1. Those who abuse prescription opioids are 40% more likely to use heroin than those who don’t.
2. The United States consumes 80% of the world’s prescription painkiller supply, despite not even making up 5% of the world’s population.
3. It’s possible to die the first time you use cocaine, consumption quadruples the risk of sudden death.
4. An estimated 88,000 people die per year due to alcohol.
5. Only about 11% of those addicted to drugs or alcohol actually receive treatment for their substance abuse disorder.

Source: Drugabuse.com

October marks National Breast Cancer Awareness Month, which focuses on increasing awareness and highlights the importance of early detection. Breast Cancer is the leading cause of cancer-related death in women with 40,000 deaths related to breast cancer in 2016. However, millions of women are surviving and thriving with breast cancer when found and treated early.

Magellan Health is a proud supporter of National Breast Cancer Awareness Month.  Help spread the importance of conducting monthly breast self-exams and the powerful impact early detection can have on a woman’s life.

Learn more about the importance of early detection and how to conduct a self-exam.

Source: Surveillance, Epidemiology, and End Results (SEER) Program. Accessed July 14, 2017

On the 10^th anniversary of the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act (MHPAEA), the Association for Behavioral Health and Wellness (ABHW), the national voice for payers that manage behavioral health insurance benefits for over 175 million people, and its member companies today declared continued support for, and further commitment to, creating parity in behavioral health treatment and coverage.

While MHPAEA was signed into law on Oct. 3, 2008, ABHW and its member companies’ efforts to address mental health and substance use disorder (MH/SUD) parity have a much longer history – decades. As an original member and Chair of the Coalition for Fairness in Mental Illness Coverage (Fairness Coalition), we worked with a diverse coalition of stakeholders to win equitable coverage of MH/SUD treatment, and were an avid advocate and supporter of the final bill that became law.

Mental health and substance use disorder parity is a right. Everyone deserves access to equitable, affordable, medically appropriate, high quality mental health and addiction services and treatment. ABHW member companies have diligently worked to drive consistent interpretation and enforcement of MHPAEA across the United States. We will continue our efforts through:

• Improved access to behavioral health treatment, services, and providers;
• Behavioral health co-payments that align with medical visit co-pays;
• Elimination of arbitrary treatment limitations on the number of days of coverage for a condition, as well as financial limits on annual and lifetime dollar caps;
• Adjustments to prior authorization requirements for mental health and substance use disorder services so that they are comparable to medical benefits; and
• Integration of medical, pharmacy, and behavioral health benefits to increase consumer engagement and reduce overall medical costs.

While great strides have been achieved, we acknowledge that more can be done to ensure that mental health and addiction parity is being implemented in the manner in which it was intended.

• Accreditation – Currently there is no parity accreditation standard that would deem a health plan parity compliant. Recognition of such an accreditation by consumers, federal and state governments, employers, and providers would support consistency of interpretation and assessment of parity compliance.
• Best Practice Examples – Additional illustrations from the federal regulatory agencies of health plans that are implementing MHPAEA correctly or states that are accurately enforcing MHPAEA would be very helpful in advancing parity compliance. If regulating agencies release de-identified information related to non-compliance issues it would provide interested parties with a thorough picture of the regulator’s intent related to MHPAEA and would lead to improved compliance.
• Substance Use Disorder – Currently, there is not parity in the way health care professionals access SUD records. This puts SUD patients at greater risk and inhibits integrated care for these individuals. Since SUD patients and their records are siloed from the rest of medicine, many individuals are receiving substandard, uncoordinated care.

ABHW and its member companies are committed to the full implementation and enforcement of the parity law. We will continue our efforts to work with consumers, employers, health plans, state Medicaid agencies, regulators, legislators, providers, behavioral health interest groups, and others to further parity compliance, educate consumers about the law, and provide the tools and resources needed to make informed decisions.

Signed,

Association for Behavioral Health and Wellness

Aetna Behavioral Health

Anthem

Beacon Health Options

Centene Corporation

Cigna

Magellan Health

New Directions Behavioral Health

Optum

PerformCare
ABHW is the leading health plan association working to improve access and quality of care for mental health and substance use disorders. ABHW’s members include national and regional health plans who care for more than 175 million people. Together we work to reduce stigma and advance federal policy on mental health and addiction care. Member companies – Aetna Behavioral Health, Anthem, Beacon Health Options, Centene Corporation, Cigna, Magellan Health, New Directions Behavioral Health, Optum, and PerformCare.

Parity Progress

Ten years ago today, the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act (MHPAEA) was passed into law. This ground-breaking legislation required health plans to treat mental health and substance use conditions like physical medical conditions without treatment or financial limitations. For more than 40 years, Magellan has wholeheartedly supported and actively advocated for parity. Every day, we work together with our customers — health plans, employers, state Medicaid and military and government clients — to innovate new solutions on behalf of those we serve, which continues to advance the law and helps to reduce the stigma around mental health and substance use issues. At Magellan, mental health is fundamentally as important as physical wellness, but it’s just a start.

Beyond equal to individualized and integrated

While our country has made positive strides in parity, we know achieving a healthy, vibrant life is tied to many factors beyond parity – namely social determinants, such as housing, poverty, education and access to transportation and healthy food. One way we are addressing and accounting for these social determinants is by focusing on providing individualized, integrated care.

Complete Care-Person-centered. Community-focused. Evidence-based.

A great example is Magellan Complete Care, which operates person-centered health plans that provide complete care coordination for recipients in Medicare and Medicaid. In the state of Florida, we developed the first-in-the-nation Medicaid specialty health plan to integrate physical and behavioral healthcare and address the social determinants of health for individuals living with serious mental illness and substance use disorders. In Arizona, Massachusetts, New York and Virginia, our Medicaid health plans integrate the full continuum of healthcare services – including mental health and substance use disorder services and treatments individualized to help each member live their healthiest, most vibrant life.

Integrated Health Neighborhoods

Magellan Complete Care plan participants include many individuals who contend with complex conditions that impact their physical health and mental well-being every single day. These individuals need to stay connected to their families, friends, neighbors and others in their communities to maintain independence and achieve optimal health and well-being. Doing so makes the difference between surviving and thriving. To these ends, we have pioneered a care coordination model called the Integrated Health Neighborhood (SM).

This model challenges the definition of what you might think a traditional health plan does for its members. Instead of just focusing on physical and behavioral health treatment, Integrated Health Neighborhoods work within existing community support agencies and local public health systems to strengthen and extend their reach. Our local teams help each member navigate these systems and supports based on their needs as well as their preferences for connecting in their own communities. This helps minimize member disruption through the use of familiar local provider networks and support from trusted community organizations.

Our Integrated Health Network teams are comprised of Magellan associates who live in the same communities as the members they serve. Our assigned teams personally know people at agencies, organizations and local resources across their neighborhood, whom they can call on, person to person, to find the right resources for each member. They work collaboratively to help each individual member find his/her path to independence and well-being.

Recovery Support Navigators

A unique part of the team are the Recovery Support Navigators. These are certified peer support specialists who have lived experiences with some of the same challenges our members face – they have experienced substance use disorders or psychiatric disabilities and may have personally been homeless, had their utilities turned off or experienced food insecurity. They can relate to the members they support, empathize, and then draw on real-world solutions to help them.

For the past 20 years, Magellan has been a leader in increasing access to peer support through partnerships with the recovery community and providers.  We have assisted state customers in developing robust certified peer specialist capabilities, driven in large part by our depth and breadth of experience.   We create shared learning opportunities for the peer workforce and others to improve and enhance the knowledge, skills, and competencies of the peer workforce across the continuum.  Our Recovery Support Navigators represent our best practice approach to tapping the power and potential of peer support.

We know people are more than just a diagnosis – or multiple diagnoses. Truly living healthy, vibrant lives means seeing more than parity for the pieces. It’s seeing and caring for the whole person and bringing together the right resources across the community to help. Integration and individualization are the next steps, and I am proud to say Magellan is out front and on the ground in neighborhoods around the country, taking these steps with our partners and members – together!

Many people who die by suicide leave loved ones behind who suffer from a range of painful emotions.

When it happens to someone you know

Losing a loved one to suicide can be overwhelmingly painful for family members and friends. Unlike a death that occurs naturally from old age or illness, a death by suicide is usually sudden, unexpected, and sometimes violent. The shock and trauma for survivors is further complicated by the social stigma of suicide, possible police investigations, media coverage, lack of privacy, and judgment of others in the community.

How many people it impacts each year

Research shows that at least six people are directly affected by the death, including immediate family members, relatives, neighbors, friends, and co-workers.

Given that more than 43,000 people take their lives each year, approximately a quarter million survivors are left behind, traumatized by the loss.¹

Many people who die by suicide suffered from clinical depression or other mental health disorder. The survivors may also be at risk for depression and anxiety.

Common responses

The emotional pain of survivors can be complicated, intense, and prolonged. People may feel a sense of guilt and responsibility and blame themselves for not seeing the warning signs. They may feel a profound sense of betrayal, rejection, and abandonment. Other common responses are:

• Feeling a need to make sense of the death and understand why the person made the decision to die. Even if the person left a note or a message, there are often unanswered questions that can persist for years.
• Replaying the events that took place before the person’s death and constantly second-guessing different outcomes.
• Experiencing symptoms of post- traumatic stress disorder such as flashbacks and anxiety, particularly if they witnessed the suicide or discovered the body.
• Shame and anger due to the stigma of suicide and mental illness, and possible negative community responses.

Some individuals experience intense grief that does not heal with time.

The bereaved person may feel empty, preoccupied with the death and unable to resume the activities of daily life. This type of grief, known as complicated grief, can affect from 10 – 20% of the survivors of suicide loss. If left untreated, complicated grief often persists, resulting in significant impairment and poor health outcomes.

How you can help

Sometimes people struggle with what to say or how to help a family who has lost a loved one by suicide. Helping the survivors means being a good listener and avoiding any criticism or judgments. Try to:

• Be present and listen attentively without feeling the need to provide answers.
• Avoid speculating on the reasons for the suicide or the person’s state of mind.
• Be sensitive about what you say. Avoid clichés such as “I know how you feel” or “time will heal all wounds.”

Helping the survivors means being a good listener and avoiding any criticism or judgments.

• Be compassionate and understanding, and remember that grieving takes time.
• Take the initiative to be helpful. Bring a meal, mow the lawn, or pick up groceries for the family.
• Be aware of support groups and offer to find one if the family is interested.

The grief of suicide survivors is unique and complicated by the circumstances of the death. You can help by being present as a caring friend and sounding board. Let the family know you’re ready to listen if and when they want to share their thoughts and emotions.

Help is available. For additional information, visit MagellanHealth.com/MYMH

1. 2014 data, released December 2015, CDC Web Based Injury Statistics Query and Reporting System (WISQARS)

Sources: American Association of Suicidology; American Foundation for Suicide Prevention; Harvard Health Publications

Common warning signs for suicide include:

• Making suicidal statements.
• Being preoccupied with death in conversation, writing, or drawing.
• Giving away belongings.
• Withdrawing from friends and family.
• Having aggressive or hostile behavior.

It is extremely important that you take all threats of suicide seriously and seek immediate treatment for your child or teenager. If you are a child or teen and have these feelings, talk with your parents, an adult friend, or your doctor right away to get some help.

Other warning signs can include:

• Neglecting personal appearance.
• Running away from home.
• Risk-taking behavior, such as reckless driving or being sexually promiscuous.
• A change in personality (such as from upbeat to quiet).

Suicidal thoughts and suicide attempts

Certain circumstances increase the chances of suicidal thoughts in children and teens. Other situations may trigger a suicide attempt.

Circumstances that increase the chances of suicidal thoughts include having:

• Depression or another mental health problem, such as bipolar disorder (manic-depressive illness) or schizophrenia.
• A parent with depression or substance abuse problems.
• Tried suicide before.
• A friend, peer, family member, or hero (such as a sports figure or musician) who recently attempted or died by suicide.
• A disruptive or abusive family life.
• A history of sexual abuse.
• A history of being bullied.

Circumstances that may trigger a suicide attempt in children and teens include:

• Possession or purchase of a weapon, pills, or other means of inflicting self-harm.
• Drug or alcohol use problems.
• Witnessing the suicide of a family member.
• Problems at school, such as falling grades, disruptive behavior, or frequent absences.
• Loss of a parent or close family member through death or divorce.
• Legal or discipline problems.
• Stress caused by physical changes related to puberty, chronic illness, and/or sexually transmitted infections.
• Withdrawing from others and keeping thoughts to themselves.
• Uncertainty surrounding sexual orientation.

Depression

Signs of depression, which can lead to suicidal behavior, include:

• Feeling sad, empty, or tearful nearly every day.
• Loss of interest in activities that were enjoyed in the past.
• Changes in eating and sleeping habits.
• Difficulty thinking and concentrating.
• Complaints of continued boredom.
• Complaints of headaches, stomachaches, or fatigue with no actual physical problems.
• Expressions of guilt and/or not allowing anyone to give him or her praise or rewards.

Take any mention of suicide seriously. If someone you know is threatening suicide, get help right away.

Help is available. For additional information, visit MagellanHealth.com/MYMH

Source: Healthwise

Myth: It’s best not to plant the idea of suicide by talking about it with someone who seems depressed.

Fact: Talking about suicide provides the opportunity for communication. Fears that are shared are more likely to diminish. The first step in encouraging a suicidal person to live comes from talking about those feelings. The first step can be the simple inquiry about whether or not the person is intending to end their life.

Myth: Only crazy people commit suicide.

Fact: Everyone has the potential for suicide. While many people who kill themselves are clinically depressed, most are in touch with reality and not psychotic.

Myth: Suicide happens more often during the holidays, such as Christmas and Thanksgiving.

Fact: Suicide rates are lowest in December and peak during the spring.

Myth: If a person is determined to commit suicide, nothing will stop them.

Fact: Suicides can be prevented. People can be helped. Suicidal crises can be relatively short-lived. Suicide is a permanent solution to what is usually a temporary problem. Most suicidal people feel ambivalent and are torn between the desire to live and the desire to die. They just want the emotional pain to stop and see no other way out.

Myth: If a person attempts suicide and survives, they will never make a further attempt.

Fact: A suicide attempt is regarded as an indicator of further attempts. It is likely that the level of danger will increase with each further suicide attempt.

Myth: Teens are the greatest risk to commit suicide.

Fact: Adults are more likely to take their own life. At particularly high risk are adults between 45 and 54, who had a suicide rate of 19.72 deaths per 100,000 people, compared with about 19 per 100,000 in people over 85, and 13 per 100,000 in the general population. Still, teenagers remain a high-risk group. The percentage of emergency room visits related to suicidal thoughts or attempts among children and teens more than doubled from 2008 to 2015. (The suicide rate for 15- to 24-year-olds is 13.15 per 100,000.)

Help is available. For additional information, visit www.magellanhealth.com/mymh

Sources: American Foundation for Suicide Prevention; CDC.gov; Nevada Division of Public and Behavioral Health Office of Suicide Prevention

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.