About 1 in 54 children in the U.S. has been diagnosed with autism spectrum disorder (ASD), according to estimates from the CDC’s Autism and Developmental Disabilities Monitoring (ADDM) Network.[1] Getting an ASD diagnosis is a life-changing event for families that can trigger feelings of panic, fear and distress. You may be uncertain or confused about what to do next and how to navigate your new reality. Here are tips to help you and ensure your child lives their best life.

Do your homework—Learn everything you can about ASD and how it may affect your child throughout their life, including the laws and rights that you and your child have under the Individuals with Disabilities Education Act. The knowledge you gain will help you be an effective advocate for your child.

Become a voice for your child—As a parent, you are your child’s first, strongest and lifelong advocate. No one knows your child better than you do. You are the best qualified person to shape your child’s situation in the most caring way and speak out when it comes to their well-being and ensuring that they have the supports they need to flourish.

Seek help—The autism community is full of parents and professionals willing to help others in their ASD journeys. Allowing others to help can lighten your load, help you become a better advocate and protector for your child, and make the sometimes difficult journey more enjoyable. Seek out support groups, teachers, therapists, social workers and others for help.

Give help when you can—If you can, helping other parents on their ASD journeys can help you to put things in perspective, feel more positive about your own circumstances and create a sense of belonging. Helping others has shown to lower levels of stress and anxiety, which improves overall well-being.

Express yourself—As human beings, we need connection. Sharing your feelings with someone you trust, such as your partner or spouse, parents and/or siblings, can be liberating and go a long way in deepening your relationships, and improving your physical and mental well-being, making you a better person, parent and family member.

Make self-care a priority—Spending most of your time caregiving can quickly lead to burnout. Proper hydration, a healthy diet and sufficient sleep can help you cope best with daily challenges. Finding time for activities that are fun and fulfilling, such as going to the gym, going for walks and meeting friends, can help you recharge and be the best parent you can be.

Find the right providers—While it is important that your child’s providers use evidence-based practices and keep abreast of treatment options, it is also important that they are culturally aware and respect your ideas and traditions. Each cultural group has its own customs, thoughts and taboos regarding physical and mental health care. Find a doctor who not only speaks your language, but is also sensitive to your cultural, religious and personal beliefs.

Foster healthy eating habits—Children with ASD often experience issues such as insomnia, eczema, constipation, diarrhea, behavioral outbursts and more. If your child has any of these issues, you might want to see if it is a reaction to foods that are not good for their system or if their intestines are out of balance. Healthy eating habits can make a big difference in the lives of children with ASD.

Nurture your child’s strengths—Children improve faster when they work on strengths. Focusing on your child’s strengths, not weaknesses, puts them on the path to their personal best, allows them to develop and excel in things they’re good at, and can greatly improve their self-esteem and well-being. It can also foster a better parent-child relationship.

Magellan Healthcare is committed to improving all lives affected by autism. Visit our Autism Awareness website here for free resources that increase awareness, celebrate differences and support inclusion.

Read more Autism content from Magellan Health Insights

[1] https://www.appliedbehavioranalysisedu.org/top-10-awesome-things-about-being-on-the-autism-spectrum/

The Role of Precision Medicine in Oncology Care

The approach to cancer treatment has been transformed dramatically over the last decade. The use of medications to treat cancer is shifting from a “one size fits all” approach to more personalized therapies. The individual patient’s specific tumor characteristics may now drive the selection of the best treatment option. Identification of these tumor characteristics is often accomplished through genomic testing. Because clinical data regarding genomic testing is being published at an unprecedented pace, both providers and payers may struggle to keep up and need access to a shared, unbiased decision-support technology to ensure patients are receiving optimal treatment options.

How can you accurately approve tests and treatments while at the same time streamlining the prior authorization processes?  Here are four ways:

1. Follow evidence-based standards – there are many different lab companies who offer genomic testing as well as variations in the testing products offered by many labs. Clinical decision support for genomic testing assures that that each molecular test ordered meets clinical, evidence-supported standards and also ensures the use of cost-efficient testing. When physicians utilize this clinical decision support to order genomic testing, it streamlines and optimizes prior authorization and reimbursement arrangements with health plans
2. Enable transparency – provide a real-time window into the precision medicine decision-making process. Currently, it is difficult to ensure that all patients who could benefit genomic testing are receiving appropriate testing. When health plans have access to real-time genomic testing results, quality initiatives can be designed to track appropriate care interventions.
3. Take a patient-centered approach – ensure patients get the most appropriate tests from preferred labs at the right time in their treatment journey. Patients are understandably anxious awaiting test results and a system that streamlines workflow for practices and expedites the delivery of test results ensures appropriate, quality care for patients when time matters most.
4. Promote collaboration – ensuring scalable, appropriate use of precision medicine for cancer means working collaboratively with oncologists and molecular testing labs. Cancer care is often fragmented and solutions are needed that align all stakeholders while keeping the patient at the center of the solution. Providing clinical decision support for genomic testing as well as corresponding drug selection allows for all parties to work quickly and efficiently in order to maximize coordinated, quality cancer care.

To learn more about Magellan Rx Management’s approach to precision medicine in collaboration with Trapelo Health, click here.

As a market leader and disruptor in specialty drug management, Magellan Rx Management has been delivering targeted and innovative solutions for over 16 years to help health plans reduce specialty drug costs on the medical benefit while maintaining a high quality of care for their members. Our suite of solutions can help plans develop customizable, flexible programs to meet some of their toughest challenges.

• Prior authorization: Ensures complex and high-cost drugs are prescribed according to evidence-based policies.
• Post-service pre-payment claims edits: Assures medical benefit drugs are paid correctly.
• Provider network strategy: Encourages lower-cost but equally effective agents through a variable fee schedule.
• Site of service management: Guides medical injectable drug administration to lower-cost and clinically appropriate site of care.
• Medical formulary management: Enhances management of medical drug classes to promote the most cost-effective therapies

Why medical pharmacy management matters

With specialty drug costs accounting for nearly half of total drug spend, health plans continue to look for better ways to manage those rising costs while staying ahead of ever-changing market dynamics (like emerging therapies for rare and orphan diseases and new-to-market biosimilars). Specialty drugs administered by healthcare professionals (typically in a provider’s office, hospital outpatient facility, or through home infusion) are paid under the medical benefit—or what we like to call “medical pharmacy”—and remain a leading driver of rising costs. In fact, according to our research, the latest five-year per-member-per-month (PMPM) trend for medical pharmacy spend was 65% in Commercial, 40% in Medicare, and 78% in Medicaid.

A real-life customized solution

One of our health plan customers with a mix of Commercial, Medicare & Medicaid lives was beginning to see significant utilization in specialty medications. They turned to Magellan Rx’s clinical and pharmacy trend experts, who analyzed trend drivers, recommended a multi-pronged approach to management based on their unique data, and collaborated with the plan to implement several programs to maximize effectiveness and meet plan goals including innovative strategies such as a drug wastage solution.

So, what are the results?

Our health plan partner realized a cost reduction in just one year by implementing a suite of solutions alongside our team of medical pharmacy experts—resulting in a nine percent decrease in medical drug spend! Based on this particular’s plan size and benefit design, each solution contributed demonstrably to overall savings.

Individual program implementation is dependent on plan size and other factors. These flexible solutions can also operate outside of the traditional payer-PBM relationship. Now, you can plug in to the extensive clinical expertise and experience at Magellan Rx by delegating specialty and medical drug management services while retaining a separate pharmacy benefit manager.

Are you looking for a customizable, flexible solution to combat rising specialty spend? Connect with us today!

For our kids, disruptions caused by the COVID-19 pandemic are likely more than just that – temporary inconveniences, varying in severity, until life goes back to “normal.” Besides missing out on once-in-a-lifetime events, like graduations, birthdays and other milestones – at least in a way they would traditionally be observed – regular human interactions, part of social and emotional development, have changed. While adults may be experiencing a serious blip on the radar, children may be experiencing an interruption in brain development and/or lack the ability to fully cope in this unchartered territory.

In this post, we will contemplate these issues and draw on knowledge from Magellan Healthcare’s recently updated clinical monograph, Understanding and Meeting the Needs of Children and Adolescents at High Risk, which highlights evidence-based prevention and treatment approaches for problematic behaviors and various types of behavioral health challenges in children and adolescents.

As we think about the significance of childhood development, the following points from Magellan’s monograph provide insights:

A growing body of scientific information has confirmed the importance of the first five years of life, when the ongoing construction of brain architecture impacts youth social and emotional development, the ability to learn new behavior and skills, and how the youth evolves into adolescence.

Advances in neuroscience have contributed new understanding of adolescent development. During adolescence, the brain experiences a period of major development comparable to that of early childhood.

With much changing in our kids’ lives and environment – virtual schooling, modified in-person play arrangements with friends and reduced time with extended family – the responsibility falls on parents and caregivers, as it always does, to ensure their child’s wellbeing and adjustment. Magellan’s monograph offers the following to ponder:

While genes determine when specific brain circuits are formed, experiences actually shape their formation and are fueled by a self-initiated, inborn drive toward competence. This phenomenon depends on appropriate sensory input and stable, responsive relationships whereby adults respond to a child’s natural reaching out for interaction.

However, when parents are under unprecedented stress and often just trying to make ends meet, attending to their child’s increasing needs can understandably be overwhelming. In addition to the role of parent and full-time employee, many adults have taken on the additional roles of teacher, daycare worker and entertainer, to name a few. In some cases, however, a parent’s struggles may lead to neglect of their children. Magellan’s monograph highlights the following of child neglect:

While child abuse is more widely acknowledged and publicized, child neglect is, in fact, the most common type of child maltreatment, which frequently goes underreported. Expanding on the earlier discussion of impaired brain development, it is now understood that lack of stimulation and necessary care early in life may cause children to remain in a state of “hyperarousal” (i.e., constantly anticipating threats and/or experiencing dissociation) rather than a normal state of attentive calm. This phenomenon leads to a decreased ability to benefit from social, emotional and cognitive experiences and results in other psychosocial consequences. Together with insecure attachments, this state of hyperarousal can significantly affect normal growth and development.

Many parents are also managing their own mental health conditions and substance use disorder during the pandemic, which adds to the impact of what children and adolescents are experiencing themselves. The monograph outlines the risks for children of these parents:

There are many serious risks to children and adolescents who have a parent or both parents with mental illness. The American Academy of Child and Adolescent Psychiatry (AACAP) calls attention to the strong genetic predisposition in children for inheriting bipolar disorder, an anxiety disorder, attention deficit-hyperactivity disorder (ADHD), schizophrenia, alcoholism or other SUD, or depression. Recent studies have also demonstrated delayed brain development in young children of depressed mothers. Further, the AACAP notes the additional stress that mental illness places on a marriage and parenting abilities of the couple, and the risks that stem from an inconsistent, unpredictable family environment that can contribute to psychiatric illness and developmental delays in children.

It’s also appropriate to consider the older children and young adults who may lack the ability to cope with increased stress and instability. Magellan’s monograph calls attention to recent research:

A CDC report on mental health, substance use and suicidal ideation during the COVID-19 pandemic shows that while 11% of adults seriously contemplated suicide in June 2020, the same was disproportionately reported by young people aged 18 to 24 (26%).

During these difficult times, we’re all doing the best we can. And we know that brighter days are on the horizon. Until then, and always, as we’re helping ourselves and our children through, let’s remember that “information is power,” as they say. To that effect, we encourage you to learn more in our full children’s clinical monograph here.

Every April, we recognize National Autism Awareness Month, which focuses on spreading awareness, improving understanding and promoting acceptance of autism spectrum disorder (ASD). Most of us are aware of the challenges families impacted by ASD may face throughout their lives. Research studies, media reports, social media and events help us keep up to date. But do we really think about the many amazing positive qualities people with ASD possess?

Traits that make people with Autism Spectrum Disorder awesome people, friends and coworkers

• Creative—People on the spectrum look at the world differently and process information in a unique way, making them independent and creative thinkers who can visualize solutions to problems that others may not see.
• Detail-oriented—People on the spectrum are highly attuned to detail. Little things that most of us might overlook, such as spelling or punctuation, stand out to individuals on the spectrum. They take note of specific details such as colors and names and remember directions.
• Honest—Many people with ASD are often black-and-white thinkers, so it makes no sense to them to lie. They are not afraid to tell us what they really think, but they tell the truth quite openly and accurately reflect their feelings, whether positive or negative.
• Non-judgmental—Because of their black-and-white thinking, people with ASD rarely compare others to any set of standards or expectations. Therefore, they are more likely to accept differences, see us as we are and not expect us to change.
• Passionate—Many people with ASD have a wide range of interests and are extremely impassioned about the things, ideas and people in their lives. They pursue interests with 100% of their energy and research obsessively until they have a deep understanding of the subject. They spend the time, energy and imagination needed to really master their interests and stick with things through difficulties and frustration.
• Reliable—People with ASD appreciate routines. Once a routine or rule is set, you can rely on them to follow it precisely. If it is on the calendar, you can be sure they will be there and arrive on time.

Keeping an eye on the positive characteristics of people with ASD is key to promoting wider acceptance. Help your family, friends and others learn why they are amazing and special by sharing this blog post.

To learn more about Magellan Healthcare’s work with Autism Spectrum Disorder, click here. 

Sources:            

• https://www.appliedbehavioranalysisedu.org/top-10-awesome-things-about-being-on-the-autism-spectrum/
• https://autismawarenesscentre.com/the-positives-of-autism/

In January 2021, the United States (US) Food and Drug Administration’s (FDA) Center for Drug Evaluation and Research (CDER) published Advancing Health through Innovation: New Drug Therapy Approvals 2020. This report provides a summary of a number of approvals and highlights the novel therapies approved in 2020, continuing the generally upward trend in approval volume seen over the past decade, despite the impact of coronavirus disease 2019 (COVID-19). Compared to 2018 and 2019, in which CDER approved 59 and 48 new drugs, respectively, 53 novel agents were approved in 2020. This number does not include new and expanded uses of already approved drugs, new formulations, new dosage forms, vaccines, blood products, cellular or gene therapy, or biosimilar approvals. Once again, the number of approvals exceeded the average of 41 novel approvals per year in the past 10 years. Figure 1 outlines approvals over the past 10 years.

Despite the ongoing pandemic the FDA continued their strategic initiatives to expedite the safe review of treatments in 2020. With the unprecedented challenges incurred in 2020, the FDA acknowledged that maintaining their commitment to bringing forth innovative therapies was difficult. Remarkably, the numbers reported by the FDA do not include the several emergency use authorizations (EUAs) issued by the FDA for COVID-19.

Last year, all 53 novel drug approvals again met their Prescription Drug User Fee Act (PDUFA) goal dates, cementing this as a priority for the Agency. In 2020, 40% were considered first-in-class, and 58% were approved for rare diseases (Orphan Drugs), the latter of which increased from 44% in 2019. Priority Review was granted to 57% of novel drugs, 23% received Accelerated Approval, 42% were designated as Breakthrough Therapy (up from 27% in 2019), and 32% garnered Fast Track designation. Overall, 68% of all drug approvals in 2020 used expedited development and review methods. In addition, 92% were approved in the first review cycle, and 75% were approved in the US prior to receiving approval in other countries. A breakdown of the types of drugs approved in 2020 is illustrated in Figure 2, with agents within the oncology spectrum representing over one-third of 2020’s novel approvals.

The notable 2020 approvals encompassed new advances for the treatment of infectious diseases, including a new medication class for the treatment of human immunodeficiency virus-1 (HIV-1). Garnering perhaps the most attention, the FDA also approved the first medication for hospitalized patients with COVID-19. Unique infectious diseases in the US also received attention, with a new drug for malaria, two new options for the Ebola virus, and a new treatment for Chagas disease approved in 2020. In the neurology arena, there were multiple approvals of agents for more common conditions, such as migraine or Parkinson’s disease. Moreover, there were significant advances for rare neurological conditions, including the first oral agent for spinal muscular atrophy and new treatments for rare seizure disorders. In addition, two immunological agents were approved for the treatment of neuromyelitis optica spectrum disorder. Additional treatment options emerged for several autoimmune conditions in 2020 as well. Not surprisingly, numerous advances were made within the oncology umbrella, including both novel approvals and new or expanded indications for several existing agents. With over half of the novel approvals being classified as Orphan Drugs, in 2020, the FDA has fortified their dedication to providing innovative and often targeted treatment options for all individuals.

When it comes to healthcare, it is all about the individual, not their condition. Healthcare organizations endeavor to help patients achieve better health, and this goes beyond reducing symptoms and healing injuries.

Behavioral economics—a science that was founded on the idea that “humans are irrational beings, but in highly predictable ways”—is empowering individuals to live healthier lives through programs that guide better decision making and create long-term healthy habits with the following three key principles:

Principle One: Understanding the human element of healthcare with the intent-behavior gap

Have you ever set your alarm to get up early, and then pressed the snooze button… multiple times… missing your morning workout?

If so, you know that achieving better health is easier said than done.

The disconnect between the healthy choices we want to make, and the instantly-gratifying choices we actually make, is called the intent-behavior gap, and it’s one of the key principles driving the science of behavioral economics.

Recognizing that we do not always follow through with our intentions, behavioral economics works to effect change through healthy habit formation. As the right choices become routine habits, it gets easier to match intentions with behaviors for better long-term health.

Principle Two: Overcoming present bias through financial incentives

Behavioral economics explains that we are all subject to present bias, the instant, tangible gratification that often drives basic human motivation. This bias leads us to prioritize immediate desires over things that will be best for us in the long run. As such, present bias is what causes us to order that dessert when we eat out with friends or lures us to stay seated on the couch, binge-watching a sub-standard reality television show when we told ourselves we were going to read.

Because what we want now often overshadows our ultimate goals, offering immediate rewards for making long-term healthy choices can motivate individuals in overcoming present bias and do what is required to be healthy, whether that’s checking glucometer readings regularly, exercising, or taking medication as prescribed.

Principle Three: Leveraging loss aversion to maximize results

If you have ever owned stocks or investments, chances are you are familiar with loss aversion, even if the term sounds unfamiliar. Imagine, your investment portfolio shows significant 15-20% growth across investments over the past year, but one of your investments dropped 10%. Are you focused on all the money you made, or walking away wondering when you could have sold that last stock to avoid a loss?

Loss aversion describes the human tendency to prefer avoiding loss, rather than gaining an equivalent amount. In other words—losing $100 feels worse than gaining $100 feels good. This means that, while traditionally structured incentives programs can be effective in changing patient behavior, they leave significant room for improvement.

Combining these three key principles of behavioral economics, with expert clinical pharmacy solutions, we can support and empower patients to better health, resulting in positive, lasting impacts and outcomes.

Taking your medications exactly as prescribed (improving medication adherence) is one of the most important things you can do to enhance your health and prevent medical complications.

For many Americans, medication adherence can be difficult to maintain. There are a number of barriers that we face every day, from social determinants of health (like medication cost, the ability to get your medication, etc.) to simply remembering when and how often to take your prescription.

As part of your pharmacy care team, we are dedicated to helping you manage your medications so you can live a healthy life. Here are 5 tips for improving medication adherence:

1. Set a reminder: Forgetfulness is the leading cause of non-adherence. Set an alarm on your phone or use a weekly pill organizer to remember when to take your medication, and include a note on how to take your medication (on an empty stomach, with water, with food, etc.)
2. Understand your medication: Understand how your medication works and why it is important to take it as prescribed. Ask your physician or pharmacist follow-up questions about anything you don’t understand. The more you know, the more likely you are to stay on track.
3. Know what happens if you miss a dose: What happens when you don’t take your medication as prescribed? Sometimes it sets back your treatment or can cause adverse effects or symptoms. If you do miss a dose, reach out to your pharmacist! Follow up with them as soon as you remember to minimize negative effects and get back on track.
4. Know your options: We understand that medication can be expensive, but there are things you can do to help reduce the cost to you. Call your health plan to make sure you are using a preferred pharmacy or to find out what medication alternatives are covered and available. If applicable, talk to your pharmacist about filling a 90-day supply, sometimes this can cost less than a monthly refill.
5. Plan ahead for refills:Get into the habit of checking your bottle for the number of remaining refills. Most pharmacies will call your doctor for you when refills run out, but it’s always a good idea for you to know when your prescription is coming to an end.