Journal of managed care & specialty pharmacy最新文献

{"title":"Improving adherence to guideline-based lipid-lowering therapy in people with hyperlipidemia using a targeted educational outreach approach.","authors":"Erin Conley, Susanna Chang, Laney K Jones, Bethany Kalich, Grant Patterson, Nick Payne, Sheriden Beard, Kizzy Steward Judie, Tina Kelley","doi":"10.18553/jmcp.2026.26004","DOIUrl":"https://doi.org/10.18553/jmcp.2026.26004","url":null,"abstract":"<p><strong>Background: </strong>Elevated low-density lipoprotein cholesterol (LDL-C) leads to atherosclerotic plaque buildup and drives cardiovascular disease. Despite the availability of effective therapies for LDL-C reduction, elevated LDL-C is common in the United States.</p><p><strong>Objective: </strong>To measure the success of a pharmacist-led telephonic outreach program designed to proactively address individuals with hyperlipidemia who were not being treated in accordance with cholesterol guidelines and collaborate with their primary care clinicians (PCCs) to increase guideline-based care.</p><p><strong>Methods: </strong>The 3-month outreach occurred from September through November 2023. Health plan members with 1 inpatient or 2 outpatient claims for hyperlipidemia within the previous year were determined using <i>International Classification of Diseases, Tenth Revision, Clinical Modification</i> codes. Members not managed in accordance with the 2018 American Heart Association/American College of Cardiology (ACC)/Multisociety Guideline and 2022 ACC Expert Consensus Decision Pathway, based on available claims data, received a personalized action recommendation. The outreach team contacted the member and scheduled a phone call with a pharmacist. If the member agreed to the pharmacist's clinical recommendation, the outreach team contacted the member's PCC directly (by fax or e-mail). PCCs were responsible for the final clinical decision and action.</p><p><strong>Results: </strong>Of 14,979 members who met the inclusion criteria, 883 were selected at random for contact by the outreach team. Of these, 667 members (76%) accepted a call with a pharmacist and were considered the intervention group. An additional 5,266 members who were not contacted and did not share a PCC with someone in the intervention group were included as the control group. In the intervention group, 92.4% of members accepted the guideline-based hyperlipidemia recommendation, allowing the pharmacist to contact their PCC. The overall percentage of members moving toward guideline-recommended care in the intervention group (25.5%) was approximately twice that in the control group (11.1%). Members could undergo an LDL-C test if they had no LDL-C result available, initiated lipid-lowering therapy (LLT) if they were not already being treated for hypercholesterolemia, or intensified their existing statin regimen or added a nonstatin LLT. The difference in proportion of members remaining on no statin throughout the program was significantly lower in the intervention group (-7.9% [95% CI = -11.3% to -4.5%]) vs the control group. At the end of the pilot, 8.7% (58 of 667) of intervention group members received LLT in accordance with current guidelines vs 6.0% (316 of 5,266) in the control group.</p><p><strong>Conclusions: </strong>This study demonstrated that a health plan-driven, pharmacist-led, educational outreach program increased movement toward guideline-based LDL-C management i","PeriodicalId":16170,"journal":{"name":"Journal of managed care & specialty pharmacy","volume":" ","pages":"1-11"},"PeriodicalIF":2.9,"publicationDate":"2026-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147838930","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}

{"title":"Principles and practices for successful gene therapy innovative contracting: insights from a multistakeholder convening.","authors":"Tyler D Wagner, Jacqlyn W Riposo, Kendra M Gould, Jonathan D Campbell, James T Kenney, Theresa Schmidt","doi":"10.18553/jmcp.2026.25356","DOIUrl":"https://doi.org/10.18553/jmcp.2026.25356","url":null,"abstract":"<p><strong>Background: </strong>Gene therapies (GTs) offer potentially 1-time, curative treatment approaches for inherited and other rare diseases, but their often high upfront costs and small patient populations challenge traditional reimbursement models. In response, US payers and manufacturers have increasingly implemented innovative contracts (ICs) tied to value and outcomes.</p><p><strong>Objective: </strong>To share key stakeholder experiences and identify opportunities for efficient and effective innovative contracting solutions for GTs.</p><p><strong>Methods: </strong>We used a 6-step multimethod approach, including a literature review, stakeholder interviews, framework development, a virtual convening of stakeholders, and a pre- and postconvening survey. We defined \"ICs\" as agreements between payers and manufacturers that use real-world outcomes to determine the total price paid for GTs, encompassing various contracting models (eg, rebates, warranties, and performance designs) and terminologies that link outcomes to pricing. We defined \"principles\" as elements of ICs for successful GT innovative contracting and \"practices\" as processes and steps for stakeholders to explore feasibility, negotiation, and execution of an IC for a GT. The consensus principles and practices include those that received at least 75.0% of the votes (9 of a possible 12 stakeholders) for minimal or no revisions, prioritizing the top 8 principles and practices with the highest consensus.</p><p><strong>Results: </strong>Eight principles of a possible 18 (44.4%) achieved 75.0% consensus with minimal to no revisions, and 7 of 26 possible practices (26.9%) achieved 100.0% consensus with minimal to no revisions. Principle topics included outcomes, duration, data collection, types of contracts, and patient costs. Practice topics included a focus on feasibility, negotiation, contract term, and evaluation. Stakeholders reviewed additional topics that did not ultimately reach consensus, including the role of patients and providers in innovative contracting.</p><p><strong>Conclusions: </strong>The mixed methods approach enabled the development of nuanced and contemporary principles and practices in innovative contracting for GTs. As more GTs are approved, there may be a need to refresh the principles and practices.</p>","PeriodicalId":16170,"journal":{"name":"Journal of managed care & specialty pharmacy","volume":" ","pages":"1-8"},"PeriodicalIF":2.9,"publicationDate":"2026-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147839000","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}

{"title":"Correction Statement.","authors":"","doi":"10.18553/jmcp.2026.32.5.637","DOIUrl":"https://doi.org/10.18553/jmcp.2026.32.5.637","url":null,"abstract":"","PeriodicalId":16170,"journal":{"name":"Journal of managed care & specialty pharmacy","volume":"32 5","pages":"637"},"PeriodicalIF":2.9,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13119486/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147774131","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":"Antiretroviral therapy switch among Medicare beneficiaries with HIV.","authors":"Mary J Christoph, Uche Mordi, Suying Li, Haifeng Guo, TingTing Gong, Travis Lim, Seojin Park, Woodie Zachry, Phyllis C Tien","doi":"10.18553/jmcp.2026.25275","DOIUrl":"10.18553/jmcp.2026.25275","url":null,"abstract":"<p><strong>Background: </strong>Persistence to antiretroviral therapy (ART) is essential for optimal HIV treatment outcomes. People with HIV (PWH) enrolled in Medicare often have a higher prevalence of comorbidities, which can negatively impact persistence, leading to suboptimal HIV outcomes.</p><p><strong>Objective: </strong>To compare ART switch patterns among PWH insured by Medicare.</p><p><strong>Methods: </strong>Using Medicare Fee-for-Service and Medicare Advantage claims data from January 2017 to December 2022, a retrospective cohort study of treatment-experienced PWH aged 18 years and older and on ART was conducted. ART regimens included bictegravir/emtricitabine/tenofovir alafenamide (B/F/TAF), dolutegravir/lamivudine (DTG/3TC), dolutegravir/abacavir/lamivudine (DTG/ABC/3TC), or multitablet regimens (MTRs; dolutegravir + emtricitabine/tenofovir alafenamide [DTG + F/TAF] or dolutegravir + emtricitabine/tenofovir disoproxil fumarate [DTG + F/TDF]). An analysis of PWH who had mental health and/or substance use disorders was also conducted. Treatment switch by ART regimen was evaluated using Kaplan-Meier curves, log-rank tests, and Cox proportional hazards models after using inverse probability treatment weighting to balance across groups.</p><p><strong>Results: </strong>A total of 30,205 treatment-experienced PWH were included. PWH who initiated DTG/3TC, DTG/ABC/3TC, and MTRs on the index date had 1.28 (95% CI = 1.13-1.45), 2.67 (95% CI = 2.47-2.89), and 5.37 (95% CI = 4.60-6.26) times higher hazard ratio of switching ART, respectively, compared with PWH indexed on B/F/TAF (all <i>P</i> < 0.0001). Similar results were observed among PWH with mental health and/or substance use disorders.</p><p><strong>Conclusions: </strong>Medicare-insured PWH indexed on B/F/TAF had lower risk of treatment switch compared with other ART regimens, both overall and in the subgroup with mental health and/or substance use disorders. These findings may inform targeted strategies for optimal treatment selection for PWH.</p>","PeriodicalId":16170,"journal":{"name":"Journal of managed care & specialty pharmacy","volume":" ","pages":"574-583"},"PeriodicalIF":2.9,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13119497/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147290214","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":"AMCP Market Insights: Getting to the heart of hard-to-control hypertension in managed care.","authors":"Bridget Flavin, Denise Wolff, Gaurang Gandhi, Hiva Pourarsalan, Florian Rader, Terry Richardson, Michael Shannon, Stephanie Spence, Susan Wescott","doi":"10.18553/jmcp.2026.32.5-a.s1","DOIUrl":"10.18553/jmcp.2026.32.5-a.s1","url":null,"abstract":"<p><p>Hard-to-control hypertension, comprising uncontrolled and resistant hypertension, is highly prevalent, meaning many patients with hypertension remain at risk of adverse outcomes despite treatment. To discuss the role of managed care in addressing hard-to-control hypertension, AMCP Market Insights virtually convened an expert panel of managed care stakeholders in November 2025. This article provides a qualitative summary of the panel discussion. Key insights were that despite multiple effective, low-cost pharmacotherapy options, a significant proportion of patients have blood pressure above recommended goals because of confounding factors at both the micro and macro levels; and managed care-specific challenges in hard-to-control hypertension include competing organizational priorities, data gaps, and lack of integration of existing resources. Opportunities to advance care in hard-to-control hypertension include focusing on prevention and providing additional patient and clinician support such as with education and enhancing use of digital technologies. Other insights were that top payer priorities in hypertension include reducing cardiovascular events and other complications and meeting quality goals, and that current clinical guidelines and provider input are important elements of payer decision-making. These findings can support informed clinical and coverage decisions, can offer practical actions for payers, and may inform future work.</p>","PeriodicalId":16170,"journal":{"name":"Journal of managed care & specialty pharmacy","volume":"32 5-a Suppl","pages":"S1-S10"},"PeriodicalIF":2.9,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13121772/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147773661","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":"AMCP Market Insights: Beyond skin deep on the role of managed care in moderate to severe atopic dermatitis.","authors":"Bridget Flavin, Denise Wolff, Mike Abdo, Aderonke Adeboye, Mona Chitre, Zachary Contreras, Gaurang Gandhi, Mark Lebwohl, Terry Richardson, Wendy Smith Begolka","doi":"10.18553/jmcp.2026.32.5-b.s1","DOIUrl":"10.18553/jmcp.2026.32.5-b.s1","url":null,"abstract":"<p><p>Atopic dermatitis (AD), is a chronic, relapsing inflammatory skin disorder that can pose a significant burden to patients and their caregivers and decrease their quality of life. Although substantial advances have been made in the safety and effectiveness of treatments for moderate to severe AD, opportunity for improvement remains. To better understand the patient journey and to consider the management of both current and emerging treatments, AMCP Market Insights virtually convened an expert panel of managed care stakeholders in November 2025. This article provides a qualitative summary of the panel discussion. Key insights include that delayed diagnosis and limited access to dermatology specialists are top gaps in the provision of equitable care in moderate to severe AD and that despite treatment advances, more effective and affordable options are needed. Additionally, treatment adherence and positive outcomes in moderate to severe AD are multifactorial and may be affected by elements such as timely access, care coordination, disease severity and variability, and medication coverage and costs. Emerging agents show promise for a more durable response with less frequent dosing than current therapies, but payers are waiting for additional data to demonstrate long-term safety and efficacy and real-world outcomes. These findings can support informed clinical and coverage decisions, can offer practical actions for payers, and may inform future work.</p>","PeriodicalId":16170,"journal":{"name":"Journal of managed care & specialty pharmacy","volume":"32 5-b Suppl","pages":"S1-S9"},"PeriodicalIF":2.9,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13119489/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147773691","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":"Medicaid access to Most Favored Nation through the Pfizer agreement: The unanswered issues.","authors":"Jeromie Ballreich, Joseph Levy, Tucker Desmond, Nathan Jibat, Gerard Anderson","doi":"10.18553/jmcp.2026.32.5.525","DOIUrl":"10.18553/jmcp.2026.32.5.525","url":null,"abstract":"<p><p>In the following commentary, we discuss the motivation for the Trump-Pfizer Most Favored Nation (MFN) pricing deal, a preliminary analysis on potential savings, and discussion on the details that will determine the success of the Trump-Pfizer deal. This deal represents the Trump administration's pursued health policy to get Americans a \"better deal\" for drug pricing by providing Medicaid programs access to MFN pricing for Pfizer-branded drugs. Using different data sources, we provide a preliminary analysis on the deal's impact on 6 Pfizer drugs. Our results suggest Medicaid programs may save a maximum of $280 million from access to MFN pricing, reflecting 11.5% in additional rebates off gross spending. Medicaid programs will have greater potential net savings when using MFN benchmarking for newer drugs with lower baseline rebates compared with older, highly rebated drugs. It is uncertain if the MFN prices will apply to all new and existing Pfizer drugs or just a selection. We also highlight several implementation challenges ranging from different marketed names of drugs to selection of countries for MFN pricing that will influence the deal's impact.</p>","PeriodicalId":16170,"journal":{"name":"Journal of managed care & specialty pharmacy","volume":"32 5","pages":"525-529"},"PeriodicalIF":2.9,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13119475/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147774082","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":"State-level variation in the use of glucagon-like peptide-1 receptor agonists for weight loss and diabetes: a real-world analysis.","authors":"Steven Do, Kathryn Christensen, Angela Inneh, Samuel Peasah, Chester Good","doi":"10.18553/jmcp.2026.32.5.625","DOIUrl":"10.18553/jmcp.2026.32.5.625","url":null,"abstract":"<p><strong>Background: </strong>Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) have demonstrated clinical benefits beyond glycemic control, including weight loss and cardiovascular protection. Given the growing interest in the clinical value of GLP-1 RAs, greater understanding of geographic variation in utilization by disease prevalence and the influence of state-level coverage policies is desirable.</p><p><strong>Objective: </strong>To assess (1) state-level utilization of GLP-1 RAs by indication for diabetes and obesity, (2) correlation of those rates to the state-level prevalence of diabetes and obesity, and (3) state-specific Medicaid formulary coverage of GLP-1 RAs for weight loss and diabetes.</p><p><strong>Methods: </strong>We conducted a cross-sectional analysis of pharmacy claims from the Komodo Healthcare Map between January 1 and December 31, 2023. GLP-1 RA utilization was defined as the prevalence of members with GLP-1 RA claims for US Food and Drug Administration-approved indications for diabetes or obesity. State-level diabetes and obesity prevalence were obtained from the 2022-2023 Behavioral Risk Factor Surveillance System. Medicaid coverage for GLP-1 RAs was categorized as \"not covered,\" \"restricted,\" or \"unrestricted.\" Pearson correlation coefficients were calculated to assess relationships between state-level disease prevalence and GLP-1 RA utilization.</p><p><strong>Results: </strong>State-level utilization of GLP-1 RAs for diabetes was strongly correlated with diabetes prevalence in the commercially insured population, but correlation was moderate with those with Medicare and weak with the Medicaid population. For obesity, utilization showed only weak or negligible correlations with obesity prevalence. Medicaid coverage policies influenced access where utilization in states with \"restricted\" or \"unrestricted\" coverage was nominally higher than in states with \"not covered\" policies.</p><p><strong>Conclusions: </strong>GLP-1 RA utilization in the United States varies substantially by payer type, indication, and state-level coverage policies.</p>","PeriodicalId":16170,"journal":{"name":"Journal of managed care & specialty pharmacy","volume":"32 5","pages":"625-630"},"PeriodicalIF":2.9,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13119483/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147773716","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":"Assessment of IPAY 2027 Medicare drug price negotiation maximum fair prices with prices in most-favored nation reference countries.","authors":"Nico Gabriel, Kristi Martin, Emma M Cousin, Kevin H Li, Jens Grueger, Sean D Sullivan","doi":"10.18553/jmcp.2026.32.5.530","DOIUrl":"10.18553/jmcp.2026.32.5.530","url":null,"abstract":"<p><strong>Background: </strong>Prescription drug list prices in the United States far exceed those in peer nations, averaging 278% of non-US prices and 422% for branded products. The Inflation Reduction Act authorized Medicare to negotiate net prices for high-expenditure drugs, resulting in maximum fair prices (MFPs) for 15 Part D products effective in 2027. Subsequently, Centers for Medicare and Medicaid Services (CMS) introduced the GLOBE and GUARD models, which propose a most-favored nation (MFN) pricing framework for both Part B and Part D, respectively, that is tied to international prices in 19 countries. CMS also introduced the GENEROUS model for Medicaid, which uses an 8-country subset of the GLOBE/GUARD reference nations.</p><p><strong>Objective: </strong>To evaluate the performance of the Medicare Drug Price Negotiation Program by comparing negotiated net prices with domestic and international list price benchmarks.</p><p><strong>Methods: </strong>We identified negotiated drugs using CMS publications and estimated initial US net prices and CMS price benchmarks for negotiation including statutory discounts. International list prices from the 19 countries that will be used as reference for the GUARD and GLOBE models were extracted from Eversana's NAVLIN database and converted to US dollars using 2025 exchange rates. Prices were adjusted using purchasing power parity. All prices were standardized to a 30-day equivalent supply following CMS methods. For drugs with multiple brands or strengths, weighted average per-unit prices were estimated using Medicare Part D utilization data.</p><p><strong>Results: </strong>Postnegotiation MFPs were 15% to 60% (median: 38%) lower than estimated US net prices with greater reductions for drugs whose ceiling price was determined by the net price. However, MFPs remained 17% to 755% (median: 108%) higher than the average purchasing power parity-adjusted published list price in MFN reference countries. The mean US-to-international price ratio declined from 5.8 before negotiation to 3.3 afterward. Twelve of 14 drugs had MFPs below their estimated ceilings, whereas the 15th drug had an inestimable ceiling. There is not enough information about the proposed GLOBE and GUARD models to project MFN prices for Part B or D at this time. Discounts varied by therapeutic class and were larger for drugs with prior negotiated comparators.</p><p><strong>Conclusions: </strong>The 2025 Medicare drug negotiations will generate meaningful reductions in domestic drug prices when they take effect in 2027 but left substantial disparities relative to peer nations. Upcoming MFN-based pricing models may exert further downward pressure, although their implementation and international effects warrant careful monitoring.</p>","PeriodicalId":16170,"journal":{"name":"Journal of managed care & specialty pharmacy","volume":"32 5","pages":"530-539"},"PeriodicalIF":2.9,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13119479/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147774023","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":"Development of a decision aid to help dually enrolled veterans make informed choices on medication sourcing.","authors":"Anna Hung, Jadyn Cleary, Ellen B Lawrence, Kaitlyn Goodwin, Theodore S Berkowitz, Valerie A Smith, Carolyn T Thorpe, Shelby D Reed, Matthew L Maciejewski, Matthew J Crowley, William E Bryan, Richard Erickson, Kelli Tharpe, Lesley McCathern, Leigh McNaughton, Gina Upchurch, Francesca Cunningham, Jeffrey T Kullgren, Angela Fagerlin","doi":"10.18553/jmcp.2026.32.5.551","DOIUrl":"10.18553/jmcp.2026.32.5.551","url":null,"abstract":"<p><strong>Background: </strong>Veterans enrolled in both Veterans Affairs (VA) health care and Medicare Part D can choose to obtain medications through the VA, Medicare Part D, or both, with each option differing in cost, coverage, and coordination of care. Poorly informed choices can lead to veteran frustration when their expectations are not met, delays in medication access, and increased risks. This study aimed to develop a decision aid (DA) to help veterans with diabetes make informed choices about medication sourcing (ie, whether to fill medications through VA health care only, Part D only, or both).</p><p><strong>Methods: </strong>DA development was guided by the International Patient DA Standards and the Ottawa Decision Support Framework. Interviews with veterans and care partners informed the prototype design. Alpha testing with 18 end users (mostly veterans) and 12 stakeholders (pharmacists, doctors, payers, Medicare counselors, and others) assessed comprehensibility, usability, and acceptability. During beta testing, the feasibility of the revised DA was assessed during interviews with 20 end users and 8 stakeholders. For end-user interviews, a survey assessing decisional conflict, satisfaction, and knowledge was provided before and after respondents filled out the DA.</p><p><strong>Results: </strong>Alpha testing feedback led to simplifying the cost and formulary comparison chart and expanding the medication list template to include more medications, fill location, and prescriber contact information. Based on beta testing responses (n = 16), the mean system usability scale score for the DA was 77.5 (SD = 14.4), suggesting usability. Beta testers also reported the DA to be acceptable in length (94%), balance (88%), and amount of information (81%). Based on pre- vs post-DA survey responses, decisional conflict was reduced, as indicated by an increase in the mean Sure of myself; Understand information; Risk-benefit ratio; Encouragement (SURE) score (pre-DA: 3.1, SD = 1.4 to all 16 respondents reporting a maximum SURE score of 4.0). Knowledge about VA and Medicare coverage of diabetes medications also improved: the proportion who answered all 5 comprehension questions correctly increased from 57% to 81%. Last, the proportion of respondents who reported being \"very satisfied\" with how they were currently filling their diabetes medicines (VA only, Part D only, or both) improved from 64% pre-DA to 81% post-DA.</p><p><strong>Conclusions: </strong>The DA developed iteratively was usable and acceptable and showed potential in reducing decisional conflict, increasing knowledge, and increasing satisfaction, so it may help Part D-enrolled veterans with decisions about medication sourcing.</p>","PeriodicalId":16170,"journal":{"name":"Journal of managed care & specialty pharmacy","volume":"32 5","pages":"551-562"},"PeriodicalIF":2.9,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13119477/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147774141","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}