How Magellan’s Behavior Health Program Saved up to $4,300 PMPY


Using an AI platform, Magellan Health was able to better support providers in prescribing behavioral health medications and addressing medication problems, which reduced pharmacy costs and increased adherence.

Annual costs for patients with behavioral health conditions, such as anxiety, depression or substance abuse, are 3.5 times higher than for those without these conditions. Spending on mental health services surged since the beginning of the COVID-19 pandemic. There was a 22% increase in the use of mental health services from March 2020 to August 2022, according to a RAND study released in August 2023.

Making sure patients with mental health conditions are taking the right medications and are adherent is critical for ensuring patient safety and controlling costs, according to speakers at a session at the Academy of Managed Care Pharmacy (AMCP) Nexus 2023 meeting in Orlando.

Nonadherence to medications can cost up to $20,000 per member per year and lead to treatment failure, rehospitalization, poor quality of life and increased risk of suicide. About 48% of patients in the United States with major psychiatric disorders are not adherent to their medication regimen.

Yoona Kim, Pharm.D., Ph.D.,

Yoona Kim, Pharm.D., Ph.D.,

Additionally, over the last two decades, there has been an increase in the number of patients who are taking more than one psychiatric medication, which can lead to drug interactions and additional costs. During the session, Yoona Kim, Pharm.D., Ph.D., co-founder and CEO of the medication intelligence company Arine Inc., said one study of patients with schizophrenia found that those were treated with monotherapy who had average healthcare costs that were $21,000 lower annually than those who have polypharmacy.

Magellan Health, along with Arine, has implemented a program focused on helping providers address medication problems, such as nonadherence and polypharmacy, for patients for who are taking behavioral health medications.

The program focused on supporting the providers to reduce gaps in care and improve member safety, Caroline Carney, M.D., president of behavioral health and chief medical officer of Magellan Health, said during the session. “We wanted to create a collaborative care model in the treatment of mental health conditions that would lead to better outcomes and longer better relationships,” she said during the session.

The program began as Navigate Whole Health and focused on behavioral health, opioid use, and AIDS Drug Assistance Program (ADAP) management. The program uses advanced algorithms to process pharmacy, medical, lab and other available information to analyze prescribing pattern. Specialty pharmacists then assist providers in dealing with complex polypharmacy issues, addressing tapering and managing adherence barriers.

The program has reduced polypharmacy by about 50%, has increased antidepressant and antipsychotic adherence, and reduced average daily morphine use. Savings in per engaged member per year have ranged from $1,500 to $4,300; pharmacy savings per engaged member per year have been between $360 to $840.

Last month, Magellan announced it was expanding the program, now called inforMED, to include pain management, cardiovascular, diabetes, and other chronic conditions for members with behavioral health conditions.

This story first appeared on Managed Healthcare Executive.

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