Introduction

Given these extraordinary times, “resilience” has become a very popular word used to refer to a capacity that can be developed in people to withstand disruption or recover from adversity more quickly and completely. It is important to ensure teams remain ready and able to adapt to increasing demands. Historically, more pressure is put on leaders, especially those who need their teams to continue to perform at a high level when it matters most.

In our experience, organizations and their leaders truly care about their employees and understand that while some individual skills can be self-developed, leaders themselves need tangible strategies to create conditions for resilience development and thriving. If a leader has the tools first, then it is easier to set a good example and have a foundation for transferring these skills to their teams.

Magellan Federal delivers cognitive training and coaching services to over 700,000 Department of the Army personnel and civilians each year. We have gained valuable expertise and insights on implementation strategies that can enhance resilience development. In this white paper, we will detail our unique approach based on experience implementing systems that embolden leadership to invest in their most important asset—their people.

The Problem

Quite often, people are promoted into leadership positions because they excel at their job, which intuitively makes sense since they are likely to be top performers at what they do. What we find overlooked is whether people are ready to lead and influence other people. When they get into a leadership role something shifts and they can’t quite do what you thought and hoped they could.

Additionally, leaders face higher demands than the general worker population because they are responsible for their own performance plus those they lead. It is not uncommon to observe these individuals with higher levels of cortisol, an indication that their bodies are not adapting well to these demands. The ability to respond favorably following increases in demands is an essential quality for sustained readiness in a leadership position. Resilience is a term often used to label this quality, but resilience is a complex concept that is often misunderstood, and therefore treated reactively, not proactively within organizations.

Resilience is personal

Resilience can be defined as resources and processes that combine to restore equilibrium, counter challenges, or transform an individual or group. Resilience is a dynamic construct made up of personal and environmental factors such as hardiness, grit, self-efficacy, social support and other lived experiences and learning that combine uniquely for an individual response. Essentially, we all respond very differently to demands and challenges based on a multitude of individual and social resources. Given that these unique resources and processes are able to be influenced, resilience can change and develop over time.

Since leaders generally experience higher demands and resilience is malleable, Magellan Federal believes it is essential to equip leaders with methods to enhance positive adaptation following adversity, laying a solid foundation for increased resilience across the entire workforce.

Our Solution — Human-Centered Leader Training

Resilience is teachable

Research is clear that leaders play a significant role in the performance, resilience, and wellbeing of their people. Therefore, targeted training and coaching for leaders can be a force multiplier for a resilient workforce.

Our depth of knowledge in the science of cognitive performance is broad and deep, particularly in the psychophysiological mechanisms of learning, thriving, and resilience. We have learned it is valuable to first train leaders, so they are equipped to be resilient themselves and better positioned to support their teams. Leaders then need to be supported and coached how to transfer resilience principles to their peers and subordinates.

Our successful coach-the-coach approach has three tenets: Leading Self, Leading Others, and Leading Teams.

• Leading Self: Helps ensure a wider swath of potential future leaders has the self-management skills which are foundational for Leading Others, particularly through volatility, uncertainty, complexity, and ambiguity. Principles include:
  • Personal philosophy, values, and core beliefs (self-awareness)
  • Fueling behaviors and restoration (diet, hydration, movement, sleep)
  • Presence (mindfulness, authenticity, confidence)
  • Psychophysiological regulation (readiness for the task and situation)
  • Mental rehearsal (intentionality, deliberate practice, imagery)
  • Self-motivation
• Leading Others: Provides new and seasoned leaders the opportunity to develop a deeper understanding of the human side of leadership and how to have the most beneficial impact on the lives of those they lead. Principles include:
  • Build trust (consistent discipline and follow-through through the ability to lead self)
  • Develop psychological safety (transparency and vulnerability, applying presence in communicating with others)
  • Promote growth (feedback, mentoring, peer support)
  • Foster motivation (autonomy, supportive leadership, behavior)
• Leading Teams: Provides senior leaders a necessary opportunity to reflect and recalibrate their internal compass, adjust their approach to leading others at a larger scale, and align both with the goals of the organization so they can move forward with increased intentionality and commitment. Principles include:
  • Executive messaging, modeling, implementing and promoting performance psychology principles across the enterprise
  • Building trust in relationships (consistency in Leading Others across the organization)
  • Mental agility, situational awareness, pattern recognition (consistent yet adaptive)
  • Authenticity & Alignment
  • Cultural awareness and sensitivity

Guidance for Organizations

Focus on manager training and support

Meaningful growth requires the transfer of knowledge, demonstration, practice, feedback, adjustment, and repetition. Expertise is accelerated with the support of a coach who can provide both the right level of challenge or adversity and effective feedback to unlock solutions to overcome these challenges and facilitate growth. We have found our greatest success when we take a human-centered approach, arming leaders not only with foundational knowledge communicated with stories and science, but coaching through authentic interactions.

Organizations should support their leaders by:

• Training leaders on general learning principles and how to effectively teach psychological and interpersonal skills to their teams.
• Providing leaders ongoing coaching support in the following areas for improved thriving and resilience:
  • Establishing a secure base
  • Facilitating connection
  • Building and sharing meaning
  • Enabling growth
  • Reinforcing work-life flow
• Using a holistic approach that values principles of physical fitness, mental fitness, social fitness, and spiritual fitness, as well as targeting opportunities for change by leading self, leading others, and leading teams.

Providing growth opportunities in these areas will fill an often much-needed gap—the human dimension of leadership.

Guidance for Leaders

Based on our experience, we recommend starting with these individual steps to build a more resilient workforce:

• Develop deep personal awareness (e.g., purpose, vision, mission, motives, beliefs)
• Develop personal and team mindfulness practices
• Build systems and practices that help you be intentional with time, both yours and your team members
• Establish regular, if not daily, check-ins with team members
• Develop an understanding of what drives your team members
• Celebrate, cultivate, and grow team members strengths
• Express gratitude authentically and liberally
• Learn and respect team members’ boundaries
• Recognize and address the role of emotion and empathy in the workplace
• When facing change or adversity, reinforce a sense of community and shared meaning

Innovating for the Future: Digital Coaching & Mentoring

Many thought leaders in human performance and resilience lead with high-tech solutions and simulation exercises to accelerate learning and optimize performance. While there is utility in technological advancements, we firmly believe in the power of trusted relationships and high-touch engagement.

Magellan Federal recently piloted a digital training and coaching intervention with midlevel managers in the corporate space. The overwhelming majority noted a desire for ongoing human engagement both with an outside expert coach and with a community group. Unsurprisingly, these leaders felt a strong sense of investment in themselves as people but understood how the content, strategies, techniques, and skills would apply in both their work and personal lives.

We are engaged in product development of digital coaching and mentoring technology that will allow for follow-on support with tactical personnel as they rotate duty stations, deploy, or otherwise distribute geographically. We understand that trust is the bedrock of personal and professional development, and that trust is a uniquely human, high-touch phenomenon. Our vision for the near future is service provision that begins human-centered, customized to the client, augmented with technology that allows our coaches and mentors to remain connected and engaged beyond the training environment, affording individual leaders more timely, relevant coaching feedback.

If you are interested in learning more about Magellan Federal’s Resilience training program, please contact our director of human performance, Dr. Jon Metzler, at metzlerjn@magellanfederal.com.

For a downloadable version of this whitepaper, visit MFed Inform.

The role of being a leader is one that is of foremost importance to Paul Messier. As Senior Director of Federal Program Management, Messier, who has been with Magellan Federal since April 2014, works on programs that provide HR services to military members and their families. He is one of three Senior Directors assigned to the Human Readiness Division (HRD), where he leads six contracts that include 310 people located at 75 Army and Navy military bases around the world.

Messier shows pride in his leadership role by pointing out that everything in the Federal service delivery contracts is designed to ensure the human readiness of Service members and their families. He also points out that the same elements of human readiness that apply in delivering operational excellence to customers are relevant when engaging with Magellan’s own employees in a culture of servant leadership. “Just as military members and their families are serving our Nation; our federal employees and their families are also serving our Nation in their respective military communities. If we expect our employees to address the human readiness needs of their customers, then we as leaders have an obligation to attend to the basic human readiness needs of our work force. From that perspective, human readiness has a double meaning to me – one is operational and the other is organizational.”  Continue reading to learn more about Messier’s work with the Human Readiness Division and what being a leader means to him.

What cool, innovative projects are you currently working on?

Right now, I’m focused on developing a new leadership model for our division. This is a reality-based, relationship-driven leadership approach that emphasizes bringing our most authentic selves to the workplace and creating more welcoming environments for our employees that foster trust and transparency. It’s an intentional effort to promote the health, well-being, and overall human readiness of our employees by integrating leadership principles and practices across four key domains:

• Practicing authentic servant leadership that emphasizes emotional and cultural awareness.
• Promoting a healthy work environment that fosters unity and cohesion for world-class service delivery.
• Providing continuous professional development through mentoring and coaching of the workforce.
• Encouraging shared governance that empowers employees to inquire, innovate and make decisions to the maximum extent within their professional scope of practice, and recognize them for their achievements.

I think there is a need for a model that offers a framework and training tool for sharing these leadership principles with our mid-level and junior leaders.

Why is Magellan Federal the best place to do these kinds of innovative projects?

I believe that when we consider our overall strategy of bringing products and services to the marketplace, we should always focus on being compelling, contemporary, and competitive. So, when I think about our collective role as leaders, I think about how we can apply these same principles to leadership. In these uncertain times, employees are asking for more from their leaders and seeking a healthier work-life balance. If we want to reach the hearts and minds of our employees and retain our human capital, we’ve got to find the courage to show them our own hearts and minds…show them who we are and how much we care for them.  If we can do that, then our message will indeed be compelling, contemporary, and competitive.

What are your thoughts on Magellan’s culture? How has the culture impacted your projects?

Magellan Health and Magellan Federal leaders have enhanced our culture by opening an atmosphere of transparency. That culture will be propagated if leaders replicate positive messaging by flowing it down the chain and engaging with our employees. Leaders cope with change, and more change always demands more leadership. We have the right leaders in place and the messaging channels and mediums are fully evolved and robust.  The stars are aligned for a new leadership model that we can share with our junior leaders and employees. Our corporate vision emphasizes leading humanity to healthier, vibrant lives, so I believe our organizational culture should also emphasize leading our own employees to help them achieve healthier, vibrant lives.  That’s what gets me excited about leading my projects.

What trends are you noticing in the healthcare industry that are related to the work being done at Magellan Federal? Are there any lessons from other industries that can be applied to the work happening at Magellan Federal?

I see many positive trends, but I also see that the healthcare industry faces many of the same challenges as an industry in general. There are remarkable things happening with innovative technologies such as artificial intelligence and digital apps that show great promise to improve healthcare outcomes.  But there are also issues and trends involving burnout of physicians and caregivers, and politicization of healthcare. What I try to do is learn the lessons I can from what I see happening around me and apply what I’ve learned as best I can when I engage with my own employees. To me, the common denominator when we look at these issues always seems to circle back to the need for authentic, reality-based leadership.

Learn more about the various solutions provided by Magellan Federal here.

Millions of people are affected by mental health conditions each year. Unfortunately, more than half of them either delay seeking treatment or do not get help at all due to the associated stigma. Stigma causes people to feel ashamed, be concerned about being treated differently, or fear the loss of their livelihood due to something that is out of their control.

Mental health stigma is among the factors contributing to Black, Indigenous and People of Color (BIPOC) being less likely than White people to receive treatment.[1] In 2020, 5.7% of Asian Americans, 9.4% of Black people or African Americans, and 10.7% of Hispanic or Latinx people received mental health services, compared to 21% of White people.[2]

What you can do

With compassion and support, people can recover and lead happier, healthier lives. Treatment is available and recovery is possible. But overcoming stigma is a critical first step in the process.

The National Alliance on Mental Illness (NAMI) offers some suggestions about what we can do as individuals to help reduce the stigma of mental illness:

1. Talk openly about mental health—and discuss it no differently than physical health.
2. Show compassion for those with mental health challenges.
3. Be conscious of language—remind people that words matter.
4. Educate yourself and others—respond to misperceptions or negative comments by sharing facts and experiences.
5. Encourage equality between physical and mental illness—draw comparisons to how they would treat someone with cancer or diabetes.
6. Be honest about treatment—normalize mental health treatment, just like other healthcare treatment.
7. Let the media know when they are presenting stories of mental illness in a stigmatizing way.

Additional mental health support and resources for BIPOC

On July 20 Magellan Healthcare hosted a webinar, “Navigating mental healthcare: Unique challenges faced by the BIPOC community,” for BIPOC Mental Health Awareness Month. Watch a recording of the webinar as we explore different roles in behavioral healthcare and overcoming stigma to help BIPOC feel more knowledgeable and comfortable about reaching out for help: https://www.magellanhealthcare.com/event/navigating-mental-healthcare/.

Visit Magellanhealthcare.com/BIPOC-MH for more information and resources covering racism, stigma and more for BIPOC mental health.

[1] “Mental Health Disparities: Diverse Populations” American Psychiatric Association

[2] 2020 SAMHSA National Survey of Drug Use and Health (NSDUH) Adult Mental Health Tables

The new 988 Suicide and Crisis Lifeline launched on July 16, 2022. With 988, it’s now easier than ever for anyone experiencing mental health-related distress–whether that is thoughts of suicide, a mental health or substance use crisis, or any other kind of emotional distress–to seek immediate help.

The new 988 dialing code operates through the existing National Suicide Prevention Lifeline (the Lifeline) network of over 200 locally operated and funded crisis centers across the U.S. People can now access a strengthened and expanded Lifeline via 988 or the existing 10-digit number (which will not go away).

In this post, we’ll continue the introduction of the new 988 Suicide and Crisis Lifeline and provide additional resources for you to learn more and be prepared if you or someone you know experiences a mental health crisis.

What is 988?

Beyond being an easy-to-remember number, 988 provides a direct connection to trained, compassionate and community-based crisis counselors for anyone experiencing mental health-related distress–whether that is thoughts of suicide, a mental health or substance use crisis, or any other kind of emotional distress.

Who can use 988?

988 services are confidential, free and available 24/7/365 for anyone experiencing a mental health, substance use or suicidal crisis. And 988 isn’t just for you. People can also dial 988 if they are worried about a loved one who may need crisis support.

How are 988 services accessed?

The 988-dialing code is available for call (multiple languages) or text (English only), and chat services (English only) can be accessed at 988Lifeline.org. 988 services are available through every landline, cell phone and voice-over-internet device in the U.S.

 How is 988 different from 911?

The focus of 988 is to provide easier access to the Lifeline network and related crisis resources, which are distinct from 911, where the focus is on dispatching Emergency Medical Services, fire and police, as needed.

Why was 988 created and where can I get more information?

Congress designated the new 988 dialing code in 2020 to improve access to crisis services in a way that meets our country’s growing suicide and mental health-related crisis care needs. The Substance Abuse and Mental Health Services Administration (SAMHSA) is the lead federal agency, along with Vibrant Emotional Health (operational home of the National Suicide Prevention Lifeline), in partnership with the Federal Communications Commission and Department of Veterans Affairs, to make 988 a reality in the U.S.

SAMHSA provides comprehensive resources for anyone to learn more about 988, suicide prevention and mental health crisis services at   SAMHSA.gov/988.

Is my state ready for 988?

States are at varying degrees of readiness for the volume increases expected from moving to the 3-digit code, 988. The federal government is responding to resource challenges with unprecedented levels of funding and an all-of-government approach to partner with state and local leaders to improve system capacity and performance.

Find additional information and materials on suicide prevention at MagellanHealthcare.com/Prevent-Suicide, and stay tuned for our September Suicide Prevention Awareness Month campaign and free webinar.

Sign up to receive updates a few times a month from Magellan on free behavioral health resources you can use and share with family, friends and colleagues here.

Sources: SAMHSA and the National Action Alliance for Suicide prevention

Magellan Healthcare is a proud supporter of BIPOC Mental Health Awareness Month in July. BIPOC is an acronym for Black, Indigenous and People of Color that aims to empower groups formerly identified as “minority” or “marginalized.”

In this post, we’ll discuss BIPOC mental health and barriers to care. You can learn more by watching a recording of our webinar, “Navigating mental healthcare: Unique challenges faced by the BIPOC community,” here.

Prevalence of mental health conditions among BIPOC communities

BIPOC face unique stressors that increase mental health vulnerability. Racism and discrimination are consistently found to be associated with poorer mental health.[1]

The Substance Abuse and Mental Health Services Administration (SAMHSA) reports the prevalence of mental health conditions among BIPOC:[2]

BIPOC adults (prevalence of any mental health condition)

• 32% Two or more races
• 19% American Indian and Alaska Native
• 18% Hispanic or Latinx
• 17% Black or African American
• 17% Native Hawaiian and Other Pacific Islanders
• 14% Asian American

BIPOC youth (prevalence of depression)

• 21% Two or more races
• 17% Hispanic or Latinx
• 15% Asian American
• 12% American Indian and Alaska Native
• 11% Black or African American
• (data not available) Native Hawaiian and Other Pacific Islanders

Barriers for BIPOC in accessing mental healthcare

BIPOC are less likely to receive treatment for mental health or substance use conditions.[2] In 2020, 5.7% of Asian Americans, 9.4% of Black people or African Americans, and 10.7% of Hispanic or Latinx people received mental health services, compared to 21% of White people.[2]

Research indicates, compared with people who are White, people in BIPOC communities are:[3]

• Less likely to have access to mental health services
• Less likely to seek out treatment
• More likely to receive low or poor quality of care
• More likely to end services early

Several factors contribute to BIPOC being less likely to receive treatment for mental health or substance use conditions, including a lack of insurance or underinsurance, mental illness stigma, language barriers and distrust in the healthcare system.[4]

Increasing awareness of the issues people of color and those in marginalized communities face helps reduce stigma so those with mental health concerns can get the help they need to thrive in their lives.

On July 20 Magellan Healthcare hosted a webinar, “Navigating mental healthcare: Unique challenges faced by the BIPOC community,” for BIPOC Mental Health Awareness Month. Watch a recording of the webinar as we explore different roles in behavioral healthcare and overcoming stigma to help BIPOC feel more knowledgeable and comfortable about reaching out for help: https://www.magellanhealthcare.com/event/navigating-mental-healthcare/.

[1] “Racism as a Determinant of Health: A Systematic Review and Meta-Analysis”, “Self-Reported Experiences of Discrimination and Health: Scientific Advances, Ongoing Controversies, and Emerging Issues”, “Discrimination and Subsequent Mental Health, Substance Use, and Well-being in Young Adults”

[2] SAMHSA 2020 National Survey of Drug Use and Health Adult and Youth Mental Health Tables

[3] Counseling Today, “The historical roots of racial disparities in the mental health system”

[4] American Psychiatric Association, “Mental Health Disparities: Diverse Populations”

“Our obligation to act is not just medical—it’s moral.”
Vivek H. Murthy, M.D., M.B.A. Vice Admiral, U.S. Public Health Service, Surgeon General of the United States

To support the Surgeon General’s recent advisory related to protecting youth mental health issues exposed by the COVID-19 pandemic, Magellan Federal offers best practices for professionals specializing in behavioral issues to foster the wellbeing of our military families.

Magellan Federal directly supports the mental health and resiliency of military youth and families, serving over 4.5 million service members and families a year. Read more about risk factors and recommendations in our whitepaper here.

Stacy Drones’, senior director of family programs at Magellan Federal, passion for helping military families comes from her real-life role as a military spouse. Since joining Magellan Federal in 2013, Drones now supervises a large array of military family programs including the Army Family Advocacy Support Services which includes the Domestic Abuse Victim Advocacy Program and New Parent Support Program, Army Exceptional Family Member Program and the Air Force Family Advocacy Program contracts. Drones is currently working on initiating various trainings for employees to better help the military families they serve in their unique situations. Continue reading to learn more about the many projects happening at Magellan Federal during Military Appreciation Month this May:

What can you tell us about Magellan Federal?

Magellan Federal has a strong history of support to the military. A lot of our employees on our contracts are military spouses, former military spouses or veterans who are passionate about the work. Many of our leaders at Magellan Federal have been in some way connected to the military, this is important and shows we have a passion for the work that we do because of our connection with service members and their families. My team has historical knowledge of our programs and we’ve been working with the government clients for a long time and know what they’re looking for and know how to execute the contracts successfully in the programs.

What cool, innovative projects are you currently working on?

The main part of my job involves managing our portfolio of programs that support military families. I personally manage the Family Advocacy Support Services contract for the Army which includes the Army Domestic Abuse Victim Advocacy Program that provides services for victims of domestic abuse. This contract also includes the New Parent Support Program that offers home visits to provide help and educational resources for new parents. This program provides licensed clinical social workers, marriage and family therapists and registered nurses to work with military families with children who are newborn up to age three. They conduct regular home visits to offer education that helps to prevent child abuse. We also have a lactation contract with the U.S. Food and Drug Administration that hosts monthly lunch seminars for mothers who are nursing. In addition, we serve as a subcontractor for a family advocacy program at Food Hood where we provide information on stress management, parenting, couples communication, relationship classes and domestic abuse. I also oversee other contracts assigned to other program managers like the Army Exceptional Family Members Program, that provides help to military families who have dependents with disabilities and connects them with referrals and resources in the community. There’s also the Air Force Advocacy contract that we’re a subcontractor on that provides domestic abuse advocates for members of the Air Force.

On the Family Advocacy side, we do at least two employee professional development trainings a year. Planning those trainings and brining in speakers from all over is our big focus right now. Government employees are welcome to participate as well. We also have a requirement to have all victim advocates credentialed through the National Advocacy Credentialing Program. Although this is a new government requirement, Magellan has had this requirement in place for our Victim Advocates for nine years. We are currently helping our government client roll this training out to the government Victim Advocates.

In the New Parent Support Program, we are currently training our home visitors on how to address sensitive topics with their clients, such as mental health, abuse and race. They’re also trained on how to help parents and caregivers deal with the unexpected, such as deployments, birth plan changes or giving birth to multiples.

What are your thoughts on Magellan’s culture? How has the culture impacted your projects?

I love this company and the leadership; I think they’re very supportive of what we do. I feel that Magellan’s leadership really cares for their employees and cares about what we’re doing and how we’re doing it.

What trends are you noticing in the healthcare industry that are related to the work being done at Magellan Federal? Are there any lessons from other industries that can be applied to the work happening at Magellan Federal?

A big focus of the DoD Family Advocacy Programs currently is working with families of problematic sexual behaviors in children and youth. We have been looking at ways to intervene early and provide help for those children who are presenting those behaviors. We have our home visitors involved with this because they’re the ones working with the families in the home and have built a rapport with them. We’re increasing training for our home visitors to ensure they know the best way to help provide services to those families. The military has partnered with a lot of civilian agencies to provide trainings to help figure out how to address and solve the problem.

Magellan Federal understands that military families may have unique challenges compared to civilian families. That’s why we are doing what we can to develop partnerships with civilian agencies that have the funding to do research and develop correct programs. Initially, the development of the new Federal Program Management Office has been great for developing relationships with organizations. If we continue to do that, it’ll be a great thing.

Learn more about the various solutions provided by Magellan Federal here.

What a year it’s been for relapsed refractory multiple myeloma (RRMM)!!  The year has already ushered in an FDA approval of a second CAR-T therapy, Carvykti™ (ciltacabtagene autoleucel, cilta-cel), in February!  Last year we saw the approval of the first RRMM CAR-T therapy, Abecma® (idecabtagene vicleucel, ide-cel). Both are approved as a single dose after at least 4 lines of therapy, with many patients enrolled in each pivotal trial having received a median of 6 or more lines of therapy.

The FDA approval and NCCN 2A recommendation for both drugs is for patients who failed prior treatment with an anti-CD38 monoclonal antibody, a proteasome inhibitor, and an immunomodulatory agent. In the ide-cel trial, 92% of patients had received prior autologous stem cell transplant while in the cita-cel trial, 90% of patients had received prior autologous stem cell transplant and, of note, 8% had received a prior allogeneic stem cell transplant. Unfortunately, RRMM has no known cure for heavily pre-treated patients. That being said,  B-cell maturation agent-directed CAR-T cell therapies reported high response rates (ide-cel:  72% ORR [28% sCR; 25% VGPR]; cilta-cel: 97.9% ORR [78.4% sCR; 16.5% VGPR]) which were durable (median DOR: ide-cel 11 months; cilta-cel 21.8 months).

MM is largely a disease of the elderly with a median age of diagnosis being 69 years. In 2018, an estimated 149,956 Americans were living with MM.  The rate of new multiple myeloma cases is trending up, with an estimated 34,920 new cases diagnosed in 2021 (1.8% of all new cancer cases) and a projected 2,410 deaths.  Even though relative 5-year survival has increased over time, it has been 55.6% from 2011-2017.

Concerns around the monetary cost of CAR-T therapy continue.  Even though CAR-T therapy demonstrates high response rates and carry the hope of a sustained, durable response, how long will response last? What treatment(s) will follow?

CAR-T therapy is a single dose, with a significant high monetary cost. The medication wholesale acquisition price for ide-cel and cilta-cel is $419,500 and $465,000 respectively. In addition, the time to product availability and rate of manufacturer product failure remains a concern (ide-cel median availability of 33 days with a 1.5% failure rate; cilta-cel median availability of 32 days with an 18% failure rate). Another hurdle is the shortage of the lentiviral vectors used to deliver ide-cel. However, the manufacturer is working to increase production.  For cilta-cel, the manufacturer plans to make vectors in-house in order to meet longer-term demand.

A forecasted cost impact model is demonstrated below. With more than 8 CAR-T drugs in the pipeline for multiple myeloma, more for hematologic cancers, and the possible expansion from hematologic to solid tumor treatment, more contemplation is sure to follow.

References:

1. Martin T, Usman SZ, Berdeja JG, et al. Updated Results from CARTITUDE-1: Phase 1b/2Study of Ciltacabtagene Autoleucel, a B-Cell Maturation Antigen–Directed Chimeric Antigen Receptor T Cell Therapy, in Patients With Relapsed/Refractory Multiple Myeloma. ASH update 12 December 2021. https://ash.confex.com/ash/2021/webprogram/Paper146060.html. Accessed April 12, 2022.
2. Berdeja JB, Madduri D, Usmani SZ, et al. Ciltacabtagene autoleucel, a B-cell maturation antigen-directed chimeric antigen receptor T-cell therapy in patients with relapsed or refractory multiple myeloma (CARTITUDE-1): a phase 1b/2 open-label study. Lancet. 2021;398(10297):314-324 doi: 10.1016/S0140-6736(21)00933-8.
3. Carvykti [package insert]. Horsham, PA; Janssen; March 2022
4. Abecma [package insert]. Summit, NJ; Celgene; March 2021.
5. Munshi NC, Anderson LD Jr, Shah N, et al. Idecabtagene Vicleucel in Relapsed and Refractory Multiple Myeloma. N Engl J Med 2021;384:705-16. DOI: 10.1056 /NEJMoa2024850.
6. National Cancer Institute Surveillance, Epidemiology, and End Results Program. Cancer Stat Facts: Myeloma. Available at: https://seer.cancer.gov/statfacts/html/mulmy.html. Accessed April 12, 2022.
7. Kanas, G, Clark O, Keeven, K et al. Population-level Projections for Multiple Myeloma Patients by Line of Therapy in the USA. Poster No. 653 | Presented at the 62nd American Society of Hematology Annual Meeting and Exposition (Virtual Format) | December 5–8, 2020. https://d201nm4szfwn7c.cloudfront.net/5f95dbd7-245e-4e65-9f36-1a99e28e5bba/5b3ee4c1-c770-4504-9d91-08c64ae7bcc6/5b3ee4c1-c770-4504-9d91-08c64ae7bcc6_viewable_rendition__v.pdf?medcommid=REF–ALL-003261. Accessed 4-12-22.
8. Liu A. Johnson & Johnson, Legend’s CAR-T Carvykti enters myeloma ring with FDA nod. Fierce Pharma. Johnson & Johnson, Legend’s CAR-T Carvykti enters myeloma ring with FDA nod | Fierce Pharma. Accessed April 14, 2022
9. Osterweil N. Novel CAR T Therapy for Solid Tumors: ‘Exciting Advance’. 2022. https://www.medscape.com/viewarticle/972297. Accessed 4-19-22.