Did you know that Parkinson’s disease psychosis (PDP) is diagnosed in about half of all Parkinson’s diseases patients and presents practitioners with significant disease management challenges?

The Journal of Managed Care & Specialty Pharmacy recently published a manuscript written by a panel of experts from neurology, psychiatry, geriatrics, and geropsychiatry as well as thought leaders from several health plans and Magellan Rx Management to discuss management of PDP.

Dr. Maria Lopes, chief medical officer of Magellan Rx Management, noted the importance of this work: “I think that this research is vital to a better understanding of complex diseases, identify opportunities to develop best practices and key insights that can improve patient care and outcomes.”

The panel discussed the challenging nature of Parkinson’s disease and PDP, the role emerging therapies may play in optimizing effective management and the need for essential education for providers and patients regarding PDP and available therapies.

Take a look at the latest issue of The Journal of Managed Care & Specialty Pharmacy to read more.

There are many healthcare-oriented apps in the marketplace, but there are few out there that offer cognitive behavioral therapy (CBT) and that have also been built on a multi-decade foundation of program efficacy data. Magellan’s CBT apps engage participants in psychoeducational content and activities through interactive sessions designed to maximize self-management of behavioral health symptoms such as sleep, depression, and anxiety. We recently released three apps to the Apple App Store including RESTORE (for insomnia and sleep problems), FearFighter (for anxiety, panic, and phobia), and MoodCalmer (for mild to moderate depression) and have plans to release two to three more in the near future.

But what does it take to build and release these kind of apps?

First and foremost, teamwork.

The best apps, healthcare or other, are not built by one person. They require a team of individuals coming together to work towards common goals. Our primary team includes two product owners, and two project managers who collectively work to get the vision from senior leadership (e.g. sketching ideas, wireframing, developing a curriculum), and then oversee the development teams building the apps (e.g. writing user stories, participating in daily scrum meetings, recording and producing videos, providing feedback), and then ensure smooth and timely deployment of various iterations that get delivered to our customers (e.g. delivering training, scheduling releases, communicating upgrades). Without teamwork these critical processes could not be completed and the App Store would have three fewer apps.

Second, and also very important, user feedback.

We have tens of thousands of active users on our platform, and we know that the majority of individuals who do two or more sessions report improvements in their sleep and mood. Therefore, it is very important for us know how to keep our users engaged. To drive engagement we seek out users and give them the opportunity to give us feedback on what would make our apps more helpful and more useful. Importantly, our users do not just include patients, members, and consumers, but also clinicians, care managers, and providers. We investigate how they use our apps and what features they would like to have included.  We incorporate this user feedback into our development sprints using what are called “user stories.” User stories help keep us focused on the core needs of our users, and they give us clear actionable tasks that can gauge what makes our apps successful and can also determine development steps for future iterations. For example, when we started asking our users what they would like added to our apps’ user experience, we learned about different features they would like to see. To help frame those features from the user perspective, we listed them out in user stories, such as, “As a RESTORE user I would like my sleep diary data to sync with my sleep data in the HealthKit app on my iPhone, so that I can see how data from my wearable device aligns with the sleep goals I set in RESTORE.”  When we roll out features developed from user stories, we see our engagement grow from previous years, and we validate our overall approach.

Lastly, we need to measure, test, learn, and keep building.

Our apps include a lot of content, in both English and Spanish speaking versions. The primary psychoeducational components include video recordings of narrators and clinical vignettes. The videos vary in length, and for each video embedded in the apps (there are dozens) we need to measure the length, test how long we can keep users watching, and learn from their experience. We have found that some videos are more watched than others, and we have found greater acceptance with shorter video length. Aside from just the videos, we have run a battery of tests on the features embedded in our apps and platform. These tests help us work out the bugs and improve the overall user experience. Once we are satisfied with our testing, we determine our readiness for release. Apple is pretty thorough with its acceptance and release of apps to the App Store, and we were very pleased with the turnaround time. We are now preparing to release our apps to Google Play, and will also be releasing later iterations with enhanced graphics, text-based reminders, and other features recommended by our users. Ironically, our apps are both complete and never finished, but I look forward to seeing how our apps will evolve, and continue to lead individuals to more healthy, vibrant lives.

Magellan Behavioral Health of Pennsylvania, Inc., a Medicaid managed care organization (MCO), started as the new HealthChoices behavioral health exclusive contractor for the Cambria County Behavioral Health Services Program on July 1, 2017. Magellan currently administers behavioral health benefits for Medicaid members through HealthChoices contracts with Bucks, Delaware, Lehigh, Montgomery and Northampton counties.

Magellan has over two decades of experience managing behavioral health benefits for HealthChoices members through close collaboration with members, providers and community organizations. Through this collaborative mindset, Magellan has succeeded in producing innovative efforts in the following areas:

• increases in access to care
• improved service use rates
• expansion of the continuum of services in alignment with evidence-based models
• maximization of clinical appropriateness
• nationally recognized level of quality services

Read more about Magellan’s collaboration with Cambria County, local providers, community organizations and members in the Tribune Democrat: New Behavioral Health Provider Brings Options, Jobs to Cambria County.

Stacy Ellingen is a woman from Wisconsin who’s never met an obstacle she couldn’t overcome. After graduating from high school, Stacy left home to attend the University of Wisconsin-Whitewater. After graduating with a degree in journalism and advertising, she moved to Oshkosh. Now in her thirties, Stacy leads a busy professional life as a small business owner and an independent contractor with InControl Wisconsin, an organization that plays a key role in advancing self-directed supports in the state. She’s become more involved in disability advocacy efforts and the community.

Stacy’s story is a successful one—living independently for more than five years, finding a job about which she is passionate and becoming involved in her community. But now consider this success as part of Stacy’s larger story – she grew up with cerebral palsy, resulting in complex physical support needs. However, Stacy grew up believing that she could do everything others do. Working with her self-directed support consultant, Kathi Miller, an employee of TMG by Magellan Health, Stacy proved she could do everything others do.

“Kathi has helped me reach my goals in many, many ways,” Stacy said. Kathi and Stacy joined forces to identify community home care providers to support Stacy in meeting her daily needs at home and at work. They partnered to identify ways that Stacy could make responsible budget decisions in purchasing services to meet her goals. When developing her small business, Kathi supported Stacy in connecting with the local business community to create professional peer connections that enhanced her business development strategies. “Most of all though, Kathi encouraged me to keep moving forward when things got tough! She has been amazing!” said Stacy.

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

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

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

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

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

Download a copy of this infographic here.

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

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

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

Watch our video to learn more.