacted information, such as, “You have not filled AtorXXXXXXXX prescription,” or contain links on which you have to click to take you to another message. Amazon doesn’t make a customer guess at the contents of their message or follow a clunky process to share information, so why do we do it in healthcare?

There are a number of regulations that govern Protected Health Information (PHI), and it’s critical that we take them seriously. After all, we’re talking about very sensitive and private material about diagnoses, medication, diagnostics and other information.

But, with careful planning and execution we can balance what is required of us by law while providing consumers with information that will help make their healthcare journey more efficient and tech-enabled. For example, we were able to craft, on behalf of our clients, end-user agreements that allow us to send texts that look like this:

“Your health is important to [Insert Client Name], please take your cholesterol medication as prescribed.”

The results from this texting pilot were nothing short of amazing. 26 percent of the people who received this message, none of whom were previously following their doctor’s orders, promptly filled the prescription. Interestingly, we saw similar results in every category we piloted. Why? It’s simple: nothing had to be decoded, no incremental steps needed to be taken, no password had to reset, etc. The best part of the pilot? 87 percent of the people who started, stayed in the program.

With pilots like this, we moved the line a smidge.

Texting was one of our first pilots and it was critical to challenging our thinking and finding new ways to solve old problems. The line needs to keep moving forward and we welcome the challenge.

Magellan Rx Management will soon be hosting the 14^th Annual Specialty Summit.  We had the opportunity to sit down with Phillip Vecchiolli, senior vice president and general manager of our specialty division at Magellan Rx Management to share his thoughts on this exciting event.

Magellan Health Insights: What can attendees expect at this year’s Specialty Summit?

Phillip Vecchiolli: The Magellan Rx Management Specialty Summit has become the source for staying ahead in today’s specialty drug management industry.  We host nationally recognized payers, physicians and industry insiders for a program packed with timely insights, thoughtful debate, and actionable dialogue on emerging trends in the evolving specialty market and effective solutions for managing specialty drug trend.

MHI: When and where is it going to be held this year?

PV: We are excited to be back in the heart of New York City. The event takes place on August 28-30, 2017 at the Sheraton New York Times Square Hotel.  And when attendees aren’t engaging in Summit activities, we encourage them to take in the sights, as we’ll be within walking distance of a number of famous attractions including Central Park, The Plaza Hotel, Radio City Music Hall, MOMA and more.

MHI: Why do you think this event is especially important?

PV: This is an exciting and disruptive time in specialty pharmacy. Specialty drug costs are skyrocketing and without an understanding of the unique dynamics around specialty drug management, payers run the risk of overlooking or misunderstanding this critical area of pharmacy spend.

At Magellan Rx Management, we specialize in connecting people with the tools, and information they need to make the best decisions for the populations they serve.  This event serves as a forum for nationally recognized payers, oncologists, and industry thought leaders to explore and discuss the key issues and challenges we face in an evolving specialty market.  Along with general topic presentations we also have a few interviews and panels for even more information-sharing discussions designed to provide an environment of teamwork and strategic information sharing.

MHI: Who typically attends the specialty summit?

PV: The Specialty Summit is designed especially for health plans, employer groups, states, third-party administrators, oncologists, practice managers, brokers, consultants and pharmaceutical manufacturers.

MHI: What are you most excited about this year?

PV: This year’s program is packed with timely insights from thought leaders across the specialty landscape and is designed to shine a light on the emerging trends and effective solutions in this evolving specialty market.

From its beginnings 14 years ago, this conference has exploded in terms of attendance and the caliber of our programming. This year, we’re expecting over 600 attendees, with numerous opportunities to network and meet with our peers, as well as compelling programming and dialogue around the most pressing topics in our industry. I’m particularly looking forward to the presentations and discussions about the oncology landscape, the Affordable Care Act, biosimilars, and medical pharmacy.  Our keynote Dr. Matt Iseman is going to be pretty spectacular too!

MHI: Any closing words?

PV: We are thrilled to again be hosting the 14^th Annual Specialty Summit.  At Magellan Rx, we are proud to be pioneers in specialty pharmacy management. By leveraging our industry-leading expertise and value-driven solutions, we help our clients solve their specialty pharmacy challenges. Our passion is to help people live more vibrant lives and to motivate them to take better control of their health.

Learn more about the Specialty Summit

Did you know that Parkinson’s disease psychosis (PDP) is diagnosed in about half of all Parkinson’s diseases patients and presents practitioners with significant disease management challenges?

The Journal of Managed Care & Specialty Pharmacy recently published a manuscript written by a panel of experts from neurology, psychiatry, geriatrics, and geropsychiatry as well as thought leaders from several health plans and Magellan Rx Management to discuss management of PDP.

Dr. Maria Lopes, chief medical officer of Magellan Rx Management, noted the importance of this work: “I think that this research is vital to a better understanding of complex diseases, identify opportunities to develop best practices and key insights that can improve patient care and outcomes.”

The panel discussed the challenging nature of Parkinson’s disease and PDP, the role emerging therapies may play in optimizing effective management and the need for essential education for providers and patients regarding PDP and available therapies.

Take a look at the latest issue of The Journal of Managed Care & Specialty Pharmacy to read more.