Simply put, hepatitis means inflammation of the liver. Chronic hepatitis C virus (HCV), a blood-borne disease of the liver, is a global health concern. In the United States (U.S.), it affects an estimated 3.9 million people, up to 30 percent of whom will develop cirrhosis and 1 percent to 3 percent of whom will develop liver cancer. There are six genotypes, with genotype 1 being the most common genotype in the U.S., accounting for over 75 percent of HCV cases. Approximately 12 percent of U.S. patients have genotype 2 and 10 percent comprise genotype 3. Genotypes 4, 5, and 6 make up less than 2 percent combined in the U.S.

Historically, treatment for chronic HCV was agonizing, as it involved injectable interferon and oral ribavirin, associated with very low cure rates, undesirable safety profile, poor tolerability and a long duration of therapy. Over the last four years, HCV treatment has undergone a paradigm shift, with the approval of once-daily oral direct-acting antiviral (DAA) regimens, providing sustained virologic response (SVR) of over 95 percent, which is synonymous with cure. The approval of sofosbuvir/velpatasvir (Epclusa^®) in 2016 marked the first pangenotypic agent, as a 12-week regimen. Pangenotypic drugs work against all genotypes. These major advancements have led to a trending down in utilization of HCV treatments with fewer patients needing retreatment and have sparked the possibility of eliminating HCV at a national and even global level. Yet, there is still an unmet need. The Holy Grail of HCV research is focused on all-oral, ribavirin-free regimens, shorter duration of therapy and options for DAA treatment failures.

Two next-generation pangenotypic HCV agents are expected to be approved in August. Gilead’s investigational sofosbuvir/velpatasvir/voxilaprevir is seeking to become a salvage therapy for prior DAA failures as a 12-week regimen, pangenotypic drug for patients without cirrhosis or with compensated cirrhosis. This agent has received FDA’s Breakthrough Therapy designation for patients with genotype 1 who have failed prior DAA therapy, specifically containing NS5A inhibitors. Breakthrough Therapy designation is given to drugs that can treat a serious or life-threatening condition and preliminary evidence suggests that the drugs may demonstrate substantial improvement over available therapy on a clinically significant endpoint. This designation helps expedite the development and review process. The Gilead product is taken as one tablet once-daily.

Glecaprevir/pibrentasvir, Abbvie’s emerging HCV pipeline drug, may be approved as a shorter eight-week regimen across all genotypes, in non-cirrhotic patients. For patients with genotype 1, it has received Breakthrough Therapy designation for those not cured with prior DAA therapy. This Priority Review product has also been studied in difficult-to-treat populations with high efficacy. An FDA Priority Review designation is given to drugs that offer major advances in treatment, or provide a treatment where none existed. The FDA goal for completing a Priority Review is six months, compared to 10 months for a standard review. Abbvie’s regimen is taken as three tablets once-daily.

This August wave of pangenotypic options for HCV should further drive competition and access in the marketplace. They can lead to a cure in larger populations with shortened durations and treating difficult-to-treat patients, including prior DAA failures. These continued advancements in turn make the quest to achieve national elimination goals a viable possibility against this national epidemic.

Download a copy of this infographic here.

Magellan understands that the market looks at pharmacy trends as a gauge to measure pharmacy benefits manager (PBM) success. However, you really can’t compare one trend number to another as every PBM uses different methodologies, different data sets and different calculations to arrive at their trend number, and often adjustments are made to these calculations year-over-year. This is something Magellan likes to call little ‘t’ trend.

Do you know what most of these trend numbers are missing? One of the largest cost drivers today – prescriptions drugs dispensed through the medical benefit – when you combine pharmacy benefit with medical benefit spend, you get what we like to call big ‘T’ Trend. In fact, you need to combine both to see that there is as much, if not more specialty spend going through the medical benefit today that is going unmanaged.

As specialty costs continue to soar the need to leverage effective management and thought-leading expertise is essential.  As pioneers in this complex specialty environment, we have dedicated ourselves to solving the challenges and creating solutions that resolve what’s truly driving big ‘T’ Trend.

Watch our video to learn more.

There is often confusion about Memorial Day relative to Veterans Day, which was first observed in 1926, to recognize and appreciate all veterans who have served our country- particularly those who are still with us. Memorial Day, which began in 1868, is focused on honoring those individuals who have made the ultimate sacrifice preserving our country and the freedom for which it stands.

The first large observance for Memorial Day was held in 1866 at Arlington National Cemetery, across the Potomac River from Washington, D.C. Various Washington officials, including Gen. and Mrs. Ulysses S. Grant, presided over the ceremony. After speeches, children from the Soldiers’ and Sailors’ Orphan Home made their way through the cemetery, strewing flowers on both Union and Confederate graves, reciting prayers and singing hymns.

More than one million American servicemembers have died in wars since the first colonial soldiers took up arms in 1775. All Americans are direct beneficiaries of these sacrifices. Some specific actions you might take on this special day might include:

• Visiting memorials
• Visiting one of the 135 veterans’ cemeteries across the nation that protect the remains of our country’s fallen
• Flying the U.S. flag at half-staff until noon
• Volunteer or donate to non-profits serving survivors
• Reading to children about the meaning of the holiday. Some books that are appropriate for children four to eight include:
  • Memorial Day by Mir Tamim Ansary
  • Memorial Day Surprise by Theresa Martin Golding
  • The Wall by Eve Bunting

While this weekend is often considered the unofficial kickoff to summer, it’s important not to forget its true meaning and sentiment. We must never forget what these heroes have done and what their loved ones have lost.

***

Magellan Federal has a long legacy of service to military survivors which dates back 1879. We are honored to be a leader in supporting military survivors, providing surviving military families with information and compassionate case management that helps them navigate a very complex set of issues and benefits.

A major trend in the pharmacy space continues to be increasing specialty drug spend, which is expected to continue with the introduction of new specialty agents for oncology, autoimmune disorders and rare diseases. In this year’s Medical Pharmacy Trend Report Employer Group Supplement, we found that 88 percent of employers reported a medical benefit spend of less than $10 million, and a year-over-year drug trend between 1-20 percent. For the few employer groups with spend above $10 million, it was due to a higher number of lives, and may be assumed that the employee mix for these groups may have included those with more costly health expenditures.

The Employer Group Supplement assists employer groups and third-party administrators in determining specialty drug trends and strategies to solve complex challenges impacting the medical benefit drug landscape. Our goal is to expand the information shared with employer groups to create a more dynamic picture of specialty drug management and help employers make more effective healthcare decisions. Building an effective medical benefit drug management strategy requires an in-depth knowledge of and expertise in this complex area, but it’s essential to help employers rein in costs and improve the quality of care for members. It is our hope that the survey data presented in this report helps employer groups begin to think about and investigate escalating medical pharmacy costs.

Download the full report or listen to our webinar to learn more.

Source: https://www.womenshealth.gov/nwhw/tools/infographics/mental-health/

Being a parent is one of the most challenging and rewarding jobs an individual can hold. When behavioral health challenges are added, it becomes even more difficult. Try, for a moment, to imagine being a foster parent to a child with behavioral health challenges. Where does one even begin to find the help and services they need to best care for their child?

Through our collaboration with the Wyoming Department of Health, Division of Healthcare Financing (Medicaid), Magellan in Wyoming coordinates care, including behavioral health interventions with other youth serving agencies in our system, using the High Fidelity Wraparound (HFWA) model to build a team of support for the successful management of complex conditions and behaviors in home- and community- based settings. The team creates steps to help youth stay in their homes, schools and communities. Through the 10 guiding principles of the program, families and youth have a voice in their care and choice in the kind of care they receive. We help to strengthen community support, understanding, and education of at risk youth ages 4-20 with complex behavioral health needs.

Magellan in Wyoming recently had the opportunity to hear from a former foster parent and HFWA graduate to discuss how the program benefited them through their challenges and supported their growth. “Opening my heart up to love and attachment with these children, parenting them with unconditional love, all the while knowing, they might not stay was difficult,” said the foster parent.

The siblings involved and their foster family cycled through numerous foster care workers in three years, creating more trauma for everyone. There was no stability and no consistency. Dealing with several different mental health diagnoses and many weekly appointments, in addition to the strain of everyday life, took a toll.

When this family discovered HFWA, they were naturally a little skeptical. They had experienced enough “new” things; however, this was the beginning of a completely new outlook on life. From the very start, HFWA taught the foster parent that it was okay to take a breath, to sleep and to ask for support. More importantly, it became evident that people wanted to help and be on the family’s team to help support them.

The family had spent so much time triaging the risk aspects of their children’s lives, that it had drained them of most of their hope. Through the strengths-based principles of the HFWA program, the family was able to gain new insight into ways they could focus on the local supports available to help them.

The program taught them to see the progress. By forming a HFWA team around the foster children and the whole family, they were able to gain some positive, strengths-based perspective along with stability and consistency.

HFWA empowered the family to have a voice and to use it effectively. “I knew all the people on my team before HFWA, but the program taught me how to use my voice. It taught me how to say what was going on and who to say it to,” said the foster parent. It was because of the family’s team, as well as community investment in the program, that today, the family is enjoying a life full of hope and possibility.

On March 22, Magellan Rx Management released its seventh annual Medical Pharmacy Trend Report, which continues to be a leading source for payers and other industry stakeholders to analyze high-cost injectable drugs paid under the medical benefit. It’s clear that specialty spend on the medical benefit accounts for a significant expenditure for both members and payers alike and it is continuing to grow rapidly, particularly for commercial health plans. Ensuring a sound medical benefit drug management structure is in place is necessary to rein in costs in both the short- and long-term, particularly as new drugs come to market.

This year’s report highlights the member and payer impact of high-cost specialty drugs billed on the medical benefit. Often unrecognized, but a critical component of total drug spend, this segment of drug utilization is especially important considering that by 2018, it’s expected that 50 percent of total United States drug spend will be composed of specialty medications. Additionally, half of specialty drug spend is billed through the pharmacy benefit and half through the medical benefit, or “medical pharmacy.” Specifically, the report found:

• Commercial medical pharmacy spend increased by an average of 12 percent each year from 2011-2015, while Medicare Advantage remained relatively stable with only a 5 percent increase over the same five-year period.
• The majority of oncology drugs are still infused or injected and the largest portion of their costs are covered through the insured’s medical benefit. Oncology and supportive care agents represent nearly 50 percent of commercial medical benefit drug spend and nearly 60 percent for Medicare Advantage.
• The leading cause of blindness in senior populations is treated with injections that are exclusively covered through the medical benefit, and this was the highest trending category on the medical benefit in 2015 (30 percent for commercial and 39 percent for Medicare Advantage).
• On average, the 10 most expensive commercial medical benefit drugs averaged $421,220 annually per patient and affected two per 100,000 members. The 10 costliest Medicare medical benefit drugs averaged $268,780 and affected eight per 100,000 members.
• In total, taking into account coinsurance, copay and deductible, members using a medical benefit drug paid 3 percent of total medical pharmacy costs in commercial (97 percent for the payer) and 5 percent in Medicare Advantage  (95 percent for the payer). While the member percentage may seem small in comparison to payer percentage, many members have trouble affording their medications or reach their maximum out-of-pocket costs, oftentimes at thousands of dollars.

Key strategies for the effective management of medical benefit drug spend outlined in the report include:

• Clinically and operationally managing drugs billed with unclassified Healthcare Common Procedure Coding System codes;
• Improving claims system capabilities to capture and report National Drug Codes;
• Employing provider network strategies for commercial members to remove disparities in cost by outpatient site of service;
• Implementing benefit design strategies, and
• Bringing transparency of medical benefit drug costs and therapeutic options to members.

Building an effective medical benefit drug management strategy requires an in-depth knowledge of and expertise in this complex area, but it’s essential to help payers rein in costs and improve the quality of care for members.

Download the full report to learn more.