Influenza (flu) season can be unpredictable. In the United States (US), flu activity typically begins in October and peaks between December and February, but activity can even continue into May. Australia recently finished their winter where they experienced the most severe flu season in five years, and the season started earlier than usual. Although flu forecasting is not perfect, the Southern Hemisphere serves as a barometer for what might happen in the Northern Hemisphere. In the US, flu activity is elevated across the country.

COVID-19, which is still circulating, is generally mild for children. During the pandemic flu was virtually non-existent. This can be partly attributed to mitigation measures such as handwashing, masking, distancing, as well as remote school, work, and limited travel. The flu hiatus also translates into less pre-existing immunity to influenza due to lack of exposure – from natural infection or vaccines – particularly notable in younger children who may have never been exposed to flu. Further, there is currently a surge in pediatric respiratory syncytial virus (RSV) cases and hospitalizations. Children and the elderly are among the populations at higher risk of influenza complications. With pre-pandemic activities resuming and school back in-person, flu is making a comeback this season.

According to the Center for Disease Control and Prevention (CDC)’s FluView (a weekly US influenza surveillance report), influenza-like illness (ILI) activity is elevated across the country. The CDC’s interactive map offers a visual picture of outpatient ILI activity in the US and links out to state-level information. Additional data such as hospitalization and mortality surveillance are also captured on the CDC’s site.

The best protection against the flu is prevention. The CDC recommends an annual flu vaccine for everyone ages ≥6 months old with rare exceptions. The ideal time for the flu shot is in September or October, and it can be offered throughout the season, as long as flu viruses are circulating. It takes about two weeks after vaccination to develop protection against the flu. New this year, all available flu vaccines in the US are quadrivalent, meaning they contain two influenza A and two influenza B virus antigens, thus designed to protect against four flu viruses. The dominant strain is currently influenza A (H3N2), which is especially tough on the elderly. Also new this year, is a preferential recommendation from the CDC Advisory Committee on Immunization Practices (ACIP) for high-dose, adjuvanted, or recombinant vaccine over other flu vaccines for adults ≥65 years old.

To find a flu vaccine provider, visit vaccines.gov. The flu and COVID-19 vaccines can be given at the same time. Prescription flu antiviral medications to treat flu are currently available. Remember, good hygiene and self care are critical in fighting the flu and a number of other viruses, so wash hands, cover your cough, rest, and stay home when sick.
As the flu continues to unfold this winter, prevention, awareness, and health literacy are key to being prepared.

Disclaimer: The content in this blog is not a substitute for professional medical advice. For questions regarding any medical condition or if you need medical advice, please contact your healthcare provider.

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

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, a lack of diversity and cultural competence among mental healthcare providers, 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”

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.

Magellan Federal honors military caregiving children through a commitment to Hidden Helpers Coalition

Military Appreciation Month is celebrated in May and is a special month for those in and out of uniform. Throughout the month we celebrate Memorial Day (May 30), Military Spouse Appreciation Day (May 6), and Armed Forces Day (May 21). But did you know that it is also Month of the Military Caregiver?

Month of the Military Caregiver

The Month of the Military honors more than five million self-identified caregivers in the United States. By observing Military Caregivers, we can raise awareness and support for both wounded warriors and the people who care for them. Many of those caregivers are children, who have largely been unrecognized and unsupported—until now.

Honoring Military Caregiving Children

There are 2.3 million children of injured, ill, and wounded service members and veterans who play a crucial role in caring for their loved ones.

Magellan Federal has joined the Elizabeth Dole Foundation’s Hidden Helpers Coalition, a group of more than 60 organizations committed to recognizing the service of military caregiving kids and enhancing support services available to them. As a Coalition member, we have pledged to engage our nation’s health care providers to create a new national model of support for caregiver children within medical institutions to ensure that the physicians, nurses, and mental health and allied health professionals better understand and address the unique challenges military children face at every stage of their development.

Through the work of targeted sub-committees, the goal of the Hidden Helpers Coalition is to create a comprehensive framework of best practices, impactful tools, and action steps focused on supporting the overall well-being and long-term positive outcomes of Hidden Helpers and their families. Through this holistic approach, the coalition will develop baseline best practices for the ecological systems that impact Hidden Helpers.

This commitment reinforces what we do here every day at Magellan Federal — supporting the behavioral health of military service members, veterans, civil servants, and their families — and is just one example of how we give back to the military community beyond our everyday work.

If you or your organization is interested in supporting military caregivers, I encourage you to stand with us to make a difference by reading more at Hiddenheros.org 

Have you heard that the world of cervical cancer therapy is evolving? There are two players who recently stepped onto the field of oncology for the treatment of recurrent, metastatic, or persistent disease. In 2021, FDA approval moved Keytruda® (pembrolizumab) from second-line to first-line therapy in PD-1 positive patients. Tivdak™ (tisotumab vedotin-tftv) also obtained FDA approval as second-line and subsequent therapy in the same space.

Why is the approval of two therapies in the same year significant? Since the 2014 approval of bevacizumab, no new first-line therapy for cervical cancer has hit the oncology market, and prior to bevacizumab, the last new approval in the category was the combination therapy with topotecan and cisplatin in 2006. So Keytruda and Tivdak are possible game-changers for patients!

From 1975-2010, new diagnoses of cervical cancer have decreased by more than 50% due to screening. With the introduction of the HPV vaccine in 2006, there was hope that HPV infection prevention would lead to decreased cervical cancer cases. In 2020, a Swedish study published in the New England Journal of Medicine found that the quadrivalent HPV vaccination was associated with a significant reduction in the risk of invasive cervical cancer. In 2018, there were 293,394 women living with cervical cancer in the U.S. As cervical cancer cases decline, according to SEER data, there were an estimated 14,480 new cases and 4,290 deaths reported in 2021. The total annual medical cost of cervical cancer care is estimated to be $1.6 billion. Due to its move from second to first-line, Keytruda will likely demonstrate a net neutral effect on the budget. A forecasted cost impact model for Tivdak is demonstrated below:

Do psilocybin, MDMA, LSD, ketamine, and cannabis sound familiar as medication therapy to help treat mental illness? It goes without saying that the pandemic has intensified mental health symptoms in the United States (US), turning an urgent matter into a crisis. One in 5 American adults suffers from mental illness, with young adults ages 18 to 25 years reporting the highest prevalence. These numbers speak volumes. Some treatment options do not adequately treat patients with mental illness and are associated with significant side effects. This underscores the need for more effective treatments. Because of these factors, psychedelics and other psychoactive substances are gaining momentum as possible alternatives.

Psychedelics are a “mind-manifesting” hallucinogenic class of psychoactive compounds that affect perception. They have been used by ancient civilizations for medicinal purposes and religious rituals for thousands of years. There is a renewed interest in using psychedelics to treat mental disorders driven by global research, influencers, education, and patient voices. Philanthropy has been the main funding source for psychedelics. However, a recent federal grant to Johns Hopkins Medicine to study psilocybin for tobacco addiction may signal a sea change in federal funding of psychedelic research.

While small-scale clinical trials have been promising, for psychedelics to become mainstream, large-scale randomized controlled trials are needed to fully evaluate their safety and efficacy. Studies are underway through several leading centers including MAPS – the Multidisciplinary Association for Psychedelic Studies – a non-profit dedicated to psychedelic research.

Psychedelics are not currently approved as prescription medications. Notably, the US Food and Drug Administration (FDA) has given Breakthrough Therapy designation to two psychedelics – MDMA-assisted psychotherapy for post-traumatic stress disorder (PTSD) and psilocybin-assisted therapy for treatment-resistant depression (TRD) and major depressive disorder (MDD). FDA’s Breakthrough Therapy is designed to “expedite the development and review of drugs which may demonstrate substantial improvement over available therapy.” As clinical trials progress, 2023 could bring regulatory approval for the MAPS’ MDMA-assisted psychotherapy for PTSD, a potential turning point in the mental health treatment paradigm.

Patients with mental health illnesses deserve to heal and restore balance to their lives without stigma and judgment and deserve treatments that are safe and efficacious. Step into Magellan’s Clinical Insights for the role of psychedelics in treating mental health conditions. This industry-first paper explores the current evidence, regulatory, and legislative landscape for psychedelics and shares Magellan’s four pillars on emerging therapeutic frontiers. We are guided by four principles:

• Education and thought leadership for patients, payers, providers, and stakeholders while addressing the stigma around mental health
• Evidence-based clinical recommendations and coverage
• Patient safety by advocating for quality standards
• Access that is responsible and sustainable

Disclaimer: The content in this blog article is not a substitute for professional medical advice. For questions regarding any medical condition or if you need medical advice, please contact your healthcare provider.

Twenty twenty-two is here, with all its possibilities and opportunities. You may be wondering how you will achieve all of your personal and professional goals this year. Your mental health in 2022 may hold the key to success. Read on for tips from Magellan Healthcare’s behavioral health experts to help you prioritize your mental health in the new year.

1. Spread out New Year’s resolutions over the year – At the beginning of the year, people usually try to accomplish too many resolutions all at once. They are quickly overwhelmed and give up. Instead, create a list of resolutions, or goals, to implement–one per month–over the year. Spreading out goals and focusing on one at a time will feel more consistent with lifestyle change than the usual New Year’s start and stop. – Candice Tate, MD, MBA
2. Plan things to look forward to – Having a daily routine is important for our mental health. It limits the chaos and helps us feel grounded. But it can get boring, especially during COVID-19 when we are closed in. Schedule things to look forward to for the upcoming weeks and months. Maybe schedule a day trip on a weekend, a few hours in the evening to watch a movie, or a phone/Zoom call with an old friend, make a reservation at your favorite restaurant or plan to place a delivery order. Choose things that make you feel good. – Linda Evans, MD, FAPA
3. Limit screen time and media exposure – Social media has been a much needed lifeline for so many of us during the pandemic, but it’s essential that we remember to limit our screen time and exposure to content that can be emotionally distressing or traumatizing. Make a habit of putting your mobile device down and stepping away from your computer to enjoy the people, plants or pets in your environment. Go outside, take a walk, and get some fresh air and sunlight. – Rakel Beall-Wilkins, MD, MPH
4. Learn that “no” is a complete sentence – You cannot pour from an empty cup. Saying yes to every request asked of you when you are already limited on time, energy or resources can increase stress levels. Putting your needs on the backburner is not healthy for you. Being a “yes” person sometimes equates to saying “no” to your own mental health. Recognize not only when to say no, but that you don’t have to feel guilty about it… It’s all about saying yes to you! – LaShondra Washington, MD, DFAPA
5. Measure something – Our perceptions often do not match the reality of a situation but picking something to measure that is related to a concern can help better align our perceptions to reality. And if the results of the measurements indicate that indeed perception and reality are aligned, then continued measurement, after an intervention, can determine the usefulness of the intervention on the measure. In other words, take steps to find out if what is bothering you is really a problem, and if it is, then make a change and reassess. – Louis Parrott, MD, PhD
6. Engage in journaling – Journaling is an effective way to manage stress and feelings. It can be cathartic to write about feelings and experiences. It is also a way to monitor your inner self and when it may be necessary to seek professional help. – Samuel Williams, MD, MBA, FAPA
7. Practice gratitude – Share gratitude with others and write three things you are grateful for every day. According to Jon Kabat-Zinn, PhD, an internationally known mindfulness advocate, we should ask ourselves three questions each day that relate to our relationships with family, friends, and co-workers: What have I received from __? What have I given to __? What troubles and difficulties have I caused? – Doris Lebischak, MD
8. Establish an attainable plan for regular physical activity and stick to it – Start with one or two days of exercise a week. Plan the days, times, and activities and commit to making it happen. Exercise is proven to reduce depression, anxiety, and negative mood.[1] – Greg Dicharry, CPRP
9. Consider expanding your exercise routine – As we age, our muscles must be challenged to maintain strength. Including strength training, stretching and physical activity that raises the heart rate in our workouts will have an immediate impact as well as long-term benefits for the body and mind. – Paula Hensley, MD
10. Eat a balanced diet with as many unprocessed foods as possible – Include colorful fruits and vegetables and prepare food in healthier ways like steaming and roasting rather than frying. If applicable, include children in meal selection and preparation, and eat at least one meal per day as a family. Try not to place food into strict bad and good categories, and understand that you are not–accordingly–bad or good depending on what you eat. It’s important to eat a balanced diet for your lifestyle. – Misty Tu, MD
11. Prioritize sleep – Push through busy schedules and life’s distractions to maintain eight hours of sleep each night and experience how it helps you think more clearly, feel better and be better able to creatively juggle the multiple demands of family, work, and beyond. – Barbara Dunn, LCSW, ACSW
12. Develop a cue that ends your workday – Whether it is pausing to watch the sunset, moving your body for 20 minutes, or ceremonially closing the door to your workspace, disconnecting from work to focus on rest, joy, or family responsibilities is a necessary way to prioritize mental health in 2022. – Dana Foglesong, MSW, NCPS, CRPS
13. Make sure to prioritize yourself – In a time when kids are home, work is piling up, and there is growing uncertainty in and outside of our homes, it’s unfortunately easy to get lost in all we have going on. But it’s vital we prioritize ourselves. Whether it’s going on a walk or other exercise, meditation, talk therapy, weekly dinner with friends or family… don’t ever forget to put yourself first because your mental health is wealth. – Yagnesh Vadgama, BCBA
14. Ask for help when you need it – Recognize that no one person can do everything. Family, friends, and neighbors can be great resources, so ask for what you need and offer help to them when you can. – Kathryn Kvederis, MD, DFAPA
15. Remember that you are not alone – One in five American adults has a mental illness and one in 18 American adults has a serious mental illness; one in six American youth has been diagnosed with depression.[2] Despite all of the glittery images we may see and our perceptions that others have it better, it’s likely that we have family members, friends, and co-workers who are right there with us when we aren’t feeling our best. – Keith Brown, MD

As we sail into a bright new year, with 2021 in the rear-view mirror, let’s remember to prioritize ourselves and our mental health. We have all experienced the trials and tribulations of a tumultuous previous two years. If we have learned anything, it’s that our mental health in 2022 is what will keep us strong and poised for happiness and success.

Visit MagellanHealthcare.com/BH-Resources for free information and tools to address mental/behavioral health needs and spread awareness to reduce stigma. Stay tuned here and on our calendar for updates on our virtual events throughout the year.

[1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1470658/

[2] https://www.samhsa.gov/data/release/2020-national-survey-drug-use-and-health-nsduh-releases