Journal of managed care & specialty pharmacy最新文献

{"title":"Cost-effectiveness of caplacizumab in immune thrombotic thrombocytopenic purpura in the United States.","authors":"Sean D Sullivan, Shruti Chaturvedi, Preety Gautam, Alix Arnaud","doi":"10.18553/jmcp.2025.31.3.277","DOIUrl":"10.18553/jmcp.2025.31.3.277","url":null,"abstract":"<p><strong>Background: </strong>Immune thrombotic thrombocytopenic purpura (iTTP) is a rare, life-threatening thrombotic microangiopathy. Caplacizumab is the only treatment approved by the European Medicines Agency and the US Food and Drug Administration for iTTP, to be given in combination with plasma exchange therapy (PEX) and immunosuppression (IS). The National Institute for Health and Care Excellence's independent appraisal committee assessed the cost-effectiveness of caplacizumab and concluded that the addition of caplacizumab to PEX+IS is cost-effective under a patient access scheme in the United Kingdom.</p><p><strong>Objective: </strong>To assess the cost-effectiveness of caplacizumab in iTTP from the US payer perspective.</p><p><strong>Methods: </strong>The National Institute for Health and Care Excellence's model was adapted to the US setting using US costs and discount rates. In contrast to previous cost-effectiveness analyses that accounted only for acute outcomes, our model consisted of a 3-month decision tree for an acute iTTP episode, followed by a Markov model to project long-term costs and outcomes (time horizon: up to 55 years; 3-monthly cycles).</p><p><strong>Results: </strong>Patients taking caplacizumab with PEX+IS experienced an incremental gain of 2.96 life years (LYs) and 1.75 quality-adjusted LYs relative to PEX+IS alone, at an increased lifetime cost of $256,000. The incremental cost-effectiveness ratio was $86,400 per LY and $146,300 per quality-adjusted LY gained.</p><p><strong>Conclusions: </strong>Considering willingness-to-pay thresholds of $150,000 to $200,000, the addition of caplacizumab to PEX+IS may be cost-effective compared with PEX+IS alone for the treatment of iTTP in a US setting.</p>","PeriodicalId":16170,"journal":{"name":"Journal of managed care & specialty pharmacy","volume":"31 3","pages":"277-288"},"PeriodicalIF":2.3,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11871163/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143531523","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Treatment patterns, health care resource utilization, and costs of chimeric antigen receptor T-cell vs standard therapy for relapsed/refractory mantle cell lymphoma in the United States.","authors":"Karl M Kilgore, Philip K Chan, Christie Teigland, Sally W Wade, Iman Mohammadi","doi":"10.18553/jmcp.2025.31.3.262","DOIUrl":"10.18553/jmcp.2025.31.3.262","url":null,"abstract":"<p><strong>Background: </strong>Standard of care (SOC) for relapsed/refractory mantle cell lymphoma (R/R MCL) has included chemoimmunotherapy and targeted therapies (eg, Bruton tyrosine kinase inhibitors [BTKis]). The approval of novel chimeric antigen receptor T-cell (CAR T) therapy in 2020 expanded therapeutic options.</p><p><strong>Objective: </strong>To compare real-world patient characteristics, treatment patterns, health care resource utilization (HRU), and costs in traditional Medicare and commercially insured patients with R/R MCL treated with CAR T vs non-CAR T SOC (non-CAR T).</p><p><strong>Methods: </strong>Adult patients with R/R MCL who had received 2 or more lines of therapy (LOTs) and continuously enrolled in their health plan between July 1, 2016, and December 31, 2021 (Medicare), or June 30, 2023 (commercial), were stratified into non-CAR T and CAR T cohorts based on therapy received during the study period after MCL diagnosis. Index date was 2L initiation for the non-CAR T cohort and CAR T infusion date for the CAR T cohort. Outcomes included time to next treatment (TTNT), treatment-free interval, MCL-related HRU (inpatient days, emergency department visits, and outpatient visits), and costs (medical and pharmacy).</p><p><strong>Results: </strong>2,835 non-CAR T and 122 CAR T patients were included. Compared with non-CAR T patients, CAR T patients were more often commercially insured (27% vs 17.3%; P < 0.01), younger (median age 69 vs 74; P < 0.0001), and male (75.4% vs 64.4%; P = 0.012). Median follow-up after index was 209.5 (CAR T) and 413 (non-CAR T) days. More than one-third (36.9%) of non-CAR T patients received 3L or higher LOT after index and median TTNT decreased with LOT from 689 days (2L) to 184 days (6L). In contrast, only 15% of CAR T patients required additional LOT, and median TTNT post-CAR T was not reached. Duration of treatment-free interval similarly declined with LOT for non-CAR T patients, and the CAR T interval was significantly longer than all non-CAR T LOT. Use of targeted therapies in non-CAR T increased sequentially by LOT (2L: 76%; 6L: 93.2%; BTKi 2L: 26.8%; BTKi 6L: 34.1%). Following CAR T, 9% of patients received targeted therapy, predominantly lenalidomide based. All MCL-related HRU and medical and pharmacy costs were lower post-CAR T than post-index non-CAR T.</p><p><strong>Conclusions: </strong>Non-CAR T was associated with a greater use of post-index LOT, which also had shorter TTNT and treatment-free intervals. This suggests frequent and earlier progression as patients cycle through non-CAR T therapies. Standardized costs were higher in post-index non-CAR T vs post-CAR T episode periods. This suggests that earlier adoption of CAR T may reduce cycling through increasingly more expensive and less effective non-CAR T LOTs, potentially reducing HRU and financial burdens on patients with R/R MCL and the health system.</p>","PeriodicalId":16170,"journal":{"name":"Journal of managed care & specialty pharmacy","volume":"31 3","pages":"262-276"},"PeriodicalIF":2.3,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11871159/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143531540","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Use of health technology assessments in specialty drug coverage decisions by US commercial health plans.","authors":"Daniel E Enright, Emma G van Duijnhoven, Daniel A Ollendorf, James D Chambers","doi":"10.18553/jmcp.2025.31.3.289","DOIUrl":"10.18553/jmcp.2025.31.3.289","url":null,"abstract":"<p><strong>Background: </strong>Health technology assessment (HTA) involves a formal review of the clinical, economic, and societal implications of health technologies. Internationally, HTA supports decisions regarding access to novel therapeutics. However, the role of HTA in the decision-making processes of US-based health care payers remains unclear.</p><p><strong>Objective: </strong>To assess how frequently US commercial health plans reference HTAs in their specialty drug coverage policies.</p><p><strong>Methods: </strong>Using the Tufts Medical Center Specialty Drug Evidence and Coverage database, we reviewed the evidence cited in the publicly available specialty drug coverage policies of 17 US commercial health plans. We assessed the frequency of HTA citations and characterized them by (1) country of origin, (2) publishing organization, (3) whether it addressed a treatment's cost-effectiveness, (4) disease category addressed, and (5) whether it assessed orphan or nonorphan treatments.</p><p><strong>Results: </strong>HTAs accounted for 450 of the 14,033 citations in our analysis (3.2%), with the frequency of HTA citations varying across health plans (0.1% to 7.4% of cited evidence). Ex-US HTAs were cited more frequently than US-based HTAs (65.3%). However, a single health plan accounted for the majority of HTA citations (57.1%) and ex-US citations (76.2%). Most cited HTAs included cost-effectiveness assessments (78.7%). The 3 disease categories for which plans most often cited HTAs were neurological disorders (24.8%), musculoskeletal disorders (21.5%), and cancers (14.6%). Health plans cited HTAs for nonorphan drugs more often than for orphan drugs (59.4%).</p><p><strong>Conclusions: </strong>HTAs represented a small portion of the evidence cited by health plans in specialty drug coverage decisions, with significant variation in citation frequency across plans. Plans cited both US and ex-US HTAs, and most cited HTAs included a cost-effectiveness assessment. These findings suggest that health plans may consider the information provided by HTAs when formulating coverage policies.</p>","PeriodicalId":16170,"journal":{"name":"Journal of managed care & specialty pharmacy","volume":"31 3","pages":"289-295"},"PeriodicalIF":2.3,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11871157/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143530988","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluating the uptake of a Global Initiative for Asthma guideline update in a commercially insured, value-based care population.","authors":"Lindsey M McInturff, Spenser Smith","doi":"10.18553/jmcp.2025.31.3.245","DOIUrl":"10.18553/jmcp.2025.31.3.245","url":null,"abstract":"<p><strong>Background: </strong>Asthma is one of the most common chronic respiratory disease states in the United States and poses a large economic burden. The Global Initiative for Asthma updated its clinical guidelines to recommend low-dose inhaled corticosteroids (ICSs)-formoterol as the preferred reliever option in the treatment of asthma. Randomized controlled trials show lower exacerbation rates in patients using an ICS-formoterol inhaler as a reliever compared with patients using a short-acting β₂-agonist-based reliever. There are minimal real-world data examining how this update impacts clinical outcomes and costs.</p><p><strong>Objective: </strong>To evaluate real-world asthma-specific outcomes and costs before and after members adopt a preferred treatment plan aligning with the updated Global Initiative for Asthma guideline recommendations and evidence.</p><p><strong>Methods: </strong>This retrospective, observational cohort study was performed using claims data for commercially insured members initiating an ICS-formoterol inhaler for asthma. The population included members aged 6-65 years with an asthma diagnosis, 2 or more pharmacy claims for an albuterol inhaler, and 1 or more pharmacy claims for an ICS-formoterol inhaler. The index date was the first pharmacy claim for an ICS-formoterol inhaler. All members were continuously enrolled during the 24-month study period, consisting of a 12-month preperiod and postperiod based on the index date. The primary clinical outcome was mean annual asthma exacerbations. The primary cost outcomes include the difference among mean annual asthma-specific pharmacy, medical, and total costs per member with asthma. A paired Wilcoxon signed rank test was used for statistical analysis.</p><p><strong>Results: </strong>Claims for 590 members were included in the analysis. The population consisted of 55.9% women with a mean age of 39 years. The mean annual asthma exacerbations decreased 25.6% from the preperiod to the postperiod (0.347 vs 0.258; <i>P</i> = 0.028). Mean asthma-specific pharmacy and total asthma costs significantly increased from the preperiod to the postperiod $474 vs $1,796 (<i>P</i> < 0.001) and $1,505 vs $2,567 (<i>P</i> < 0.001), respectively. The mean asthma-specific medical costs significantly decreased in the postperiod compared with the preperiod ($1,031 vs $771; <i>P</i> = 0.031).</p><p><strong>Conclusions: </strong>In this descriptive study, initiators of ICS-formoterol experienced a decrease in asthma exacerbations and an increase in professional visits. Initiators also had higher mean asthma-specific pharmacy and total costs, but lower mean asthma-specific medical costs. Health plans can take additional steps to promote implementation of updated guidelines. Pursuing clinical programs to further reduce asthma exacerbations would benefit members, providers, and the health plan.</p>","PeriodicalId":16170,"journal":{"name":"Journal of managed care & specialty pharmacy","volume":"31 3","pages":"245-252"},"PeriodicalIF":2.3,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11871162/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143531567","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The impact of patient characteristics and social drivers of health factors on oral oncolytic adherence.","authors":"Nikki Uyehara, Valerie Nguyen, Stacey Yu, Yingjie Weng, Ashley Son, Priyanka Patneedi, Sheila Haidar, Serena Evans, Elizabeth Oyekan, Neera Ahuja","doi":"10.18553/jmcp.2025.31.3.306","DOIUrl":"10.18553/jmcp.2025.31.3.306","url":null,"abstract":"<p><strong>Background: </strong>Oral oncolytic medication adherence is crucial for effective cancer treatment, yet adherence rates vary widely (16%-100%) depending on cancer subtypes, assessment methodologies, and patient contexts. The increased use of oral medications for various cancer types, although often advantageous over traditional parenteral infusions, has transferred the responsibility of medication administration and management to patients. As such, Stanford Specialty Pharmacy uses a team of pharmacists and liaisons who proactively follow-up with patients before each refill to track adherence and make recommendations where required. Although this program is a step forward in bettering patient outcomes, it does not address the root cause of medication nonadherence. It is vital to better understand trends associated with oral oncolytic medication adherence to better support patients with adherence.</p><p><strong>Objective: </strong>To conduct a retrospective analysis of patient records at Stanford Health Care (SHC) Specialty Pharmacy to probe correlations between patient characteristics, social determinants and drivers of health, and adherence to oral oncolytic medications to better support patients with their medication adherence.</p><p><strong>Methods: </strong>This population included patients aged at least 18 years who had an oral oncolytic dispensed from SHC Specialty Pharmacy between May 2022 and April 2023, with patient characteristics and adherence data taken from patients' electronic health records. Medication nonadherence was defined as a proportion of days covered less than 80%. Using multivariable mixed-effects logistic regression, the rate of nonadherence was compared across several patient characteristics, including age, race and ethnicity, and geographic residence.</p><p><strong>Results: </strong>Among 939 patients, 73.75% demonstrated medication adherence, highlighting a high adherence rate within the SHC Specialty Pharmacy cohort. Smoking was significantly associated with 395% higher odds of nonadherence (95% CI = 1.07 - 14.6; P = 0.04) compared with smoking abstinence, whereas patients with obesity presented 59% lower odds of nonadherence compared with patients with normal weight (95% CI = 0.24-0.69; P < 0.001). Additionally, trends in primary language, race and ethnicity, and geographic residence in relation to medication adherence were seen.</p><p><strong>Conclusions: </strong>These findings show multiple patient characteristics that are associated with oral oncolytic adherence. These identified patterns and additional studies will better inform targeted interventions for achieving equitable care and enhancing access to effective cancer treatments, leading to improved patient outcomes.</p>","PeriodicalId":16170,"journal":{"name":"Journal of managed care & specialty pharmacy","volume":"31 3","pages":"306-320"},"PeriodicalIF":2.3,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11871160/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143531538","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Receipt of Medicare Part D comprehensive medication reviews in older adults with dementia.","authors":"Antoinette B Coe, Jonathan Martindale, Julie P W Bynum","doi":"10.18553/jmcp.2025.31.3.296","DOIUrl":"10.18553/jmcp.2025.31.3.296","url":null,"abstract":"<p><strong>Background: </strong>Older adults with Alzheimer disease and related dementias (ADRDs) are at high risk for medication-related problems. Comprehensive medication reviews (CMRs), required in Medicare Part D medication therapy management (MTM) programs, aim to optimize medication use and reduce adverse events. Individual factors related to MTM eligibility and CMR receipt among beneficiaries with ADRD are unknown.</p><p><strong>Objective: </strong>To examine MTM eligibility and CMR receipt among older adults with ADRD compared with those without.</p><p><strong>Methods: </strong>This retrospective, cross-sectional study included 2014 Health and Retirement Study participants aged at least 65 years, with continuous Medicare fee-for-service and Part D coverage. Outcomes were MTM eligibility and CMR receipt in 2014 or 2015. Our primary independent variable was presence of diagnosed ADRD. Covariates included sociodemographic characteristics, health conditions, and functional limitations. Weighted descriptive and bivariate statistics and multivariable logistic regression were used.</p><p><strong>Results: </strong>We included 14,778,506 older adults and 10.1% had ADRD. Those with ADRD were older (mean age [SE] = 83 [0.6] vs 75 [0.2] years; <i>P</i> < 0.001), had a higher proportion of Black (11.6% vs 6.3%) and Hispanic (5.7% vs 4.7%) race and ethnicity (<i>P</i> = 0.008), and had higher MTM eligibility (25.3% vs 14.8%; <i>P</i> < 0.001) compared with those without ADRD. Older adults with ADRD were more likely to be eligible for MTM (odds ratio [OR] = 1.95, 95% CI = 1.41-2.70) but not after adjusting for covariates (adjusted OR = 1.41, 95% CI = 0.88-2.27). Overall, 16.9% received a CMR. CMR receipt was lower in those with ADRD compared with those without (10.4% vs 18.2%), but not significantly different (<i>P</i>  = 0.12). ADRD status was not associated with CMR receipt (OR = 0.52, 95% CI = 0.23-1.21, adjusted OR = 0.75, 95% CI = 0.25-2.29).</p><p><strong>Conclusions: </strong>Older adults with ADRD were not more likely to be MTM eligible or receive a CMR compared with those without ADRD. Strategies to improve MTM program design are needed to increase CMR receipt among older adults with ADRD.</p>","PeriodicalId":16170,"journal":{"name":"Journal of managed care & specialty pharmacy","volume":"31 3","pages":"296-305"},"PeriodicalIF":2.3,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11871161/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143531581","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Real-world adherence to erenumab, rescue medication utilization, and work absenteeism for patients with migraine: Results from an outcomes-based agreement.","authors":"Elizabeth C S Swart, Samuel K Peasah, Yan Huang, Mark E Bensink, Melissa S Greco, Chronis Manolis, Chester B Good","doi":"10.18553/jmcp.2025.31.3.236","DOIUrl":"10.18553/jmcp.2025.31.3.236","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Migraine prevalence is estimated to be 15% (approximately 50 million people) in the United States, posing a significant burden on the health care system and a top cause of years lived with disability. Consequently, migraine leads to increased work-related disability, including presenteeism and absenteeism. Novel prophylactic treatments for migraine that target the calcitonin gene-related peptide pathway, including monoclonal antibodies to the calcitonin gene-related peptide ligand or the calcitonin gene-related peptide receptor (calcitonin gene-related peptide monoclonal antibodies) and gepants, offer new options for migraine prevention. The advent of new medications presents an opportunity for development of outcomes-based agreements, particularly because these agents are more costly than traditional, nonspecific treatment alternatives. Outcomes-based agreements are pricing agreements between pharmaceutical manufacturers and payers, centered around predefined performance metrics to better align incentives and create shared risk between them.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To report results of an outcomes-based agreement that was executed in a large integrated delivery and finance health system for patients with migraine who were prescribed erenumab, an anti-calcitonin gene-related peptide pathway monoclonal antibody.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This is a prospective real-world analysis of commercial or health insurance exchange data from a large regional health system, based on parameters of an outcomes-based agreement. Eligible patients were new to calcitonin gene-related peptide monoclonal antibodies. Outcomes of interest included an erenumab adherence metric and changes in work absenteeism and rescue medication use. Proportion adherent and rescue medication use were assessed for the entire eligible patient cohort, whereas work absenteeism was only evaluated for a subset of eligible patients for whom work outcomes data were available.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;There were 5,507 patients who filled erenumab during the contract period, and 1,281 patients were new to calcitonin gene-related peptide monoclonal antibodies medications. Of those, 865 constituted the eligible patient cohort and 224 constituted the work outcomes cohort. Patient adherence to erenumab was 80.5% and 81.7% for the entire patient cohort and work outcomes cohort, respectively. Absenteeism was reduced by 5.5% (21.64 vs 20.44 hours; &lt;i&gt;P&lt;/i&gt; = 0.664) and rescue medication use was decreased by 3.6% (0.362 vs 0.349 doses; &lt;i&gt;P&lt;/i&gt; = 0.589). Absenteeism could have been impacted by the onset of the COVID-19 pandemic.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;As measured, adherence to erenumab was high within the cohort. The inclusion of a work outcomes cohort provided valuable insights about the clinical benefits of erenumab for migraine prevention. Our findings provide additional insights on the real-world use of erenumab within the context o","PeriodicalId":16170,"journal":{"name":"Journal of managed care & specialty pharmacy","volume":"31 3","pages":"236-244"},"PeriodicalIF":2.3,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11871164/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143531574","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Integrated health system pharmacy role in adherence, persistence, and adverse effect management for oral chronic lymphocytic leukemia therapy.","authors":"Houston Wyatt, Stephanie White, Hannah Holloway, Josh DeClercq, Autumn D Zuckerman, Leena Choi, Mei Xue, Karen Carr, Swetha Challgulla, Keri Yang, Chelsea Renfro","doi":"10.18553/jmcp.2025.31.3.253","DOIUrl":"10.18553/jmcp.2025.31.3.253","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Oral oncolytic therapy for the management of chronic lymphocytic leukemia (CLL) or small lymphocytic leukemia (SLL), such as ibrutinib, acalabrutinib, and venetoclax, have vastly changed CLL treatment. Although effective, adverse effects of these agents remain challenging. Pharmacists have an important role in managing oral chemotherapy, educating patients, and intervening to reduce adverse effects.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To evaluate medication utilization patterns (adherence, persistence, discontinuation, and switching therapy) and pharmacists' management of adverse effects in patients initiated on an oral oncolytic therapy for CLL/SLL at an integrated health system specialty pharmacy.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This single-center, retrospective review of data collected from electronic health records and a specialty pharmacy management system was conducted at the institution's outpatient oncology and hematology clinics from January 1, 2019, through June 30, 2022. Patients were included if they were prescribed acalabrutinib, ibrutinib, or venetoclax for treatment of CLL/SLL. Patients were followed through December 2022, with all patients having at least 6 months of follow-up. Primary outcomes were adherence (calculated as proportion of days covered [PDC] for patients with ≥3 fills), persistence (defined as absence of a ≥30-day gap in treatment), discontinuation or therapy switch, and reasons for discontinuation or therapy switch. A secondary analysis evaluated pharmacist interventions and intervention outcomes for patient-reported adverse effects. Descriptive statistics were used for analyses.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;There were 145 patients included in the study; among the 137 with at least 3 fills, the median PDC was 0.98 (interquartile range [IQR] 0.90-1.00) and 51 patients (37%) were found to be nonpersistent with median time to nonpersistence of 10 (IQR 6-19) months. Among 53 patients (39%) who discontinued therapy, common reasons included adverse effects (n = 26, 49%) and disease progression (n = 25, 47%). Common reasons for switching therapy among patients with a switch (n = 25; 17%) included adverse effects (n = 18, 72%) and progressive disease (n = 8, 32%). Pharmacists completed 141 interventions in 69 patients (43%) and most often acted by reviewing or updating the patient's chart (n = 85, 60%) and counseling patients (n = 50, 35%). Intervention outcomes included identified issue resolved (n = 79, 56%), follow-up care scheduled (n = 9, 6%), medication administration held (n = 2, 1%), dose adjustment made (n = 4, 3%), or medication discontinued (n = 4, 3%).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;In a population of patients initiating oral CLL/SLL therapy through an integrated health system specialty pharmacy, adherence and persistence to therapy was high. Adverse effects were attributed in 36% of therapy discontinuations and 72% of therapy switches, indicating a continued opportunity fo","PeriodicalId":16170,"journal":{"name":"Journal of managed care & specialty pharmacy","volume":"31 3","pages":"253-261"},"PeriodicalIF":2.3,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11871158/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143531570","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The effectiveness and value of disease-modifying therapies for transthyretin amyloid cardiomyopathy.","authors":"Dmitriy Nikitin, Jason H Wasfy, Aaron N Winn, Finn Raymond, Kanya K Shah, Sodam Kim, Daniel R Touchette, Woojung Lee, Marina Richardson, David M Rind, Steven D Pearson, Foluso Agboola","doi":"10.18553/jmcp.2025.31.3.323","DOIUrl":"10.18553/jmcp.2025.31.3.323","url":null,"abstract":"","PeriodicalId":16170,"journal":{"name":"Journal of managed care & specialty pharmacy","volume":"31 3","pages":"323-328"},"PeriodicalIF":2.3,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11871155/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143531586","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Thanks to <i>JMCP</i> Peer Reviewers, 2024.","authors":"","doi":"10.18553/jmcp.2025.31.3.329","DOIUrl":"https://doi.org/10.18553/jmcp.2025.31.3.329","url":null,"abstract":"","PeriodicalId":16170,"journal":{"name":"Journal of managed care & specialty pharmacy","volume":"31 3","pages":"329-331"},"PeriodicalIF":2.3,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143531584","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}