Journal of managed care & specialty pharmacy最新文献

{"title":"Burden of illness and unmet needs in patients with erythropoietic protoporphyria and X-linked protoporphyria: A large US nationwide claims analysis.","authors":"Maral DerSarkissian, Chelsea Norregaard, Hela Romdhani, Aruna Muthukumar, Priyanka Bobbili, Melanie Chin, Wenxu Liu, Ly Trinh","doi":"10.18553/jmcp.2025.25132","DOIUrl":"https://doi.org/10.18553/jmcp.2025.25132","url":null,"abstract":"<p><strong>Background: </strong>Erythropoietic protoporphyria (EPP) and X-linked protoporphyria (XLP) are rare genetic disorders caused by the accumulation of the toxic metabolite protoporphyrin IX, which results in painful phototoxicity upon sunlight exposure. Despite their significant impact on quality of life and potential for serious complications, treatment options for EPP/XLP are limited and real-world burden of illness and unmet needs have been understudied in this population.</p><p><strong>Objective: </strong>To retrospectively evaluate real-world health care resource utilization (HRU) and costs among patients with EPP/XLP compared with matched comparators and to characterize the current EPP/XLP management in the United States using a large, nationwide claims database.</p><p><strong>Methods: </strong>Data were obtained from the Komodo Research Database (2016-2023). Patients with EPP/XLP (≥2 EPP/XLP diagnosis codes, first diagnosis defined index date) and comparator patients without an EPP/XLP diagnosis were identified and matched at a 1:4 ratio on index date and key characteristics. Patients were required to have ≥6 months of continuous enrollment pre-index (baseline period). HRU and costs were assessed post-index on a per patient per year (PPPY) basis. Comparison between cohorts were conducted using rate ratios (RRs) estimated from negative binomial regressions and cost ratios estimated from 2-part linear models, respectively. The use of treatments for EPP/XLP and concomitant medications commonly prescribed for associated comorbidities was also assessed during the follow-up period.</p><p><strong>Results: </strong>In total, 696 patients with EPP/XLP and 2,784 matched comparator patients were included. In both cohorts, mean age was approximately 45.5 years; 55% were female and 55% were White. Over a mean follow-up of 30 months, patients with EPP/XLP had significantly higher all-cause HRU compared with comparators, with a mean PPPY number of inpatient stays of 0.8 vs 0.2 (RR = 3.4; <i>P</i> < 0.001), emergency department visits of 1.5 vs 0.9 (RR = 1.7; <i>P</i> = 0.002), and outpatient visits of 35.2 vs 17.5 (RR = 2.0; <i>P</i> < 0.001). All-cause costs were also significantly higher among patients with EPP/XLP compared with comparators with a mean PPPY total cost of $71,714 vs $18,646 (ratio = 3.9; <i>P</i> < 0.001), driven by inpatient costs (mean = $30,909 vs $6,318; ratio = 4.9; <i>P</i> < 0.001) and outpatient costs (mean = $33,416 vs $7,573; ratio = 4.4; <i>P</i> < 0.001). Although only 7.6% of patients with EPP/XLP received treatment for EPP/XLP, most commonly afamelanotide (3.9%), most (68.4%) used medication related to EPP/XLP-associated comorbidities, including narcotics (46.3%), nonsteroidal anti-inflammatory drugs (38.2%), and antidepressants (35.1%).</p><p><strong>Conclusions: </strong>Patients with EPP/XLP experienced substantially higher HRU and costs compared with matched comparators, yet few received EPP/XLP-specific treatm","PeriodicalId":16170,"journal":{"name":"Journal of managed care & specialty pharmacy","volume":" ","pages":"1-13"},"PeriodicalIF":2.9,"publicationDate":"2025-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145337113","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":"Trends in opioid prescribing by oncologists for Medicare beneficiaries from 2014 to 2022.","authors":"Shaimaa Elshafie, Lorenzo Villa Zapata","doi":"10.18553/jmcp.2025.31.10.991","DOIUrl":"10.18553/jmcp.2025.31.10.991","url":null,"abstract":"<p><strong>Background: </strong>Overprescribing of opioids has led to hundreds of thousands of overdose deaths and substantial health care costs. In response, the US Food and Drug Administration (FDA) implemented a revised Risk Evaluation and Mitigation Strategy (REMS) for opioids in 2018.</p><p><strong>Objective: </strong>To evaluate trends in opioid prescribing by oncologists for Medicare Part D beneficiaries from 2014 to 2022.</p><p><strong>Methods: </strong>This cross-sectional study used data from the 2014-2022 Medicare Part D Prescriber Public Use Files. Opioid claims and prescribing trends were assessed by opioid types, oncologist subspecialty, geographic region, and rurality status. An interrupted time series analysis was conducted to assess the changes in oncologists' prescribing patterns before and after the 2018 REMS modifications.</p><p><strong>Results: </strong>The analysis included 25,371 unique oncologists, with the majority being male (66%) and specializing in hematology-oncology (47%). Over the study period, oncologists issued more than 9.4 million opioid prescriptions, with long-acting opioids accounting for 18% of these claims. Hematology-oncology specialists were responsible for the largest share of the prescriptions (67%). Oncologists practicing in the South and rural areas exhibited higher prescribing rates and longer average supply durations than those in other regions. A national sustainable decline in opioid prescribing was observed among oncologists between 2014 and 2022, with a significant immediate decline following 2018 in which the REMS changes were implemented.</p><p><strong>Conclusions: </strong>The 2018 FDA REMS update coincided with significant declines in opioid prescribing by oncologists treating Medicare beneficiaries. Although other factors, such as the COVID-19 pandemic, may have also contributed to this decline, the sustained downward trend over time highlights the need for targeted policies and tailored provider education to ensure effective cancer pain management and to address persistent regional and rural-urban disparities in prescribing practices.</p>","PeriodicalId":16170,"journal":{"name":"Journal of managed care & specialty pharmacy","volume":"31 10","pages":"991-996"},"PeriodicalIF":2.9,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12467766/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145149399","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":"Impact of copay maximizers on total patient liability among patients using specialty medicines.","authors":"Daniel Sheinson, Achal Patel, William B Wong","doi":"10.18553/jmcp.2025.31.10.982","DOIUrl":"10.18553/jmcp.2025.31.10.982","url":null,"abstract":"<p><strong>Background: </strong>Insurers increasingly use copay maximizer programs to control costs. Although these programs shield patients from out-of-pocket (OOP) exposure for drugs, the impact on OOP costs for other health care services is unknown.</p><p><strong>Objective: </strong>To examine the impact of copay maximizer programs on overall patient liability for all health care services.</p><p><strong>Methods: </strong>This retrospective analysis of pharmacy and medical claims from the IQVIA PharMetrics Plus database included patients who were required to have 3 or more prescriptions (for autoimmune, multiple sclerosis, or oral oncolytic drugs) in a calendar year between 2018 and 2022 and have been continuously enrolled in a commercial plan during that year. An algorithm was applied to identify patients with presumed exposure to a copay maximizer program within each calendar year. Patients with presumed exposure to a maximizer program in a given year and no exposure to a maximizer program in prior years were eligible for the maximizer cohort. Patients without presumed exposure to a maximizer program were eligible for the nonmaximizer cohort. Eligible patients were matched 1:1 for the study cohorts. The outcome of interest was the effect of copay maximizer programs on patient liability for other health care services (via a difference-in-difference [DiD]) approach using a generalized linear mixed-effects model).</p><p><strong>Results: </strong>In total, 5,976 patients were included in the analysis. Assuming no change in total costs from baseline to follow-up, copay maximizer programs were associated with increased patient liability for other health care services. When patient liabilities for the maximizer drug in the baseline period were $125, there was no effect on patient liabilities for other health care services (DiD [95% CI] = 0.98 [0.71-1.37]), whereas at $4,000, there was a 51% increase in patient liabilities for other health care services (1.51 [1.17-1.95]). In scenario analyses for which total costs changed from baseline to follow-up, results were similar to the base case. In the patient subgroup with no other health care patient liability at baseline ($0), a greater proportion of those who participated in a copay maximizer program had some (>$0) patient liability for other health care services in the follow-up period, compared with patients who did not participate (94.3% vs 63.2%).</p><p><strong>Conclusions: </strong>Our results indicated that copay maximizer programs are associated with an increase in patient liability for other health care services, especially for patients who relied heavily on the maximizer drug to meet deductible requirements or OOP maximums. These findings should be factored into decisions and policies on implementing and regulating these programs.</p>","PeriodicalId":16170,"journal":{"name":"Journal of managed care & specialty pharmacy","volume":"31 10","pages":"982-990"},"PeriodicalIF":2.9,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12467765/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145149427","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":"Associations of oseltamivir with neuropsychiatric and behavioral adverse events: A systematic review and meta-analysis.","authors":"Hye Su Jeong, Yeo Wool Lee, Taeho Greg Rhee, Sung Ryul Shim","doi":"10.18553/jmcp.2025.31.10.1051","DOIUrl":"10.18553/jmcp.2025.31.10.1051","url":null,"abstract":"<p><strong>Background: </strong>Influenza causes approximately 3-5 million severe cases and 290,000-650,000 deaths annually, and oseltamivir is considered the first-line pharmacotherapy. Recent reports on neuropsychiatric events (NPEs) associated with the use of oseltamivir necessitated a systematic safety profile review.</p><p><strong>Objective: </strong>To systematically review and meta-synthesize the evidence on the associations of oseltamivir with adverse NPEs and behavioral events.</p><p><strong>Methods: </strong>We conducted a systematic review and meta-analysis following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines using the PubMed/Medline, Embase, and Cochrane Library databases from inception through October 31, 2024. Studies comparing oseltamivir with other control groups for NPEs were analyzed. Outcomes were categorized into (1) affective disorders, (2) neuropsychiatric symptoms, (3) anxiety disorders, (4) schizophrenic/psychotic disorders, and (5) suicide-related behaviors.</p><p><strong>Results: </strong>9 studies with 1,139-3,352,015 patients were identified. Oseltamivir significantly associated with a lower overall NPE incidence (risk ratio [RR] = 0.83; 95% CI = 0.72-0.97), except in patients younger than 20 years. Subgroup analyses showed significant association with a lower incidence risk in suicide attempts across all ages (RR = 0.60; 95% CI = 0.46-0.77) and in schizophrenia/psychotic disorders for patients younger than 20 years (RR = 0.75; 95% CI = 0.61-0.93).</p><p><strong>Conclusions: </strong>This is the first comprehensive meta-analysis examining the associations of oseltamivir with various NPEs and behavioral adverse events, and we found no evidence supporting increased risks of these adverse events with oseltamivir use.</p>","PeriodicalId":16170,"journal":{"name":"Journal of managed care & specialty pharmacy","volume":"31 10","pages":"1051-1061"},"PeriodicalIF":2.9,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12467762/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145149366","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":"Changes in urine albumin-to-creatinine ratio and health care resource utilization and costs in patients with type 2 diabetes and chronic kidney disease.","authors":"Kevin M Pantalone, Rakesh Singh, Aozhou Wu, Keith A Betts, Yan Chen, Youssef Mk Farag, Scott Beeman, Yuxian Du, Sheldon X Kong, Todd Williamson, Qixin Li, Brendan Rabideau, Navdeep Tangri","doi":"10.18553/jmcp.2025.24302","DOIUrl":"10.18553/jmcp.2025.24302","url":null,"abstract":"<p><strong>Background: </strong>Albuminuria, indicated by an elevated urine albumin-to-creatinine ratio (UACR) at baseline, is consistently associated with poor clinical outcomes and increased economic burden. The effect of a change in albuminuria over time on health care resource utilization is not well understood.</p><p><strong>Objective: </strong>To assess the association between changes in UACR and economic outcomes in patients with chronic kidney disease (CKD) associated with type 2 diabetes (T2D).</p><p><strong>Methods: </strong>The Optum electronic health records database (January 2007 to September 2021) was used to identify adult patients with albuminuria, measured by UACR of 30 mg/g or more (initial test) after diagnosis of T2D and CKD. UACR change was categorized as increased (>30% change), stable (30% increase to 30% decrease), or decreased (>30% change) based on the percentage of change between the initial test and the follow-up test (the last test within 0.5 to 2 years after the initial test). All-cause inpatient (IP) admissions, emergency department (ED) visits, outpatient (OP) visits, and total medical costs were evaluated during the year after the follow-up test. The association of UACR change with health care resource utilization (HRU) was evaluated using Poisson regression, adjusting for key baseline characteristics. Medical costs (2022 US dollars) were estimated using a unit costing approach based on HRU frequencies.</p><p><strong>Results: </strong>Among 144,814 eligible patients included in the study, 81,084 (56%) had decreased, 31,766 (22%) had stable, and 31,964 (22%) had increased UACR. Patients with increased UACR had higher HRU (IP admissions: 0.24 per-person per-year [PPPY]; ED visits: 0.35 PPPY; OP visits: 21.20 PPPY) and annual medical costs ($15,013 PPPY) than patients with stable UACR (IP: 0.18 PPPY; ED: 0.31 PPPY; OP: 19.13 PPPY; costs: $12,521 PPPY) and decreased UACR (IP: 0.17 PPPY, ED: 0.31 PPPY, OP: 19.90 PPPY; costs: $12,329 PPPY). Compared with patients with increased UACR, those with decreased UACR had adjusted incidence rate ratios of 0.79 (95% CI = 0.76-0.82) for IP, 0.88 (0.85-0.92) for ED, and 0.96 (0.95-0.97) for OP, and patients with stable UACR had adjusted incidence rate ratios of 0.82 (0.78-0.86) for IP, 0.91 (0.87-0.95) for ED, and 0.94 (0.92-0.95) for OP (all <i>P</i> values of <0.001).</p><p><strong>Conclusions: </strong>Among patients with CKD and T2D who had albuminuria, an increase in UACR over time was associated with significantly higher HRU and costs compared with patients with stable or decreased UACR. Managed care organizations and other health care decision-makers should consider strategies that enhance monitoring and management of UACR in patients with CKD and T2D to potentially reduce HRU and associated costs.</p>","PeriodicalId":16170,"journal":{"name":"Journal of managed care & specialty pharmacy","volume":" ","pages":"1017-1028"},"PeriodicalIF":2.9,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12467748/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144957185","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":"Patterns and costs associated with glucagon-like peptide-1 receptor agonist use in US adults with type 2 diabetes.","authors":"Jun Wu, Alexandra Perez, Patrick W Sullivan","doi":"10.18553/jmcp.2025.31.10.1029","DOIUrl":"10.18553/jmcp.2025.31.10.1029","url":null,"abstract":"<p><strong>Background: </strong>Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) offer cardiorenal benefits in diabetes management. Since 2020, public awareness of GLP-1 RAs for diabetes, weight loss, and the prevention of cardiovascular disease has led to a surge in their utilization. However, the high cost of GLP-1 RAs and limitations in insurance coverage have been considered significant barriers to access. Current knowledge regarding how GLP-1 RA use affects total health care costs in diabetes care after 2020 in the United States remains limited. Consequently, further research is needed to examine the financial burden of GLP-1 RA use on patients and payers, as well as its overall impact on total health care costs at the national level.</p><p><strong>Objective: </strong>To examine GLP-1 RA utilization and association with health care costs among US adults with type 2 diabetes.</p><p><strong>Methods: </strong>Using data from the 2021-2022 Medical Expenditure Panel Survey, the study sample included individuals (aged ≥18 years) with a diagnosis of type 2 diabetes. Outcomes included GLP-1 RA use and all-cause and diabetes-related health care costs, including medical and prescription drug costs paid by patients and insurers. Generalized linear regression with a log link and gamma distribution was used to assess the effect of GLP-1 RA use on health care costs, adjusting for sociodemographic and health-related characteristics.</p><p><strong>Results: </strong>Among 3,587 eligible adults with type 2 diabetes, 637 (18.8%) used GLP-1 RAs, representing an estimated 3.66 million US adults-a marked increase compared with pre-2020 estimates of less than 10%. Fewer older adults (aged ≥65 years) used GLP-1 RAs (35.1%) compared with adults aged 45-64 years (50.6%). The average annual per-person cost of GLP-1 RA was $6,947. Although insurance covered more than 95% of GLP-1 RA cost, these medications represented a substantial proportion of diabetes care costs: 63.3% of antidiabetic drug costs and 55.7% of total diabetes-related costs among GLP-1 RA users. After adjustment, GLP-1 RA use was associated with a 219% increase in diabetes-related costs and a 55.3% increase in total all-cause health care costs.</p><p><strong>Conclusions: </strong>GLP-1 RA utilization among US adults with type 2 diabetes has substantially increased, with use in 2021-2022 nearly double that of the period prior to 2020. The higher health care costs associated with taking GLP-1 RAs were largely attributable to high drug costs, of which over 95% were covered by insurance.</p>","PeriodicalId":16170,"journal":{"name":"Journal of managed care & specialty pharmacy","volume":"31 10","pages":"1029-1038"},"PeriodicalIF":2.9,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12467763/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145149346","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":"Clinical and economic impact of recurrence in unresected non-small cell lung cancer treated with primary stereotactic body radiotherapy: A real-world study using SEER-Medicare data.","authors":"Pragya Rai, Andrew Song, Su Zhang, Yan Song, Chi Gao, Anya Jiang, Jiayang Li, Peixi Jiang, James Signorovitch, Ashwini Arunachalam, Ayman Samkari, Megan E Daly","doi":"10.18553/jmcp.2025.31.10.1006","DOIUrl":"10.18553/jmcp.2025.31.10.1006","url":null,"abstract":"<p><strong>Background: </strong>Stereotactic body radiotherapy (SBRT) is the recommended treatment for inoperable, early-stage non-small cell lung cancer (NSCLC). Although prior research has assessed overall survival (OS) and recurrence rates post-SBRT, limited data exist on the clinical and economic impact of recurrence and the association between event-free survival (EFS) and OS in this patient population.</p><p><strong>Objective: </strong>To compare OS, health care resource utilization (HRU), and costs between patients with early-stage NSCLC receiving primary SBRT, with and without recurrence, and assess the association between real-world EFS (rwEFS) and OS.</p><p><strong>Methods: </strong>The SEER-Medicare database (2007-2020) was used to identify patients with stage I-IIB (N0) NSCLC receiving primary SBRT. Patients were categorized into recurrence and nonrecurrence cohorts based on disease recurrence status post-SBRT. OS, all-cause and NSCLC-related HRU, and health care costs were compared between patients with and without recurrence. The correlation between OS and rwEFS was assessed using the normal scores rank correlation and landmark analyses.</p><p><strong>Results: </strong>A total of 3,014 patients met the inclusion criteria, with 1,455 (48.3%) experiencing disease recurrence. Median OS was significantly shorter for the recurrence cohort (18.9 months) compared with the nonrecurrence cohort (51.4 months; log-rank <i>P</i> < 0.001). Patients with recurrence had a 2.16-fold higher risk of death (95% CI = 1.94-2.42; <i>P</i> < 0.001). HRU and health care costs were significantly higher in the recurrence cohort, with adjusted monthly all-cause and NSCLC-related costs per patient exceeding those of nonrecurrence patients by $5,458 and $3,838, respectively (both <i>P</i> < 0.001). A significant correlation was observed between rwEFS and OS (ρ = 0.74; <i>P</i> < 0.0001).</p><p><strong>Conclusions: </strong>Recurrence after SBRT in unresected, early-stage NSCLC was associated with worse survival and substantial economic burden. The strong correlation between rwEFS and OS suggests that EFS may serve as a good predictor for OS and be a clinically relevant trial endpoint. These findings highlight the need for novel strategies to prevent/delay recurrence.</p>","PeriodicalId":16170,"journal":{"name":"Journal of managed care & specialty pharmacy","volume":"31 10","pages":"1006-1016"},"PeriodicalIF":2.9,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12467756/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145149363","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":"Examining racial and ethnic differences in health care expenditures among older adults with arthritis in the United States.","authors":"Samuel C Ofili, Paroma Arefin, Olajumoke A Olateju, Sujit S Sansgiry","doi":"10.18553/jmcp.2025.31.10.1075","DOIUrl":"10.18553/jmcp.2025.31.10.1075","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;More than 65 million Americans suffer from arthritis, which is the primary cause of disability in older adults. Arthritis is also a leading disease, with more than $600 billion in medical expenses each year. There is, however, little research on health care expenditure by race and ethnicity among older adults with arthritis.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To examine the racial and ethnic differences in health care expenditures among older adults with arthritis in the United States.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A retrospective multiyear cross-sectional study using the Medical Expenditure Panel Survey (MEPS) data (2018-2022) analyzed health care expenditures of adults aged 65 years and older with arthritis across different races and ethnicities. All-cause expenditures (total, office-based visits, hospital inpatient visits, prescription medicine, and outpatient visits) were compared between Hispanic patients, non-Hispanic Black (NHB) patients, and non-Hispanic White (NHW) patients, adjusting for covariates using SAS version 9.4.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The study analyzed 15,345 adults (weighted frequency = 29,915,198) with arthritis. The mean total annual health care expenditure was $15,052 (95% CI = $14,435-$15,667) for all adults with arthritis. Although Hispanic patients had the lowest total expenditure ($14,159, 95% CI = $11,955-$16,363), NHB and NHW patients had similar total annual health care expenditures at $15,623 (95% CI = $12,228-$19,015) and $15,237 (95% CI = $14,599-$15,876), respectively. After adjustment for covariates, Hispanic and NHB patients spent 34% (95% CI = 24%-43%) and 31% (95% CI = 22%-39%) less than NHW patients (&lt;i&gt;P&lt;/i&gt; &lt; 0.0001). This was largely because of lower office-based expenditures, where both Hispanic and NHB patients spent approximately 52% (95% CI = 42%-60%, &lt;i&gt;P&lt;/i&gt; &lt; 0.0001) less than NHW patients. Also, Hispanic patients incurred 23% (95% CI = 1%-41%) lower hospital inpatient expenditure (&lt;i&gt;P&lt;/i&gt;  =  0.0406) than NHW patients. For outpatient visits, Hispanic patients spent 71% (95% CI = 59%-80%) and NHB patients 50% (95% CI = 34%-62%) (both &lt;i&gt;P&lt;/i&gt; &lt; 0.0001) lower than NHW patients. Hispanic and NHB patients differed only in outpatient expenditures, where NHB patients significantly spent 75% more than Hispanic patients (95% CI = 16%-162%, &lt;i&gt;P&lt;/i&gt;  =  0.007) after adjusting for covariates.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Total health care expenditures were substantially lower for Hispanic and NHB patients with arthritis compared with NHW patients after adjusting for various covariates. Specifically, Hispanics and NHB patients had lower office-based and outpatient expenditures. Additionally, Hispanic patients incurred lower hospital inpatient expenditures than NHW patients. There is a need for further studies delving into finding reasons for these differences in expenditures, such as behavioral and belief systems that may limit the use of care among racial a","PeriodicalId":16170,"journal":{"name":"Journal of managed care & specialty pharmacy","volume":"31 10","pages":"1075-1085"},"PeriodicalIF":2.9,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12467764/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145149393","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":"Recommendations for use and coverage of digital, binocular treatments for amblyopia.","authors":"Brenda L Bohnsack, James Bowerman, K David Epley","doi":"10.18553/jmcp.2025.31.10-a.s1","DOIUrl":"10.18553/jmcp.2025.31.10-a.s1","url":null,"abstract":"<p><p>Amblyopia is the most common cause of vision impairment in children and presents as reduced visual acuity caused by suppression of neurologic signals from an eye. Traditional treatments include penalizing the better-seeing eye by occlusion, most commonly with patching. This does not address the binocular vision deficits of amblyopia and leaves most patients with unresolved disease and permanent vision loss. Digital, dual-acting therapy (Luminopia, Luminopia, Inc) was cleared in October 2021 via US Food and Drug Administration de novo market authorization for the treatment of amblyopia associated with anisometropia and/or with mild strabismus in children aged 4-7 years. Binocular digital therapy is now included in the American Academy of Ophthalmology's amblyopia treatment guidelines, the Amblyopia Preferred Practice Pattern (PPP). The pivotal randomized, controlled phase 3 trial evaluating Luminopia was recognized in the PPP as Level I+ evidence. Pediatric ophthalmologists and national and regional health plan leaders formed a roundtable panel to evaluate disease impact, the current treatment landscape, and guideline-based treatment principles. At the conclusion of this discussion, the panel developed a unanimous recommendation for the appropriate clinical and value-driven use of Luminopia and payer coverage recommendations. Luminopia is recommended for use to treat amblyopia and should be covered by payer policies. Duration of therapy should be based on patient needs as determined by prescribing physician expertise. Luminopia may be covered under either medical or pharmacy benefit. Step-edits may be used, and documentation of inadequate response to other therapies may be necessary to obtain coverage. Clinical documentation and medical letters of exception may also be needed for off-label use of Luminopia. The recommendations achieved in this roundtable based on the clinical evidence available provide a justification for broad payer coverage and improved patient access to a full range of evidence-based amblyopia treatments.</p>","PeriodicalId":16170,"journal":{"name":"Journal of managed care & specialty pharmacy","volume":"31 10-a Suppl","pages":"S1-S10"},"PeriodicalIF":2.9,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12467751/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145149381","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":"First-line cyclin-dependent kinase 4 and 6 inhibitors in combination with an aromatase inhibitor for HR+/HER2- metastatic breast cancer: A real-world cost-effectiveness assessment in a US Medicare-eligible population.","authors":"Lucille Sun, David L Veenstra, Adam Brufsky, Timothy Pluard, Rickard Sandin, Stella Stergiopoulos, Xianchen Liu, Troy Williams, Sean D Sullivan","doi":"10.18553/jmcp.2025.25063","DOIUrl":"10.18553/jmcp.2025.25063","url":null,"abstract":"<p><strong>Background: </strong>In hormone receptor-positive, human epidermal growth factor 2-negative (HR+/HER2-) metastatic breast cancer (mBC), cyclin-dependent kinase 4 and 6 inhibitors (CDK4/6is) in combination with an aromatase inhibitor (AI) are the preferred first-line (1L) treatment. Although prior cost-effectiveness models comparing CDK4/6is palbociclib, ribociclib, and abemaciclib have used data from placebo-controlled clinical trials, no analyses in the United States have been conducted using real-world evidence (RWE) for a US Medicare-eligible population.</p><p><strong>Objective: </strong>To estimate the long-term clinical outcomes and health care costs of 1L CDK4/6i treatment in patients aged 65 years and older using RWE.</p><p><strong>Methods: </strong>We developed a partitioned survival model to project patient time in progression-free and progressed disease health states. Progression-free survival (PFS) and overall survival (OS) curves for palbociclib + AI were obtained from an analysis of patients aged 65 years and older treated 1L for HR+/HER2- mBC using the Flatiron Health Analytic Database (Flatiron). Adjusted comparative effectiveness estimates vs palbociclib + AI for both ribociclib + AI (PFS hazard ratio = 0.98 [95% CI = 0.86-1.13]; OS hazard ratio = 1.01 [95% CI: 0.87-1.18]) and abemaciclib + AI (PFS hazard ratio = 0.99 [95% CI = 0.86-1.15]; OS hazard ratio = 1.00 [95% CI = 0.84-1.19]) were obtained from the same analysis. All-cause medical costs and CDK4/6i drug costs were based on an analysis of patients aged 65 years and older in Optum Clinformatics DataMart. We used a Medicare perspective over a lifetime horizon for a cohort of patients with mean age of 73.7 years. Sensitivity analyses were performed to assess the robustness of results to plausible variation in input values.</p><p><strong>Results: </strong>Projected life-years (LYs) with palbociclib + AI, ribociclib + AI, and abemaciclib + AI were similar: 5.16 (95% credible range [CR] = 4.94-5.35), 5.12 (95% CR = 4.53-5.82), and 5.16 (95% CR = 4.49-5.90), respectively. Total lifetime health care costs were also similar ($865,000 [95% CR = $807,400-$925,000], $866,800 [95% CR = $786,000-$965,000], and $901,000 [95% CR = $809,000-$1,004,600], respectively). Sensitivity analyses further supported no differences in LYs or total costs between CDK4/6is.</p><p><strong>Conclusions: </strong>Based on effectiveness and cost estimates from real-world data, our analyses suggest that palbociclib, ribociclib, and abemaciclib produce similar life expectancy and health care costs in US patients aged 65 years and older with HR+/HER2- mBC.</p>","PeriodicalId":16170,"journal":{"name":"Journal of managed care & specialty pharmacy","volume":" ","pages":"1039-1050"},"PeriodicalIF":2.9,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12467758/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144742207","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}