This month, we are sharing thoughts and insights on the importance of peer support services in healthcare, as well as other systems where peer supporters can be integrated. As the impact of the COVID-19 pandemic continues to be felt across the U.S. and around the world and folks struggle with the fallout, we are seeing an increased need for mental health and substance use disorder services and supports.

COVID-19 mental health impacts  

For many, the virus has taken a terrible toll. Family and friends have been lost. Millions of jobs have been lost. Our collective and individual sense of what is “normal” has been lost.

In a May 14, 2020 news release, the United Nations called for a substantial investment in mental health services to avoid a “massive increase in mental health conditions in the coming months.”

World Health Organization Director-General Dr. Tedros Adhanom Ghebreyesus said this:

“It is now crystal clear that mental health needs must be treated as a core element of our response to and recovery from the COVID-19 pandemic. This is a collective responsibility of governments and civil society, with the support of the whole United Nations System. A failure to take people’s emotional well-being seriously will lead to long-term social and economic costs to society.”

Focus on prevention

Public health experts, media and a growing number of policy makers are urgently emphasizing the critical necessity to take a preventive approach to this crisis, urging people to wear masks in public, practice physical distancing and increase testing. If we don’t embrace prevention, we will not beat this disease.

It’s not just infectious diseases like COVID-19 that require a robust, full court press preventive public health response. We need to get serious about prevention in mental health. A 2015 research article, Preventing Mental Illness: Closing the Evidence-Practice Gap Through Workforce and Service Planning stated:

Despite advances in treatment, there is little evidence that prevalence rates of mental illness are falling. While the prevention of cardiovascular disease and cancers are common in policy dialogue and service delivery, the prevention of mental illness remains a neglected area.

Note the reference to “evidence-practice gap” in the article title. What does that mean? Here’s a great, succinct description from a 2014 article published in PLOS Medicine.

Health research promises societal benefit by making better health possible. However, there has always been a gap between research findings (what is known) and health care practice (what is done), described as the “evidence-practice” or “know-do” gap.

Peer support contributions

So, what are the implications to the peer support workforce I mentioned at the beginning of this article? How does prevention apply to this discussion? Why is there still an “evidence-practice” gap with regard to peer support?

There are 200+ articles published in the literature on peer support. Peer support has long been recognized as an evidence-based practice. In fact, there are several peer-developed, peer-delivered models grounded firmly in the principles of recovery and resiliency, choice and self-determination, and an understanding of a holistic approach to wellness. And these models have been shown to have a positive impact on traditional outcomes, predominantly measured in behavioral health, including significant reductions in hospital admissions, fewer re-admissions and decreased spending on high-cost, restrictive settings like psychiatric inpatient. While peer support is not a clinical service, it has been shown to impact clinical outcomes. Beyond this, folks receiving peer support services express very high degrees of satisfaction with those services and report improved quality of life.

This is an excerpt from the Magellan Healthcare eMpowered for Wellness July newsletter. To read the full article, go here.

Telehealth services have been available for years to help remove geographical and other boundaries for people in rural and medically under-served areas; however, use has been limited. Driven by the COVID-19 pandemic, including shelter-in-place orders, social distancing, and federal agencies mandating use for certain programs, telehealth has grown exponentially since March.

While companies like Teladoc and MD Live have been operating telehealth platforms for nearly two decades, many platforms are dedicated only to physical health. Magellan Healthcare has maintained a telehealth network for behavioral health since 2014 and helps:

• Health plans offer a cost-effective alternative to traditional doctor visits, urgent care and the emergency room; provide access to valuable care that is convenient and available anytime and anywhere; expand existing programs and services focused on health and wellness; and attract new members by offering the modern convenience of an on-demand service.
• Employers improve employee access to healthcare; reduce tardiness and absenteeism; increase employee productivity; offer a competitive benefits package; improve employee satisfaction; and retain and attract the best employees.
• Members have more privacy; access a deep and specialized network; receive treatment before work, after work or on weekends; have more frequent touch points to improve compliance with treatment and avoid unnecessary hospitalizations; and avoid travel, lost time from work and weeks of waiting for an appointment.
• Providers reach out to members in remote areas or where specialties are needed; provide care to homebound members; provide behavioral health services from home, office or while traveling; reduce no-shows and cancellations; offer additional and/or non-standard appointment times; and expand the patient base and improve relationships with existing patients.

Although the benefits of telehealth are many, people may feel uncomfortable using services. That’s why Magellan Healthcare created a video called Telehealth: Get Care and Treatment Wherever You Are. This video can help people understand:

• How to schedule a telehealth visit
• What to do once a telehealth visit is scheduled
• How to get the most from telehealth

The more comfortable people are using telehealth for their behavioral healthcare, the more options they have available to them. This can lead to improved compliance and better health outcomes.

Watch the video here.

Prescription drug prices can be expensive. How can the average person save money on prescriptions in a quick, easy way? Pharmacy discount cards are available widely, but what are they and why should people use them? Here are five important things to know about pharmacy discount cards.

1. They can save you money!
   Pharmacy discount cards can be used to lower your costs on medications you need to fill that may not be covered by your employer’s health insurance plan. Using a discount card can save up to 80% off the cash price when you need to fill a non-covered drug. Comparing prices between your insurance and discount card is important to make sure you are not overpaying for your prescription. You should also check other pharmacies as prices do vary from chain to chain as well as independent pharmacy locations.

2. Using them won’t count toward insurance plan deductibles.
   Prescriptions filled using a discount card do not count toward your deductible or out-of-pocket maximum amounts. Discount card transactions fall outside of your health plan policy and should be used when a drug is not covered or if you are uninsured. Discount cards cannot be used in combination with insurance.

3. They are free to use.
   Most pharmacy discount cards do not require membership fees to use their cards, but some programs do require you to provide personal information. Make sure you review their privacy policy to ensure you are comfortable sharing information before using their services. The privacy policy is typically posted on their website.
4. No paperwork necessary.
   With pharmacy discount cards, there are no forms to fill out and no paperwork. When you present your discount card at the pharmacy, you are given the discounted prescription price at the counter and you pay the balance. There is no further obligation on your part to the discount card. You can use the card for future transactions, but typically there is no requirement to do so.

5. They work for pets, too!
   If you have pets, many discount cards extend their benefits to them as well. Many people fill their prescriptions at their veterinary office without realizing they may be overpaying. There are some prescriptions for your dog or cat that can only be filled by a vet, but many can be filled by your local pharmacy and usually at a much lower cost. You can ask your vet to write a prescription for your pet and have it filled at your neighborhood pharmacy. Make sure the vet includes their DEA number as most discount cards require this information to process the prescription.

There are many companies offering to save you money on your prescription drugs, which can sound too good to be true. Pharmacy discount card providers are only compensated when you fill a prescription using their card and the pharmacy benefits from your business. You get to save money on your prescription and improve or maintain your health of you or your loved ones.

In contrast to the conventional drug approval pathway in which drugs are reviewed under a New Drug Application (NDA), approval of a biological product is done under a separate pathway known as the Biologics License Application (BLA). Examples of biologics include therapeutic proteins such as insulin, monoclonal antibodies, vaccines, and blood-derived products. While the NDA and BLA processes are similar, they are not identical. The typical generic drug provisions (e.g., same active ingredient, bioequivalence) do not apply to BLAs. Instead, the single biological product already approved by the United States (US) Food and Drug Administration (FDA) is referred to as the reference product; the new potential biosimilar is then compared to the reference product. For approval as a biosimilar, the manufacturer must demonstrate that the agent is highly similar with no clinically meaningful differences.

In July 2018, the FDA released their Biosimilar Action Plan, described by then FDA Commissioner Dr. Scott Gottlieb, as “aimed at promoting competition and affordability.” Then, in December 2018, the FDA announced the plan to transition biological products that were historically regulated as drugs and approved via NDAs to the biologics pathway, taking effect in March 2020. These products include insulin, human growth hormone, and glucagon, among others. This change was mandated by Congress in the 2009 Biologics Price Competition and Innovation Act, which allowed 10 years for the transition. When considered as drugs under the NDA pathway, it was virtually impossible to develop a generic equivalent due to the nature and the inherent variation in the manufacturing process of these products. On March 23, 2020, the FDA issued a statement noting that this change is now in effect.

However, in the US, even if an agent is determined to be biosimilar, it is not automatically interchangeable (a process by which a product can be substituted for another without the approval of the prescriber). For a biosimilar to be considered interchangeable by the FDA, it must meet even more rigorous requirements and be approved as interchangeable. For products that are biosimilar but not interchangeable, the prescriber still needs to write for the specific product. In addition, even if determined to be interchangeable by the FDA, state pharmacy laws may further regulate what substitutions may be made at the pharmacy level without the approval of the prescriber. Just as a listing of generic equivalents is available through the FDA in their Orange Book, the FDA lists biologics and any respective biosimilars in their Purple Book. Recently converted to an online database format, the Purple Book provides details on reference products, their corresponding approved biosimilars, and whether or not the biosimilar is interchangeable. To date, no biosimilar has been designated as interchangeable.

As described in a previous blog post, the cost of insulin has risen substantially, leading patients to take desperate measures. At a time of economic instability and health uncertainty, these access concerns are even larger. Now that these products have transitioned to the biologic approval pathway, once patent exclusivity has passed, biosimilars can be developed, evaluated, and approved. Moreover, biosimilars can be reviewed further and may be classified as interchangeable, which can further alleviate the burden by allowing substitution at the retail level depending on local laws. This landmark change can promote market competition, potentially driving increased availability and decreased cost. The FDA reports that even having one generic drug on the market can decrease prices to approximately two-thirds of the price without competition. Generally, initial list prices of launched biosimilars have been 15% to 35% lower than their reference products. Most importantly, in their announcement of this change on March 23, the FDA pledged that they are ready to review eligible applications to ensure efficient approval. Ultimately, this revised process will provide an opportunity for other manufacturers to introduce safe and effective product competition without clinically meaningful differences. While this may be challenging in light of the ongoing global pandemic, this change, 10 years in the making, offers hope for patients who use these medications.

When your workplace is disrupted by a tragic event, employees may feel overwhelmed, anxious, insecure, and distracted. Everyone reacts differently to stress events, but tragic workplace events are serious and can cause significant physical, cognitive, and emotional reactions. A team of experienced mental health consultants can help reduce the negative impact of the event and its long-term impact on the organization, speed recovery, and return people to everyday life. Critical event interventions can also prevent post-traumatic stress disorder (PTSD).

Types of traumatic events

Tragedies come in many forms. Typical traumatic events include the unexpected death of an employee, a chronic illness of an employee, an injury at work, robberies, shootings and other acts of violence, criminal attacks, industrial or natural disasters, or even organizational restructuring or dismissal. People who have witnessed the event or know the people affected can experience a number of symptoms of the stress response, such as:

• Insomnia, nausea, dizziness, fatigue, racing heart, headache and loss of appetite
• Nightmares, hyper vigilance, panic attacks, intrusive images and poor concentration
• Feelings of anxiety, guilt, depression, irritability, anger and fear
• Social withdrawal and self-medication with alcohol or other drugs [1]

Critical events can also trigger memories of previous intense stressors.

How Magellan’s Employee Assistance Program Can Help

Magellan’s Critical Incident Response (CIR) team consists of specially trained clinical staff who are available 24 hours a day, 365 days a year. CIR Consultants help employees process and manage the emotional and physical effects of a traumatic event.

The first step is to consult with you about what has happened and assess the situation. Once the situation is assessed and an action plan is developed, we will send a CIR consultant to your workplace within a reasonable and agreed time frame. The CIR consultant will carry out a structured intervention on site to help deal with the incident, if necessary, and will also be available to managers and individual employees if needed. Services are confidential and provide employees with the resources and support they need to cope with the stress and anxiety caused by the event and return to normal life.

Our broad spectrum of CIR services includes management consultancy, telephone crisis support, group and individual support for affected employees, as well as follow-up care.

Critical incidents and tragic events occur in all types of companies and industries. Preparation with an existing CIR program is key to effectively managing the aftermath and associated risks.

[1] https: //www.osha.gov / SLTC/emergencypreparedness/guides/critical.html

Featuring excerpts used with permission from the Magellan Rx Management Medical Pharmacy Trend Report^TM, ©2020. Get a copy of the full report at magellanrx.com/trendreport.

In 2010, plans were just starting to manage drugs on the medical benefit; there were only nine approvals for medical injectable drugs, and biosimilars were talked about but still five years away. Now, the medical benefit is top of mind, and in 2019 alone there were triple that number of approvals—seven of them biosimilars.

For the 10th year in a row, the top five commercial drugs were Remicade, Neulasta, Rituxan, Herceptin, and Avastin. Remicade saw decreases in PMPM due to the introduction of biosimilars Renflexis and Inflectra. We may see similar trends in upcoming data, since all of these top 5 agents now have marketed biosimilars.

How have biosimilars impacted some of the top-spend medical benefit categories?

There are 26 FDA-approved biosimilar products across three different therapeutic categories, of which 17 have been launched. Fifteen of those are oncology or oncology support agents.

Biologic Drugs for Autoimmune Disorders (BDAIDs)

Trend remained relatively flat in this category as Remicade market share decreased, with biosimilars Renflexis and Inflectra beginning to gain market share (market share data for these biosimilars was not available for 2017 and 2018, but we expect to include it in next year’s report).

Oncology & Oncology Support

Oncology spend is a concern for payers, and oncology immunotherapies and gene therapy will continue to contribute to this spend. However, many opportunities for savings are anticipated with the biosimilars for Avastin, Herceptin, and Rituxan.

There are currently several biosimilars on the market in the oncology support category for the long- and short-acting CSFs and the ESAs. The predicted negative forecast growth illustrates their impact. Specifically, Neulasta biosimilars are now on the market, with Fulphila and Udenyca gaining market share.

Payer feedback on current bio-similar strategies

The biosimilars currently on the market proved to have an impact on medical pharmacy strategy, as 40% of plans, based on number of lives, reported they were currently reimbursing based on a maximum allowable cost (equivalent reimbursement for reference and biosimilar). At the time of our survey (summer 2019), there were no oncology bio-similar products on the market, but payers were planning to utilize the same formulary strategies, including step therapy.

What biosimilar strategies should payers be deploying NOW to prepare for the FUTURE?

At Magellan Rx, our 16+ years of total specialty drug management expertise enables us to prepare our customers for what comes next through forward-thinking solutions that keep a pulse on future industry trends. Through successful medical pharmacy management across all sites of service, we can deliver targeted, customized solutions designed to yield substantial drug cost savings while maintaining a high level of clinical quality.

• We’ve seen that health plans can experience a significant shift in utilization to lower-cost biosimilars through implementation of a comprehensive utilization management solution.
• Initial results from our new oncology biosimilar solution show proactive utilization management of oncology drugs via step therapy increases use of less expensive biosimilars. We encourage customers to combine the power of all our oncology solutions—such as utilization management, drug wastage, dose optimization, sophisticated claims editing, enhanced regimen review, site of service management, targeted solutions for oncology immunotherapies and oncology care management—to enhance outcomes and improve member quality of care.

Learn more about our total specialty drug solutions.

As the COVID-19 pandemic continues, and social distancing becomes the new normal, we have seen rapid expansion of digitally delivered peer and family support. In this post, we explore emerging issues and considerations for using technology to reach others.

The use of technology to offer peer support is a practice that has been around for quite a while. Think about telephonic peer support via peer-operated warmlines. A from December 4, 2019 said this about warmlines:

“Unlike a hotline for those in immediate crisis, warmlines provide early intervention with emotional support that can prevent a crisis.”

Magellan has long been a supporter of peer-operated warmlines and has helped launch warmlines in multiple states.

You can find more information about warmline availability by state at www.warmline.org or by visiting the National Empowerment Center’s directory of peer-run warmlines.

As opportunities for in-person, face-to-face support have decreased, many peer-run organizations, along with traditional mental health providers, have shifted delivery of services to telehealth platforms. Yet, during this unprecedented COVID-19 public health crisis, we see increased demand for support from folks living with anxiety and depression. As more families are impacted by the pandemic, access to peer support is more critical than ever.

Peers have been quick to step up with a national grassroots-driven expansion of support via video conferencing platforms like Zoom. With this rapid expansion, however, we see wide variability in practices. Skills learned by providing in-person peer support do not necessarily translate onto a digital delivery platform. Individuals who are used to seeing a peer supporter in person may have a different experience when it’s offered through technology. In some cases, apps that purport to offer peer support are actually “peer-bots,” with real-time interactions being driven by algorithms and predictive analytics.

Fortunately, solutions to address the nuances of digital peer support have been developed. One of the most beneficial is training in digital peer support. Magellan partnered with Dr. Karen Fortuna to provide specialized training to our team members who provide peer and family support. Many other organizations and agencies have completed this training as well. It’s an important and necessary step to take as we navigate this new normal.

If you want to learn more about the state of practice relevant to digitally delivered peer support, check out this article from the April 2020 Journal of Medical Internet Research by Dr. Fortuna, Digital Peer Support Mental Health Interventions for People With a Lived Experience of a Serious Mental Illness: Systematic Review.

As we learn more about what works and what could be improved with peer support services via telehealth, we are paving new ground. What we do over the coming weeks and months will set the trajectory for digitally delivered peer support.  Let’s make sure we get to where we want to go safely, respectfully and responsibly.

This is an excerpt from the full eMpowered for Wellness May newsletter. To read the full article, go here.

Anyone who has gone through a traumatic event can develop symptoms of stress disorders such as post-traumatic stress disorder (PTSD).  Although the COVID-19 pandemic in general would not meet the criteria for formally causing a stress disorder, many of the same issues can result from such a widespread and overwhelming event.

The pandemic could be viewed as a long-term stress event.  It has become life-changing for the whole world.  As COVID-19 spreads across the globe, people may experience increased anxiety and fear triggered by the pandemic and constant news. In addition, the pandemic can be traumatizing for others: healthcare workers, people who have lost friends and loved ones, and people whose lives have drastically changed.

What are stress-related disorders?

Stress-related disorders can occur after you have been through a traumatic event. A traumatic event is something horrible and scary that you see or that happens to you. During this type of event, you think that your life or others’ lives are in danger. You may feel afraid or feel that you have no control over what is happening. These symptoms can change your behavior and how you live your life.

How can reaction to the COVID pandemic be similar to a stress disorder?

When you struggle with a stress disorder, it can be hard to anticipate when anxiety or depressive symptoms may flare up. Although it may appear that symptoms come out of nowhere, in most cases they are cued by factors called triggers. Internal triggers are the feelings, thoughts, memories, emotions, and bodily sensations that you feel or experience. External triggers are the people, places, and situations that can bring back memories of the traumatic event.  In the current environment this could be caused by news reports, social media or discussion with friends or family.

The first thing to realize is that many fears are unwarranted; anxiety may arise when you are in a completely safe environment. When you begin to despair or your fears consumer you, try to remember that your worries and fears may be extreme because of previous experiences and not current facts. Once you’ve realized what may trigger these fears and anxiety, you can begin to try to deal with them.

How to cope with stress-related symptoms amid COVID-19

• Cultivate ways to be calmer. It’s understandable to feel anxious and worried about what may happen. While circumstances may be stressful and beyond your control, you can try to offset them with positive, calming activities. Practice slow, steady breathing and muscle relaxation, as well as any other actions that are calming for you (yoga, exercise, music, keeping the mind occupied).
• Understand what is within your control. Accept circumstances that cannot be changed and focus on what you can do. Evaluate your risk of contracting the virus, practice social distancing and follow clinical guidance on other practices. If you are in quarantine or isolation, do things that can support your mental health.¹ Focusing on what you can control and do can help you deal with the unknown.
• Remain hopeful. Keep a long-term perspective. Look for opportunities to practice being more patient or kind with yourself, or to see the situation as an opportunity to learn or build strengths. Celebrate successes, find things to be grateful about, and take satisfaction in completing tasks, even small ones. Remember that this will not last forever.
• Lean on your network. Make the most of technology and stay in touch with colleagues, friends and family via phone calls, texts, social media and video conferencing. Consider joining a free support group online to stay connected.² If you have a therapist, try to continue your treatment by phone or online.
• Focus on the potential positives. Try and focus on the things that can be viewed positively such as spending more time with family and a experiencing a potential to grow. Many times, going through a stressful time like this can lead to post-traumatic growth. This growth can be seen as though the stressful event was a trial or challenge that you conquered, something you learned from and became more resilient through. Sometimes stress can stimulate personal growth and improved overall coping.

For more information and tips, www.MagellanHealthcare.com/COVID-19.