On January 31, 2020, the United States (US) issued a public health emergency for 2019 novel coronavirus (2019-nCoV), a new virus first identified in Wuhan City, Hubei Province, China. This comes on the heels of the World Health Organization (WHO) declaring the coronavirus outbreak an international public health emergency. The disease now called coronavirus disease 2019 (COVID-19), which is a new type of coronavirus without a vaccine or medications to prevent or treat it, has resulted in thousands of confirmed cases and hundreds of deaths in China. This human respiratory illness is moving quickly with cases reported in a number of other countries and continents. In the US, while the number of confirmed cases are currently low, safety measures are being enacted to keep the risk of transmission low. As ongoing investigations seek to learn more about this infection, US public health agencies have dedicated coronavirus sites. They actively update these sites as new information becomes available and communicate up-to-date guidance. 

• Centers for Disease Control and Prevention (CDC): https://www.cdc.gov/coronavirus/2019-nCoV/index.html
• Food and Drug Administration (FDA): https://www.fda.gov/emergency-preparedness-and-response/counterterrorism-and-emerging-threats/coronavirus-disease-2019-covid-19
• World Health Organization (WHO): https://www.who.int/emergencies/diseases/novel-coronavirus-2019

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.

Drones have been a part of military operations for decades as they have engaged in drone warfare and performed reconnaissance and surveillance missions. Civilian drones are popular with drone enthusiasts of all ages. Whether it is to take a hobby such as aerial photography or drone golf to the next level, keep the kids entertained, or to simply enjoy flying these unmanned winged vehicles, drones continue to trend on the hottest gift lists.

Zero emission unmanned aerial vehicles (UAVs) are already being utilized across a number of industries including reshaping search and rescue operations. Scores of emergency services including volunteer rescue teams, police officers, and firefighters deploy drones to save lives in natural disasters and to ensure public safety. Commercial drones are now going airborne and transforming healthcare services delivery, including the delivery of prescription medications.

On November 1, 2019, the United Parcel Service (UPS) drone delivery division, UPS Flight Forward (UPSFF), and CVS Pharmacy made the first commercial residential drone deliveries of prescription drugs in the United States (US). For the maiden flight, pharmacists loaded the drones with prescription medications at a CVS drugstore in Cary, NC. The Matternet M2 drones flew to nearby residences and slowly lowered the small packages to the ground from a hover height of about 20 feet over the properties. A remote drone operator was on standby to step in, if needed. One of the revenue-generating deliveries was made to a front lawn of a private home while the other to the public space at a nearby retirement home. Per UPS, one of the packages was delivered to a CVS customer with limited mobility, for whom traditional store pick up was a challenge. UPS drone deliveries are expected to fly on pre-planned routes, carry packages up to 5 pounds, and deliver in 5 to 10 minutes. Prior to these deliveries, UPS had deployed Matternet quadcopter drones in the hospital setting at the WakeMed Raleigh, NC hospital campuses for commercial transport of medical supplies. As of early November 2019, this business-to-business model had yielded over 1,500 revenue-generating deliveries at WakeMed, since launching in March 2019. UPS is already partnering with the drone logistics startup Matternet on its next iteration of delivery services to medical campuses.

What is remarkable about the UPS/CVS autonomous delivery in Cary, NC is that it was for prescription medications flown directly to a patient’s home. Wing, a drone delivery service owned by Google’s parent company Alphabet, has partnered with FedEx and Walgreens Pharmacy for a home delivery pilot for health and wellness products in the Christiansburg, VA community. In partnership with local merchants, Wing already has drone deliveries of goods available in select areas of Australia and Finland. In June 2019, Amazon’s drone operator system, Prime Air, announced its plans to launch a drone delivery service in the “coming months.” Amazon’s UAVs are expected to fly up to 15 miles and deliver packages under 5 pounds. According to Amazon, 75% to 90% of purchased items weigh less than 5 pounds. These drones will employ “sense and avoid” technology fueled with computer vision, machine learning algorithms, and artificial intelligence to navigate around obstacles such as trees, birds, power lines, people, and pets. Zipline, a CA drone startup, has been actively delivering lifesaving medical supplies including blood and vaccines in Rwanda and Ghana. Notably, Rwanda will be home to the world’s first “droneport” – an airport for drones.

“Drone-to-Door” delivery of prescription medications is a pharmacy quantum leap. This innovation opens the door to swiftly delivering medications at the point of need and can benefit an array of people. Immobility can be a barrier to getting medications for patients with disabilities or those who have sustained injuries because it can be difficult for these patients to get to the pharmacy. Likewise, it can be challenging for the elderly or parents with a sick child at home to make it to the pharmacy, and people who work or travel may not be able to conveniently access a pharmacy. Patients in assisted living facilities also benefit from drone delivery of life-saving medications directly to the site of need. With a number of independent pharmacies and smaller hospitals closing their doors, consumers in rural communities are left without access to vital prescription medications and medical supplies. Drones can rise to fill part of this void. CVS Pharmacy is exploring these options in rural, as well as suburban and urban, markets. Moreover, medication delivery by sustainable UAVs saves time and provides consumers with convenience.

While questions about safety, privacy, intrusiveness, theft, medication exposure, noise, and light pollution remain, there are still significant regulatory hurdles to overcome before drone delivery becomes commonplace. Drones require aviation regulation similar to commercial airplanes. In September 2019, UPS became the first company to receive full Part 135 Standard Certification by the Federal Aviation Authority (FAA) granting UPS its highest certification. This allows the carriers to fly at night and out of operator’s line of sight, to fly as many drones supported by as many operators as needed to meet customer demand, and to collect payment for drone deliveries. In April 2019, Wing received a similar but more restrictive certificate limiting it to a single pilot allowing it to only complete one flight at a time. The FAA guidelines to inform how UAVs will operate in US airspace are anticipated in 2021.

The ascent of “The Airborne Pharmacy” is an inflection point in the delivery of medications to consumers and provides an aerial glimpse of its mainstream future. When imagining that future, the sky’s the limit for real-world, everyday life applications of drone-centric technology. What originated as a part of military infrastructure can now change how life-saving medications reach patients at home or in the inpatient and outpatient settings. “Drone-to-Door” not only has the potential to reshape how medications are delivered but also to transform the consumer experience by providing convenience in an on-demand healthcare economy.

While there have been significant drug shortages in the past as a result of unforeseen circumstances, such as Hurricane Maria’s effect on Puerto Rico’s drug manufacturing facilities in 2017, drug shortages often crop up and continue despite no obvious reason. The ongoing shortage of vincristine, an older, traditional chemotherapy agent used for several cancers, has compelled tough decisions by providers and families. In some cases, there are few other treatment options for patients or the treatment regimen is incomplete without vincristine. Other shortages, including those for heparin, critical antimicrobials, and immunoglobulin, have also made national news. The United States (US) Food and Drug Administration (FDA) monitors and reports drug shortages and has historically worked with manufacturers and public health partners to mitigate the impact of shortages. For instance, during Hurricane Maria, the FDA allowed temporary importation of certain products from select manufacturers and worked to expedite reviews of drug applications that could alleviate shortages of affected medications. According to the FDA, the biggest causes for drug shortages are quality or manufacturing issues (37%), lack of raw materials (27%), and manufacturing delays and capacity concerns (27%).

Due to the ongoing issues associated with drug shortages and prompting from a bipartisan Congressional group in June 2018, the FDA developed an interagency Drug Shortages Task Force. This group was tasked with studying shortages, determining their root causes, and developing strategies to limit the occurrence and widespread effect of drug shortages. The Task Force evaluated products that were affected by a shortage between 2013 and 2017 and solicited public and key stakeholder feedback. In late October 2019, the FDA issued a press release announcing the publication of a report from the Task Force entitled, “Drug Shortages: Root Causes and Potential Solutions.” Notably, the Task Force confirmed that drug shortages not only persist but also have continued to rise again recently since falling from their peak in 2011. As an example of their impact, the group highlighted select medications whose shortages have had a significant clinical impact (e.g., pediatric oncology medications, medications for septic shock). Of the 163 drugs in shortage they analyzed, 63% were sterile injectables and 67% were products available as a generic. The median time since first approval was nearly 35 years and most were considered relatively “cheap,” as they were several years off-patent (median price of $2.27/unit for oral drugs and $11.05 for injectables).

The Task Force identified 3 root causes associated with drug shortages: (1) lack of incentives for manufacturing less profitable drugs; (2) lack of recognition and incentives for mature quality and production management, as well as production contingency plans; and (3) logistical and regulatory hurdles that limit production responsiveness. Moreover, the Task Force proposed solutions to alleviate the impact of drug shortages. The first recommendation is to create a shared understanding of the impact of drug shortages, including quantifying costs, frequency, persistence, and intensity, as well as improving transparency of contracted price and stipulations. The group also recommends the development of a rating system to incentivize a manufacturer’s investment in maturing quality management, beyond the minimum threshold of Current Good Manufacturing Practices (CGMPs), to improve voluntary transparency. Finally, the group recommends the promotion of sustainable private sector contracts. This recommendation would involve providing incentives for manufacturers that would mitigate the financial risk of introducing or keeping products on the market, in addition to quality-based manufacturing financial incentives. The Task Force further identified legislative proposals that could limit product availability interruptions (including improved data sharing), risk assessment to identify vulnerabilities, and additional expiration date/shelf-life data. Likewise, the Task Force also stated that the FDA plans to publish guidance for the industry. These would be regarding FDA notification of permanent or temporary manufacturing of a product and risk management plans to prevent and limit shortages.

In addition, other legislation has been proposed, such as the Mitigating Emergency Drug Shortages (MEDS) Act, introduced to legislation by Senator Susan Collins (R-ME) and Senator Tina Smith (D-MN). According to Collin’s office, shortages can add approximately $230 million in drug costs and $216 million in labor costs annually in the US. Key priorities of the Act include strengthening transparency to disclose causes, expected impact, and estimated durations of shortages; extending reporting requirements to include active ingredients (not only the finished product); requiring contingency and redundancy plans for critical medications; and incentivizing manufacturing of products in shortage. Furthermore, the proposed legislation would require the Department of Health and Human Services (DHHS) and Department of Homeland Security (DHS) to conduct a risk assessment associated with shortages of critical drugs that could affect national security. So far, the MEDS Act has support from several healthcare organizations, including the American Pharmacist’s Association (APhA), American Society of Health-System Pharmacists (ASHP), American Society of Clinical Oncology (ASCO), and the American Hospital Association (AHA).

In the meantime, drug shortages continue to creep into national news. While a lack of drug accessibility is often linked to cost, drug shortages are a reminder that cost is not the only roadblock to treatment. Despite the innovation of the US healthcare system, and the novel drug and biologic discoveries that have dramatically altered care, some Americans, because of a variety of factors and causes, still find themselves scrambling to obtain routine or essential medications.

The Drug Shortages Task Force’s report may be found here: https://www.fda.gov/media/131130/download.

We live in a fast paced, on-demand world, one in which information is available to patients through multiple channels on any medical topic. So, how do you help your patients navigate all the information and working with them, determine what is right for them and their loved ones? How do you help patients understand a diagnosis or a medical condition that needs to be effectively managed?

Care management is a solution that is intended to improve patient care and reduce the need for medical services by helping patients effectively navigate their own health condition. These programs have become a vital tool for organizations in order to meet the needs of their patients while also effectively improving quality and reducing the cost of care. Care Management can be provided by various types of clinical professionals, such as nurses, social workers, and pharmacists.

A successful care management program should include an integrated suite of services such as:

1. Care Coordination: Coordinating with the patient’s physician on assessments, care planning, and interventions.
2. Patient Engagement: Identifying opportunities for patients and developing a care plan that is supported through educational tools and resources to help them achieve their healthcare goals.
3. Health and Wellness: Helping patients make positive and lasting changes to their health through establishing healthy habits and setting achievable goals.
4. Advanced Digital Tools: Providing patients with the convenience and ease of managing their health through digital applications.
5. Data Analytics: Identifying members at risk for non-adherence or in need of care management through data-led and evidence-based algorithms.

A care management solution should be a comprehensive system that offers a suite of products to help patients navigate their health journey. Our MRx Navigate program is one such program that offers a medical management solution for customers and patients. MRx Navigate integrates data-driven, population health, and personalized intervention that leads patients to healthy, more vibrant lives. To learn more about MRx Navigate, click here.

The following is an excerpt from the 2018 Community Impact Report.

The MRx Cares program, developed by Magellan Rx Management, is one great example where we deliver – value and results!

Helping when life is complex

As a next-generation pharmacy benefit manager (PBM), Magellan Rx Management leans into the complex pharmacy challenges facing our members. One such challenge is specialty pharmacy. MRx  Cares is available to members who live with complex chronic conditions— like Crohn’s Disease, Cystic Fibrosis, HIV, Rheumatoid Arthritis and the aftermath of organ transplants—and are currently receiving their medication through Magellan Rx Specialty Pharmacy.

When members first fill a specialty medication, they are automatically enrolled in MRx Cares at no cost. Members receive an easy-to-understand welcome kit specific to their medications and conditions. Soon after, a personal health coach reaches out.

Our MRx Cares program offers a unique approach to member management with Motivational Interviewing-based health coaching. Motivational Interviewing is a counseling method that helps patients resolve ambivalent feelings and insecurities to find the internal motivation to change their behavior and meet their personal goals.
Providing personalized support from  caring experts

The MRx Cares program is led by specially trained nurses and pharmacists. These expert health coaches work closely, one on one, with each individual. Together, they develop a personalized care plan with achievable goals. The health coaches check in monthly, or more if needed, via calls, texts or video consultations.

Helping improve drug adherence

In addition to 24/7 access to nurses and pharmacists who understand the member’s situation, the program offers monthly refill reminders to improve drug adherence. The health coaches are also there to help if members need assistance with the cost of their medications. They can help connect members to opportunities for financial assistance and community support groups.In the most recent participant survey, 99% of respondents indicated they were highly satisfied with the benefits of MRx Cares and the services they receive.

Having type 2 diabetes can be overwhelming. The good news? While everyone’s treatment plan will be different, there’s a good chance you can manage your type 2 diabetes by making healthy choices. Convinced, but still struggling to work good choices into your real life? Start here for tips on treating type 2 diabetes.

The key to treating type 2 diabetes is to keep blood sugar levels controlled and in your target range.

All of the following help to lower blood sugar:

• Making healthy food choices. Try to manage the amount of carbohydrates you eat by spreading them out over the day.
• Losing weight, if you are overweight
• Getting regular exercise
• Taking medicines, if you need them

It’s also important to:

• See your doctor. Regular checkups are important to monitor your health.
• Test your blood sugar levels. You have a better chance of keeping your blood sugar in your target range if you know what your levels are from day to day.
• Keep high blood pressure and high cholesterol under control. This can help you lower your risk of heart and large blood vessel disease.
• Quit smoking. This can help you reduce your risk of heart disease and stroke.

It seems like a lot to do—especially at first. You might start with one or two changes. Focus on checking your blood sugar regularly and being active more often. Work on other tasks as you can.

It can be hard to accept that you have diabetes. It’s normal to feel sad or angry. You may even feel grief. Talking about your feelings can help. Your doctor or other health professionals can help you cope.

With a little support and guidance, patients with diabetes can live healthy, vibrant lives. Our Live Vibrantly: Diabetes care program helps manage all aspects of diabetes from improving wellness, diet, and exercise to optimizing medication use. To learn more about Live Vibrantly: Diabetes, click here.

©1995–2019, Healthwise, Incorporated

Read the full article here:  https://www.healthwise.net/magellanhealth/Content/StdDocument.aspx?DOCHWID=hw135189#hw135192

This document is for your information only. It is not meant to give medical advice. It should not be used to replace a visit with a provider. Magellan Health does not endorse other resources that may be mentioned here.

Follow your body’s hunger and fullness signals. Smart snacking can help you keep your blood sugar levels stable, especially if you are taking medicine for diabetes.

Try these tips:

• Enjoy eating the right portion. Try using a smaller plate, bowl, or glass while you slowly eat your snack.
• Make healthy choices. Eat a piece of fresh fruit. Or combine that fruit with some protein, such as a small apple and a tablespoon of peanut butter. Or try dipping your fruit in some light yogurt.
• Be prepared. Keep cut-up raw vegetables in your refrigerator. If these are ready to eat, you’re more likely to grab them than something else. Try a low-fat dip on the side.
• Eat nuts. Try a small handful of almonds, walnuts, or pecans. These treats each have less than 15 grams of carbohydrate.
• Choose filling foods that can satisfy your hunger without a lot of calories. Try a hard-boiled egg or an ounce of reduced-fat cheese, such as string cheese.
• Skip high-fat dips. Instead, mix plain yogurt, fat-free mayonnaise, cottage cheese, or fat-free sour cream with a small amount of dry soup mix. Or try a bean dip made with fat-free refried beans, topped with salsa.
• Get more fiber. Put that turkey sandwich on whole wheat bread. Mix wheat germ into yogurt or sprinkle it on salads. Choose whole-grain breads and cereals.
• Try something new. Make a pita pizza with a piece of whole wheat pita bread, tomato sauce, and a sprinkling of reduced-fat cheese. Top with sliced zucchini or mushrooms. Bake until cheese is melted. Enjoy!

And remember:

• Don’t eat out of the bag or box. Take a single serving, and eat from a plate or bowl. It’s easy to eat more than you need or want when the bag is open in front of you.
• Don’t buy snacks that aren’t healthy choices. If unhealthy snacks aren’t around, you won’t eat them.
• Keep an eye on the nutrition facts label, especially in low-fat or fat-free foods. To make up for flavor, sugar and salt is often added when fat is taken out.

With a little support and guidance, patients with diabetes can live healthy, vibrant lives. Our Live Vibrantly: Diabetes care program helps manage all aspects of diabetes from improving wellness, diet, and exercise to optimizing medication use. To learn more about Live Vibrantly: Diabetes, click here.

©1995–2019, Healthwise, Incorporated

Read the full article here:  https://www.healthwise.net/magellanhealth/Content/StdDocument.aspx?DOCHWID=av2453

This document is for your information only. It is not meant to give medical advice. It should not be used to replace a visit with a provider. Magellan Health does not endorse other resources that may be mentioned here.

The costs associated with cancer care continue to rise, and many new therapy developments are on the horizon. When looking specifically at medical benefit drug spend, which has historically gone unmanaged, oncology medications make up one-third of total per-member-per-month spend, with an average cost per claim of over $2,300 for commercial plans.¹  With estimates that overall oncology spending will reach $220-$250 billion dollars over the next five years², there is a critical need to provide better management for this spend category.

We asked Rebecca Borgert, Pharm.D., Senior Director of Clinical Oncology Product Development at Magellan Rx Management, for her thoughts on what strategies payers should consider for patient-focused, holistic oncology management.

When it comes to tried-and-true cost containment strategies, like utilization management guidelines, what innovations do you see in the oncology space that are making an impact for payers and their members?

The need to ensure patients are receiving evidence-based cancer treatment continues to be of paramount importance. In the era of precision medicine , treatments are often personalized and based on the patient’s specific genomic profile; payers want to ensure their members are receiving the best treatment for their particular cancer. Due to the extremely high cost of most cancer medications, interventions aimed at unit cost savings can improve value and decrease waste. For example, waste often occurs as part of the drug compounding process due to limited vial size availability. Compendia guidelines endorse rounding doses to within 10% of the calculated dose in order to optimize vial utilization and decrease waste. Additionally, other classes of drugs may be candidates for dose optimization strategies. These increased efficiencies can account for thousands of dollars of savings per dose while decreasing overall waste in healthcare.

While a focus on the patient is critical, there’s also the need to engage providers and provide solutions that allow for cohesive workflow. Enhanced claim edits and appropriate network/fee schedules can also be effective management strategies. At Magellan Rx, we stay up to date on the latest trends and have more than 15 years of experience in providing our customers with flexible interventions, like the ones just discussed, to manage both medical and pharmacy oncology spend. It’s important to understand that a one-size-fits-all approach will not work in today’s dynamic healthcare environment.

In 2018, the U.S. Food and Drug Administration set an all-time record with the highest number of drug approvals in the last 23 years (59 total). Several new medical pharmacy drugs were approved for oncology, including 6 biosimilars. How can payers and providers be better prepared for this evolution and ever-expanding pipeline?  

Unlike the pharmacy benefit where formulary management is an industry standard practice, formulary management under the medical benefit is a relatively underused strategy. The introduction of multiple oncology biosimilars presents a perfect opportunity to execute a medical pharmacy formulary strategy in this space.

Currently there are a number of oncology supportive care biosimilars already in the market and, most recently, we have seen the launch of two oncology therapeutic biosimilars. In late 2019 and early 2020, we anticipate the launch of several more of these FDA-approved oncology biosimilars which will create true competition in the marketplace. While discounts for biosimilars compared to their reference products are in generally only in the range of 10%-15%, due to the high cost of these therapies and their prevalent utilization, it is possible for payers to achieve large cost savings with these agents by adopting a thoughtful biosimilar formulary strategy.

At the center, we have patients and their caregivers who are trying to navigate the complex journey from diagnosis to treatment through survivorship. Is this an area of focus that can have a positive effect on outcomes and mitigate rising oncology spend?

Receiving a diagnosis of cancer often results in a total upheaval of the patient’s life as well as the lives of their family members. Providing patients with consistent support and personalized assistance can help to ensure they are able to be compliant with their prescribed treatment. This also helps patients understand the anticipated side effects of treatment and how to proactively manage those side effects, avoiding the need for unplanned acute care.

1. IQVIA. 30 May 2019. Global Oncology Trend Report 2019. https://www.iqvia.com/insights/the-iqvia-institute/reports/global-oncology-trends-2019. Accessed October 15, 2019.