Journal of managed care & specialty pharmacy最新文献

{"title":"Pre-exposure prophylaxis adherence and risks of HIV and sexually transmitted infection among adult men before vs during the COVID-19 pandemic.","authors":"Ikenna F Unigwe, Chanakan Jenjai, Amie J Goodin, Wei-Hsuan Lo-Ciganic, Robert L Cook, Jennifer W Janelle, Haesuk Park","doi":"10.18553/jmcp.2026.32.10.1271","DOIUrl":"10.18553/jmcp.2026.32.10.1271","url":null,"abstract":"<p><strong>Background: </strong>The COVID-19 pandemic disrupted HIV prevention services, including reductions in pre-exposure prophylaxis (PrEP) prescription and HIV testing. However, evidence on the association between the pandemic with PrEP use, as well as HIV and sexually transmitted infection (STI) rates among PrEP users remained limited.</p><p><strong>Objective: </strong>To compare patterns of PrEP adherence, HIV incidence, and STI rates among adult men newly initiating PrEP before vs during the COVID-19 pandemic.</p><p><strong>Methods: </strong>We conducted a new-user retrospective cohort analysis of commercially insured PrEP users using the 2018-2021 MarketScan administrative claims database. Adult men aged 18-49 years in the MarketScan administrative claims database prescribed tenofovir disoproxil fumarate with emtricitabine or tenofovir alafenamide with emtricitabine for PrEP were included. Group-based trajectory modeling was used to identify PrEP adherence patterns. After balancing group demographic and clinical characteristics with inverse probability treatment weighting, time-varying Cox proportional hazards models were used to evaluate HIV risk and Poisson regression was used to assess STI rates.</p><p><strong>Results: </strong>Of 8,683 adult men (43% aged 25 to 34 years), 5,957 initiated PrEP before the pandemic and 2,726 during the pandemic. Prepandemic adherence trajectories included nonadherence (11.8% of the cohort) and rapidly declining (20.8%), gradually declining (21.1%), and consistently high (46.3%) adherence. Pandemic adherence trajectories included early discontinuation (35.7%) and rapidly declining (19.5%), gradually declining (14.8%), and consistently high (29.9%) adherence. Initiating PrEP during the pandemic was associated with higher risk of HIV acquisition (adjusted hazard ratio = 2.20 [95% CI = 1.08-4.47]). STI rates did not differ between groups (adjusted incidence rate ratio = 1.04 [95% CI = 0.88-1.23]).</p><p><strong>Conclusions: </strong>Individuals initiating PrEP during the pandemic were associated with reduced PrEP adherence and higher HIV incidence. Targeted strategies to maintain access and continuity of HIV prevention services during public health emergencies are needed.</p>","PeriodicalId":16170,"journal":{"name":"Journal of managed care & specialty pharmacy","volume":"32 10","pages":"1271-1280"},"PeriodicalIF":3.3,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13621906/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149074986","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, economic, and quality-of-life outcomes of brexucabtagene autoleucel for the treatment of relapsed/refractory mantle cell lymphoma and B-cell acute lymphoblastic leukemia: A systematic literature review and meta-analysis.","authors":"Bijal D Shah, Chibuzo Iloabuchi, Sean Harrigan, Markqayne Ray, Aida Santaolalla Revenga, David Cobley, Francis Nissen, Steve Kanters, Olalekan O Oluwole","doi":"10.18553/jmcp.2026.32.10.1296","DOIUrl":"10.18553/jmcp.2026.32.10.1296","url":null,"abstract":"<p><strong>Background: </strong>Brexucabtagene autoleucel (brexu-cel), a CD19 chimeric antigen receptor T-cell therapy, has shown efficacy in clinical trials for relapsed/refractory (R/R) mantle cell lymphoma (MCL) and B-cell acute lymphoblastic leukemia (B-ALL). However, although effectiveness and safety evidence is well established, real-world evidence (RWE) on health care resource use (HCRU), costs, and health-related quality of life (HRQoL) remains limited.</p><p><strong>Objective: </strong>To systematically review and synthesize RWE on clinical, HCRU, and cost outcomes, and both RWE and trial evidence on HRQoL, for brexu-cel in adults with R/R MCL and B-ALL.</p><p><strong>Methods: </strong>Systematic searches were conducted to identify studies reporting outcomes for adults with R/R MCL and B-ALL treated with brexu-cel. RWE was included for clinical, HCRU, and costs outcomes, and HRQoL outcomes. Effectiveness and safety were analyzed using meta-analysis, while HCRU, cost, and HRQoL were summarized descriptively.</p><p><strong>Results: </strong>69 publications representing 31 cohorts were identified (19 MCL, 7 B-ALL, 3 mixed). Pooled overall response and complete response rates in MCL were 88% and 76%, while B-ALL showed complete response and measurable residual disease negativity of 74% and 73%, consistent with pivotal trials ZUMA-2 and ZUMA-3, respectively. Median overall survival was 40.3 months in MCL and 23.3 months in B-ALL. Cytokine release syndrome and immune effector cell-associated neurotoxicity syndrome were the most common adverse events; severe events were less frequent in real-world cohorts compared with trials, potentially reflecting advances in safety management and earlier identification of toxicities. HCRU and cost evidence was limited; 1 MCL study reported reduced post-chimeric antigen receptor T costs. No real-world HRQoL data were identified.</p><p><strong>Conclusions: </strong>Brexu-cel provides substantial and durable benefit in R/R MCL and B-ALL, with real-world effectiveness and safety consistent with pivotal trials. However, evidence gaps remain for HRQoL and economic outcomes, underscoring priorities for future research.</p>","PeriodicalId":16170,"journal":{"name":"Journal of managed care & specialty pharmacy","volume":"32 10","pages":"1296-1310"},"PeriodicalIF":3.3,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13621901/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149075009","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":"Payers should cover COVID-19 vaccines for all ages and risk groups with no patient cost sharing.","authors":"Randy C Hatton, Laura E Happe","doi":"10.18553/jmcp.2026.32.10.1319","DOIUrl":"10.18553/jmcp.2026.32.10.1319","url":null,"abstract":"<p><p>The COVID-19 vaccine saved millions of lives during the pandemic. Clinical trials at the time of authorization and approval showed remarkable effectiveness. However, the effectiveness of the COVID-19 vaccine has changed now that people are no longer naive to the virus. The benefit of vaccination is incrementally lower for some people, raising questions about who should receive the vaccine, what the vaccines should cost, and which subpopulations would be cost-effective to vaccinate. The Institute for Clinical and Economic Review (ICER) recently released its assessment of the COVID-19 vaccine. It was ICER's first vaccine assessment, presumably because of the uncertainty of future coverage policies for the COVID-19 vaccine. ICER found that the COVID-19 vaccine is most beneficial for the very young, the very old, and those in between with risk factors. Cost-effectiveness models mirror effectiveness assessments. Limiting vaccine access to people with risk factors in specific age bands would require a prior authorization, adding complexity and administrative costs for payers. Coverage restrictions may further reduce population vaccinations rates, resulting in higher virus community load and prolonged circulation. Although the US regulatory framework requires insurers to cover vaccines included on the Centers for Disease Control and Prevention (CDC) Immunization Schedules without cost sharing, the future placement of COVID-19 vaccines on these schedules is uncertain. Given the evidence and population benefits, we support ICER's recommendation for private payers to cover COVID-19 vaccines with no patient cost sharing. We further recommend no restrictions on coverage based on risk factors, regardless of CDC Immunization Schedules, which have recently been subject to considerable uncertainty.</p>","PeriodicalId":16170,"journal":{"name":"Journal of managed care & specialty pharmacy","volume":"32 10","pages":"1319-1328"},"PeriodicalIF":3.3,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13621894/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149075021","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":"Return on investment of SGLT2 inhibitors and GLP-1 receptor agonists: Implications of real-world use for managed care.","authors":"Hannah Rapp, David Marr, Ashley Modany, Andrew Bryk, Nicholas Christian, Chester Good","doi":"10.18553/jmcp.2026.32.10.1167","DOIUrl":"https://doi.org/10.18553/jmcp.2026.32.10.1167","url":null,"abstract":"<p><p>Sodium-glucose cotransporter 2 inhibitors (SGLT2is) and glucagon-like peptide-1 receptor agonists (GLP-1RAs) use has rapidly expanded across multiple chronic disease states, resulting in substantial growth in pharmacy spending. Although these agents demonstrate strong clinical benefit in clinical trials, real-world adherence and persistence remain suboptimal, raising questions about their financial value to payers.This viewpoint examines return on investment (ROI) associated with real-world use of SGLT2is and GLP-1RAs, alone and in combination, within a regional managed care organization. Review of claims and electronic health record data from more than 29,000 treatment-naive members revealed negative short-term ROI across treatment groups, driven primarily by high pharmacy costs and compounded by low adherence and persistence. Although adherent members generally experienced less growth in acute care use compared with nonadherent members, these trends were insufficient to offset medication costs within an 18-month time horizon.These findings highlight the limitations of using short-term ROI as a proxy for clinical value in high-cost chronic therapies. Negative ROI in this setting does not directly correlate to low therapeutic benefit but rather reflects delayed time to benefit, high baseline medical risk, and real-world medication use patterns. Payers may benefit from reassessing success metrics and pairing access to these therapies with targeted adherence and use management strategies to better align financial expectations with long-term value.</p>","PeriodicalId":16170,"journal":{"name":"Journal of managed care & specialty pharmacy","volume":"32 10","pages":"1167-1172"},"PeriodicalIF":3.3,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149075004","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":"Real-time continuous glucose monitoring related to reductions in inpatient and emergency department encounters and their associated costs among non-insulin-treated people with type 2 diabetes.","authors":"Katia Hannah, Poorva Nemlekar, Gregory J Norman","doi":"10.18553/jmcp.2026.26112","DOIUrl":"10.18553/jmcp.2026.26112","url":null,"abstract":"<p><strong>Background: </strong>The use of real-time continuous glucose monitoring (RT-CGM) is well established to support people with type 2 diabetes (T2D) in achieving adequate glycemic control. However, health care resource utilization (HCRU) studies have previously tended to focus on individuals with T2D who are receiving treatment with insulin.</p><p><strong>Objective: </strong>To examine the impacts of RT-CGM on inpatient and emergency department (ED) HCRU in non-insulin-treated people.</p><p><strong>Methods: </strong>This retrospective study analyzed US administrative claims data from Optum's Clinformatics Data Mart database between September 1, 2016, and December 31, 2024. Continuous glucose monitoring (CGM)-naive individuals with T2D who initiated a Dexcom G-series RT-CGM between September 1, 2017, and December 31, 2023, were included (index date: first RT-CGM claim). Change in the number of all-cause and diabetes-related encounters by service location (inpatient and ED) and the mean change in associated medical costs were assessed over a 6-month pre-index period (baseline) and in 2 consecutive 6-month segments post-index (0-6 months and 7-12 months). Stratification by baseline HCRU encounter frequency unique to service location included the following: nonutilizers, zero baseline encounters; low utilization, 1 to 2 baseline encounters; high utilization, 3 or more baseline encounters.</p><p><strong>Results: </strong>The analysis included 4,463 people with T2D. Decreases were observed in the numbers of inpatient and ED encounters among those using such encounters in the baseline period. Those considered that low utilizers (1-2 baseline encounters) experienced a 66% decrease in inpatient encounters and 63% decrease in ED encounters, whereas high utilizers (≥3 encounters) experienced a 67% decrease in inpatient encounters and 68% decrease in ED encounters. These decreases coincided with significant reductions in associated costs.</p><p><strong>Conclusions: </strong>People with T2D who were not receiving insulin treatment and have had recent inpatient or ED encounters had lower observed HCRU after the initiation of RT-CGM with Dexcom G-series systems.</p>","PeriodicalId":16170,"journal":{"name":"Journal of managed care & specialty pharmacy","volume":" ","pages":"1281-1288"},"PeriodicalIF":3.3,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13621904/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148535960","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":"Which drugs will Medicare negotiate next? Predicting selected drugs for Initial Price Applicability Year 2029.","authors":"Kevin H Li, Emma M Cousin, Sean D Sullivan","doi":"10.18553/jmcp.2026.26277","DOIUrl":"10.18553/jmcp.2026.26277","url":null,"abstract":"<p><strong>Background: </strong>The fourth cycle of the Medicare Drug Price Negotiation Program (MDPNP) for Initial Price Applicability Year (IPAY) 2029 will continue to include both Medicare Part B and Part D drugs while incorporating several important policy changes that affect eligibility and selection. These changes, including clarification of drug eligibility criteria, expiration of the temporary small biotech exception, and implementation of the biosimilar delay provision, may substantially influence which drugs are selected for negotiation.</p><p><strong>Objective: </strong>To predict the Medicare Part B and Part D 20 drugs most likely to be selected for IPAY 2029.</p><p><strong>Methods: </strong>Using the Centers for Medicare & Medicaid (CMS) Medicare Part B and Part D drug-spending data from 2020 through 2024 and Average Sales Price 2025 pricing files, we projected 2025 gross Medicare expenditures (GMEs) using regression models incorporating historical use and pricing trends. Statutory exclusion criteria were applied consistent with the Inflation Reduction Act, the One Big Beautiful Bill Act, and the June 2026 CMS proposed rules to identify negotiation-eligible drugs and rank drugs by projected GME. A secondary forecasting approach incorporating unadjudicated quarterly Medicare Part B and Part D spending data through quarter 3 of 2025 was conducted to approximate the statutory CMS expenditure assessment period (November 1, 2025-October 31, 2026).</p><p><strong>Results: </strong>Fifty qualifying single-source drugs were identified. Twenty drugs, each with projected 2025 GMEs exceeding $500 million, were predicted to be selected for IPAY 2029. The primary and secondary forecasting approaches identified similar results, with 17 of the top 20 drugs appearing in both. Three drugs became newly eligible following expiration of the temporary small biotech exception. We also identified 27 drugs with projected 2025 GMEs exceeding $1 billion that remained ineligible because of statutory time on market or orphan drug exclusions as well as additional drugs potentially affected by the biosimilar delay provision.</p><p><strong>Conclusions: </strong>Recent legislative and regulatory changes continue to reshape eligibility for the MDPNP. These findings provide an updated framework for anticipating future negotiation cycles and demonstrate how evolving CMS policy may influence drug selection and the future implementation of the MDPNP.</p>","PeriodicalId":16170,"journal":{"name":"Journal of managed care & specialty pharmacy","volume":" ","pages":"1189-1200"},"PeriodicalIF":3.3,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13621897/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149030708","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":"Evaluation of continuous glucose monitoring outcomes and health care resource utilization in patients with non-insulin-treated type 2 diabetes.","authors":"Shannon Gadd, Connor Willis, Ishfaq Rashid, Kyu Yun Park, Kayla Holland, Amy Beal, Carl Asche, Priyanka Ghule, Diana Brixner","doi":"10.18553/jmcp.2026.32.10.1215","DOIUrl":"10.18553/jmcp.2026.32.10.1215","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Although continuous glucose monitoring (CGM) is well established for insulin-treated diabetes, its utility in non-insulin-treated type 2 diabetes (T2D) remains less studied.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To evaluate the short-term clinical and economic outcomes following personal use of CGM in patients with T2D.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This prospective pre-post study enrolled adults with poorly controlled non-insulin-treated T2D (hemoglobin A1c ≥8%; target N = 200) initiating G7 CGM and observed them for 6 months. Primary endpoints were changes in A1c and Audit of Diabetes-Dependent Quality of Life (ADDQoL) scores. Glycemic events, health care utilization, and medication use were evaluated in a subgroup with claims data. Baseline was defined as the 3 months before CGM initiation. Changes at 3 and 6 months were assessed using the Wilcoxon signed-rank test. Multivariable analysis of covariance models evaluated A1c change, adjusting for baseline A1c and clinical covariates. ADDQoL was analyzed using linear mixed-effects models with random intercepts and fixed effects for time, whereas Cuzick's test assessed quality-of-life trends.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Of 217 enrolled patients, a subgroup of 76 had claims data. Most were White (75%) and male (58%), with mean age 58.3±11.5 years. Baseline median A1c was 8.60% (IQR = 8.20-9.10), and mean A1c was 8.96%±1.24%. Prevalent comorbidities included hyperlipidemia (73%), hypertension (70%), and obesity (44%). A1c significantly decreased at 3 and 6 months after CGM (median: -1.10%, -1.40%; mean: -1.28%, -1.42%; &lt;i&gt;P&lt;/i&gt; &lt; 0.001). In adjusted models, the adjusted mean change in A1c from baseline was -1.32 percentage points at 3 months (95% CI = -1.48 to -1.15; &lt;i&gt;P&lt;/i&gt; &lt; 0.001; n = 153) and -1.48 percentage points at 6 months (95% CI = -1.68 to -1.28; &lt;i&gt;P&lt;/i&gt; &lt; 0.001; n = 143). American Diabetes Association (ADA) (&lt;7%) and Healthcare Effectiveness Data and Information Set (HEDIS) (&lt;8%) target attainment improved from 0% at baseline to 26.4% and 50.9% at 6 months (both &lt;i&gt;P&lt;/i&gt; &lt; 0.001). Hyperglycemic events declined from 53.7% at baseline to 16.3% at 6 months, although not significantly. No significant changes were observed in health care utilization, medication adherence, or medication burden. Greater CGM use and higher time in range were associated with improved A1c and glucose management indicator outcomes. The proportion reporting good-to-excellent quality of life increased from 24.1% at baseline to 45.8% at 6 months, while weighted ADDQoL scores remained stable.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;CGM use in non-insulin-treated patients with T2D was associated with significant improvements in glycemic control and perceived quality of life, with stable health care utilization and medication therapy. These findings support expanded implementation and reimbursement of CGM in this population, but further research is required to assess the long-term sustaina","PeriodicalId":16170,"journal":{"name":"Journal of managed care & specialty pharmacy","volume":"32 10","pages":"1215-1226"},"PeriodicalIF":3.3,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13621895/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149074957","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":"Embedding metabolic dysfunction-associated steatotic liver disease fibrosis risk stratification within pharmacist-integrated diabetes comanagement in primary care.","authors":"Ryan P Wexler, Jeremy Chimene-Weiss, Courtney Cameron, Sandra Schipelliti, Pavan Vuddanda, Aileen Roman, Arpan Mohanty","doi":"10.18553/jmcp.2026.32.10.1289","DOIUrl":"10.18553/jmcp.2026.32.10.1289","url":null,"abstract":"<p><strong>Background: </strong>Metabolic dysfunction-associated steatotic liver disease (MASLD) is highly prevalent among patients with type 2 diabetes mellitus (T2DM) but remains underdiagnosed in primary care despite clinical guidelines. We investigated whether a multicomponent workflow that included expanding the role of ambulatory pharmacists, who already manage T2DM under collaborative care agreements to include MASLD risk stratification, is associated with improved detection of liver fibrosis.</p><p><strong>Objective: </strong>To evaluate the feasibility of a pharmacist-integrated, multicomponent intervention and its association with MASLD fibrosis risk stratification, vibration-controlled transient elastography (VCTE) referral and completion, and detection of clinically significant fibrosis among patients with T2DM in a safety net primary care setting.</p><p><strong>Methods: </strong>We conducted a 6-month pre-post feasibility and implementation pilot in a safety net family medicine clinic, with the pre-period serving as a baseline of usual care. The multicomponent intervention expanded MASLD risk stratification to pharmacists comanaging T2DM and incorporated targeted education, co-location of VCTE, and internal facilitation. Pharmacists calculated Fibrosis-4 index (FIB-4) scores during T2DM visits and referred patients with FIB-4 greater than or equal to 1.3 for VCTE. Outcomes included VCTE referral among patients with elevated FIB-4 scores, VCTE completion, detection of clinically significant fibrosis (liver stiffness measurement ≥8 kPa) or possible cirrhosis (liver stiffness measurement ≥12 kPa), and hepatology referral.</p><p><strong>Results: </strong>In the pre-intervention period, 41% (52 of 127) of patients with available laboratory data had FIB-4 greater than or equal to 1.3, and none were referred for VCTE. In the post-intervention period, 45% (61 of 136) of such patients had FIB-4 greater than or equal to 1.3. Of these, 87% (53 of 61) were referred for VCTE, and 85% (45 of 53) completed testing. VCTE identified 8 new cases of clinically significant fibrosis, including 6 with possible cirrhosis, leading to 6 hepatology referrals.</p><p><strong>Conclusions: </strong>A pharmacist-integrated, multicomponent workflow was associated with increased VCTE referrals and completion, enabled identification of fibrosis, and facilitated specialist referrals among patients with T2DM in a safety net primary care setting. These findings support this pharmacist-integrated workflow as a feasible, patient-centered strategy to enhance MASLD detection, warranting further evaluation of scalability, sustainability, and impact.</p>","PeriodicalId":16170,"journal":{"name":"Journal of managed care & specialty pharmacy","volume":"32 10","pages":"1289-1295"},"PeriodicalIF":3.3,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13621905/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149074980","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: Managed care approaches to <i>ESR1</i>-mutated advanced breast cancer.","authors":"Bridget Flavin, Carol Tweed, Janna Evans, Sara L Fleszar, Gaurang Gandhi, Kirollos S Hanna, Ryan Haumschild, Timothy O'Shea, Terry Richardson, Tina Valbh, Denise Wolff","doi":"10.18553/jmcp.2026.32.10-b.s1","DOIUrl":"10.18553/jmcp.2026.32.10-b.s1","url":null,"abstract":"<p><p>A mutation in the estrogen receptor alpha gene (<i>ESR1</i>m) following first-line treatment with endocrine therapy in hormone receptor-positive metastatic breast cancer occurs in nearly half of patients. Detection of this mutation prior to radiologic progression using circulating tumor DNA (ctDNA)-based monitoring is an emerging practice that may allow an early switch to a more effective therapy. To discuss approaches to managing <i>ESR1</i>m advanced breast cancer (aBC) including ctDNA-based monitoring, AMCP Market Insights virtually convened an expert panel of managed care stakeholders in February 2026. This article provides a qualitative summary of the panel discussion along with key insights and suggested payer practices meant to support informed coverage decisions and guide future work. Key insights include that community oncologists and patients may benefit from support, for example, with treatment pathways and patient navigators. Additionally, patients care about survival outcomes when combined with sustained quality of life and want monitoring practices that take patient-specific considerations into account. A primary consideration of payers related to aBC is that the optimal biomarker testing parameters, including ctDNA-based monitoring for <i>ESR1</i>m aBC, are uncertain, which leads to inconsistent testing practices and the need for management that promotes consistency while mitigating delays in care. Payers acknowledge that the role of next-generation selective estrogen receptor degraders is evolving based on current data and ongoing clinical trials. Suggested payer practices involve care delivery, coverage, and system advancements including engaging in multistakeholder conversations and advocating for or participating in evidence generation.</p>","PeriodicalId":16170,"journal":{"name":"Journal of managed care & specialty pharmacy","volume":"32 10-b Suppl","pages":"S1-S12"},"PeriodicalIF":3.3,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13622885/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149080971","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":"Vaccines for COVID-19: Effectiveness and value.","authors":"Avery McKenna, David M Rind, R Brett McQueen, Antal Zemplenyi, Lisa A Prosser, Marina Richardson, Sophia Cassim, Marie Phillips, Harry Gyimah Gyamfi, Daniel A Ollendorf","doi":"10.18553/jmcp.2026.32.10.1313","DOIUrl":"10.18553/jmcp.2026.32.10.1313","url":null,"abstract":"","PeriodicalId":16170,"journal":{"name":"Journal of managed care & specialty pharmacy","volume":"32 10","pages":"1313-1318"},"PeriodicalIF":3.3,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13621896/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149074679","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}