Journal of managed care & specialty pharmacy最新文献

{"title":"Association of diabetes medication adherence quality measure performance with A1c control among Medicare Advantage beneficiaries.","authors":"Rachel C Winters, Regina Nwamaka Nechi, Sarah Blandy, Victoria Hetherington, Casey Penland, Ismaeel Yunusa, Amanda S Moyer","doi":"10.18553/jmcp.2026.32.10.1201","DOIUrl":"10.18553/jmcp.2026.32.10.1201","url":null,"abstract":"<p><strong>Background: </strong>The Centers for Medicare & Medicaid Services provide financial incentives for insurance plans demonstrating high-quality care to improve patient outcomes. Medicare Advantage (MA) plan performance is assessed by nearly 40 quality measures, with diabetes care heavily represented by 5 of those measures. Medication Adherence for Diabetes (MAD) and Hemoglobin A1c Control for Patients with Diabetes (HBD) are emphasized as triple-weighted measures that strongly impact the overall quality rating. The national average ratings for MA Prescription Drug (MA-PD) plans from 2022 to 2026 show a flat average pass rate 5 years in a row for the MAD measure but a steadily increasing pass rate each year for the HBD measure. Observation of this trend, along with rising 4- and 5-star cut points, raise questions about whether the MAD measure methodology currently contributes to the achievement of clinical outcomes in patients with diabetes and whether it guides health care resources to the population in need.</p><p><strong>Objective: </strong>To identify the relationship between MAD performance and hemoglobin A1c (A1c) control. Secondary objectives were to evaluate the relationship between MAD and additional diabetes care quality measures and to evaluate factors associated with MAD measure performance.</p><p><strong>Methods: </strong>This cross-sectional study included Aetna MA beneficiaries attributed to Prisma Health primary care providers participating in the inVio Health Network who indexed into the MAD measure during the 2023 measurement year. Data were collected from January 1, 2023, to December 31, 2023. The primary outcome was glycemic control, defined as achievement of A1c of less than 7%. Secondary outcomes included HBD, Eye Exam for Patients with Diabetes (EED), Statin Use in Persons with Diabetes (SUPD), and Kidney Health Evaluation for Patients with Diabetes (KED). Associations between MAD performance with A1c and diabetes quality measures were evaluated using descriptive statistics, χ<sup>2</sup> tests, and multivariable logistic regression. Independent variables included demographic characteristics, health care use measures, prior-year MAD status, day-supply category, and index medication class; these factors were evaluated as predictors of MAD performance and included as covariates in adjusted logistic regression models.</p><p><strong>Results: </strong>The final study population included 1,386 beneficiaries (mean age = 72.3 years; 50.5% male). Among beneficiaries with available A1c values (n = 1,278), mean A1c did not differ significantly between those who passed and those who failed the MAD measure (6.80 ± 0.98% vs 6.66 ± 1.16%; <i>P</i> = 0.114). In adjusted analyses, passing the MAD measure was not associated with achieving A1c less than 7% (adjusted odds ratio [aOR] = 0.87 [95% CI = 0.60-1.27]; <i>P</i> = 0.474). Similarly, passing the MAD measure was not associated with HBD or SUPD performance but was associated with","PeriodicalId":16170,"journal":{"name":"Journal of managed care & specialty pharmacy","volume":"32 10","pages":"1201-1214"},"PeriodicalIF":3.3,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13621898/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149075030","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":"Expanding the definition of unmet medical need: Findings from a multistakeholder workshop.","authors":"Antal Zemplenyi, Michael J DiStefano, Hanke Zheng, Jonathan D Campbell, R Brett McQueen","doi":"10.18553/jmcp.2026.32.10-c.s3","DOIUrl":"10.18553/jmcp.2026.32.10-c.s3","url":null,"abstract":"<p><strong>Background: </strong>Unmet medical need (UMN) is frequently referenced in health policy and health care decision-making, including the Centers for Medicare & Medicaid Services' (CMS) Drug Price Negotiation Program (DPNP). However, the concept of UMN is often defined inconsistently and has a narrow focus, primarily centered on clinical effectiveness and the availability of treatment. This approach may overlook the wider needs of patients, caregivers, and society as a whole. A broader conceptualization of UMN has been proposed, yet there remains a lack of an actionable implementation framework.</p><p><strong>Objective: </strong>To examine how stakeholders interpret and distinguish among UMN elements, prioritize these elements based on perceived importance, and elicit perspectives on the applicability of a prioritized UMN framework in a decision-making context.</p><p><strong>Methods: </strong>A multistakeholder workshop was conducted in June 2025 involving 17 participants representing researchers, industry, payers, policymakers, and a patient organization. Participants evaluated 38 UMN elements grouped into 7 domains derived from a prior structured literature review. Using an interactive polling platform, participants assessed the conceptual distinctness of elements within domains, ranked domains by importance, and completed a pairwise weighting exercise grounded in the Simple Multi-Attribute Rating Technique. Quantitative voting results were aggregated, and qualitative feedback from plenary discussions was recorded and thematically synthesized.</p><p><strong>Results: </strong>Participants confirmed the conceptual distinctness of the proposed domains and elements. In the weighting exercise, traditional clinical effectiveness received the highest importance (24%), followed by availability of other treatments (19%) and impacts on patient, caregiver, or family quality of life (16%), although differences across domains were modest and should be interpreted with caution, given the exploratory sample. Economic burden on patients and families (13%), societal perspective elements (11%), and economic burden on society (10%) received moderate weights, whereas treatment administration attributes received the lowest weight (7%). Participants agreed that the broader element set captures dimensions of UMN not addressed by the current framework under CMS's DPNP. Key qualitative themes included perceived overlap within elements of the quality-of-life domain, the need for clearer conceptual boundaries between UMN and comparative effectiveness, and feasibility concerns around implementation.</p><p><strong>Conclusions: </strong>UMN is inherently multidimensional and extends beyond traditional clinical measures. These exploratory findings suggest that structured prioritization of UMN domains may support more transparent and policy-relevant frameworks for evaluating unmet need in the United States, including within CMS's DPNP.</p>","PeriodicalId":16170,"journal":{"name":"Journal of managed care & specialty pharmacy","volume":"32 10-c Suppl","pages":"S11-S20"},"PeriodicalIF":3.3,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13622887/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149080933","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 Format for Formulary Submissions 6.0.","authors":"","doi":"10.18553/jmcp.2026.32.10-a.s1","DOIUrl":"10.18553/jmcp.2026.32.10-a.s1","url":null,"abstract":"","PeriodicalId":16170,"journal":{"name":"Journal of managed care & specialty pharmacy","volume":"32 10-a Suppl","pages":"1-72"},"PeriodicalIF":3.3,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13639156/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149110898","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":"Economic advantage of daratumumab, bortezomib, lenalidomide, and dexamethasone vs bortezomib, lenalidomide, and dexamethasone for transplant-ineligible or transplant-deferred newly diagnosed multiple myeloma: A cost-per-responder evaluation.","authors":"Santosh Gautam, Laura Morrison, Philippe Thompson-Leduc, Avani Samandur, Brian Macomson, Vipin Khare, Xin Yin, Rohan Medhekar","doi":"10.18553/jmcp.2026.26127","DOIUrl":"10.18553/jmcp.2026.26127","url":null,"abstract":"<p><strong>Background: </strong>In the phase III CEPHEUS trial, 8 cycles of daratumumab (D), bortezomib (V), lenalidomide (R), and dexamethasone (d) followed by monthly DRd were associated with a higher rate of minimal residual disease (MRD) negativity compared with VRd followed by Rd among patients with transplant-ineligible/transplant-deferred, newly diagnosed multiple myeloma.</p><p><strong>Objective: </strong>To compare the health care costs of patients achieving and sustaining MRD negativity with first-line (1L) DVRd vs VRd.</p><p><strong>Methods: </strong>Using CEPHEUS trial data, an economic model was developed from a US mixed-payer perspective (80% Medicare, 20% commercial) over a 60-month horizon. Model inputs included drug acquisition and administration costs for 1L and second-line (2L) therapies, medical care costs during 1L and 2L treatment, adverse event management costs, and next-generation sequencing MRD testing costs. Cost per patient negative for MRD was calculated based on the cost per patient treated and the cumulative proportion of patients achieving MRD negativity at 60 months after randomization. Cost per patient achieving sustained MRD negativity was estimated based on the proportion of patients with MRD-negative status on at least 2 occasions that were at least 12 months apart during the 60 months after randomization in CEPHEUS. Costs were reported in 2025 US dollars.</p><p><strong>Results: </strong>At 60 months, the total costs per patient negative for MRD were $652,113 lower with DVRd vs VRd, driven by a higher proportion of patients achieving MRD-negative status (DVRd = 60.9%; VRd = 39.4%) and the lower 2L treatment costs per patient with MRD-negative status with DVRd vs VRd (DVRd = $186,371; VRd = $958,840), attributable to the lower proportion of patients progressing to 2L treatment (DVRd = 11.2%; VRd = 33.3%). The cost per patient achieving sustained MRD negativity was $1,964,539 lower with DVRd than VRd, driven by a higher proportion of patients achieving sustained MRD negativity (DVRd = 48.7%; VRd = 26.3%) and the $1,203,376 lower 2L treatment costs per patient in the DVRd cohort (DVRd = $233,060; VRd = $1,436,436).</p><p><strong>Conclusions: </strong>Among patients with transplant-ineligible or transplant-deferred newly diagnosed multiple myeloma, 1L treatment with DVRd was associated with lower costs per patient with MRD-negative status and per patient achieving sustained MRD negativity compared with treatment with VRd. These findings complement the superior clinical efficacy observed with 1L DVRd compared with VRd in the CEPHEUS trial by demonstrating the potential cost savings associated with DVRd.</p>","PeriodicalId":16170,"journal":{"name":"Journal of managed care & specialty pharmacy","volume":" ","pages":"1261-1270"},"PeriodicalIF":3.3,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13621899/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148945021","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":"Trends in annual medication possession in older adults with type 2 diabetes.","authors":"Sarah Krahe Dombrowski, Jaejin An, Meredith Lewis, Vanessa A Hayduk, Romain Neugebauer, Patrick J O'Connor, Luis A Rodriguez, Julie Schmittdiel, Stephanie A Hooker, Andrew J Karter, Caryn E S Oshiro, Andrea E Cassidy-Bushrow, Margaret B Nolan, Lisa K Gilliam, Jove Graham, Eric A Wright","doi":"10.18553/jmcp.2026.32.10.1227","DOIUrl":"10.18553/jmcp.2026.32.10.1227","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Older adults (≥65 years) make up a substantial portion of individuals with type 2 diabetes (T2D) and frequently experience multimorbidity requiring complex, costly medication regimens. Cost-related nonadherence is prevalent in this population because of fixed incomes, polypharmacy, and a historically complex Medicare Part D coverage structure with variable out-of-pocket expenses over the year, which saw significant changes in 2025. We hypothesized that, among Medicare beneficiaries, brand medication possession would decline more rapidly than generic possession over the calendar year and rebound in January of the subsequent year when coverage resets.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To examine comparative trends in medication possession for brand and generic classes of glucose-lowering medications among older adults over the calendar year stratified by insurance type.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We conducted a retrospective cohort study using electronic health record and claims data from 6 US health systems. For each year from 2015 through 2020, adults aged at least 65 years with T2D who possessed at least 1 glucose-lowering medication on January 1 (index), filled the medication at least once during the following year, and maintained continuous prescription insurance coverage for 15 months from index were included; individuals could contribute multiple observations across years and medications. Medication possession was determined on January 1 and, thereafter, based on dispense date and days supply for each glucose-lowering medication. We calculated the daily proportion of individuals in possession of each medication class over 15 months and compared trends by brand/generic classification, medication class, and insurance. Medications were classified into brand and generic status based on class availability and prescribing trends during the study period. Segmented linear regression estimated slope changes before and after day 365. Difference-in-differences-in-slope approach compared brand vs generic medications before and in the first month after the new year. Additional analyses compared individual branded classes with biguanides.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Among 88,060 older adults with T2D (240,542 medication observations), mean age for the population was 73.7 years, 46% were female, 60% were White, 83% of medications were covered by Medicare insurance, and 92% were generic classes of glucose-lowering medications. Medication possession declined uniformly during the first 3 months of each year across all insurance types, followed by steeper declines for brand vs generic classes of medications (slopes -19.6% and -7.9% per year) for the Medicare-insured cohort. Brand classes exhibited a more significant positive slope change compared with generics (18.2% and 1.3% per year; &lt;i&gt;P&lt;/i&gt; &lt; 0.001) in the first month of the new year (days 366-395) for Medicare-insured cohort, a pattern differing from the commercial","PeriodicalId":16170,"journal":{"name":"Journal of managed care & specialty pharmacy","volume":"32 10","pages":"1227-1237"},"PeriodicalIF":3.3,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13621907/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149074427","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":"Association between cachexia-associated diagnoses, health care resource utilization, and costs in patients with pancreatic, lung, and colorectal cancers: A US insurance claims database analysis.","authors":"Kathryn Perkins, Joshua A Roth, Josh Carlson","doi":"10.18553/jmcp.2026.32.10.1249","DOIUrl":"10.18553/jmcp.2026.32.10.1249","url":null,"abstract":"<p><strong>Background: </strong>Cancer cachexia is a wasting disease characterized by changes in metabolism, muscle and weight loss, inadequate food intake, and functional decline. The disease affects 30%-50% of patients with solid tumors. There is limited literature describing the relationship between cachexia and health care resource utilization (HRU) and costs in the United States.</p><p><strong>Objective: </strong>To compare the HRU and direct health plan costs for patients with colorectal, lung, and pancreatic cancer with and without a cachexia-associated diagnosis.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study in Merative MarketScan commercial and Medicare claims databases. Patients with cachexia-associated diagnoses were identified following a colorectal, lung, or pancreatic cancer diagnosis between October 1, 2016, and December 31, 2022. Patients without a cachexia-associated diagnosis were propensity score-matched 2:1 to patients with a cachexia-associated diagnosis. Average 1-year HRU and direct health plan costs were calculated using a modified Kaplan-Meier sample average approach to account for patients lost to follow-up before the end of the 1-year observation period. The significance of group differences was assessed by nonoverlapping bootstrap 95% CIs.</p><p><strong>Results: </strong>The matched sample included 10,445 patients with a cachexia-associated diagnosis and 20,890 without across colorectal, lung, and pancreatic cancers. One-year health care costs were significantly higher for patients with a cachexia-associated diagnosis ($123,092; 95% CI = $119,664-$126,557) than for those without ($88,959; 95% CI = $86,964-$91,022). Patients with cachexia-associated diagnoses had significantly greater HRU than those without cachexia-associated diagnoses, including higher average 1-year hospital admissions (1.50; 95% CI = 1.47-1.53 vs 0.99; 95% CI = 0.97-1.01), emergency department visits (1.46; 95% CI = 1.42-1.50 vs 0.96; 95% CI = 0.93-0.98), outpatient visits (15.49; 95% CI = 15.15-15.83 vs 14.24; 95% CI = 14.02-14.46), and prescription fills (26.83; 95% CI = 26.31-27.35 vs 24.46; 95% CI = 24.11-24.80).</p><p><strong>Conclusions: </strong>Patients with colorectal, lung, and pancreatic cancer and cachexia-associated diagnoses had substantially higher 1-year HRU and cost of care compared with patients with cancer without cachexia-associated diagnoses. Our results highlight evidence of clinical and economic burden associated with cachexia-associated diagnoses in the US health care system.</p>","PeriodicalId":16170,"journal":{"name":"Journal of managed care & specialty pharmacy","volume":"32 10","pages":"1249-1260"},"PeriodicalIF":3.3,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13621903/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149075006","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Real-world treatment patterns and cost per patient achieving treatment targets among tirzepatide and semaglutide initiators in US patients with type 2 diabetes.","authors":"Meredith M Hoog, Carlos Vallarino, Juan M Maldonado, Michael Grabner, Chia-Chen Teng, Kendra Terrell, Emma L Richard","doi":"10.18553/jmcp.2026.32.10.1173","DOIUrl":"10.18553/jmcp.2026.32.10.1173","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Tirzepatide, a dual glucose-dependent insulinotropic polypeptide and glucagon-like peptide-1 (GLP-1) receptor agonist (RA), and semaglutide, a GLP-1 RA, are approved for type 2 diabetes (T2D) management. Clinical trials demonstrated that tirzepatide provided greater hemoglobin A1c and weight reduction vs comparators. Studies using trial-based effect estimates indicate it may also offer a lower cost per patient achieving treatment targets. However, real-world comparative data on treatment patterns, effectiveness, and economic value are limited.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To compare real-world treatment patterns, A1c and weight outcomes, and type 2 diabetes-related pharmacy (T2D-Rx) costs per patient achieving treatment targets in patients initiating tirzepatide for T2D, stratified by prior GLP-1 RA use.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This retrospective cohort study used claims and laboratory data from the Healthcare Integrated Research Database. Adults with T2D initiating tirzepatide (Mounjaro only) or semaglutide (Ozempic only) from May 2022 to May 2023 were propensity score matched and classified as naive or non-naive based on GLP-1 RA exposure in the 6 months before initiation. Outcomes over 12 months of follow-up included adherence (proportion of days covered ≥0.80), persistence (no ≥45-day gap), and T2D-Rx cost per responder (mean T2D-related pharmacy cost ÷ proportion achieving treatment target) to achieve A1c (&lt;8%, &lt;7%, ≤6.5%, &lt;5.7%) and weight loss (≥5%, ≥10%, ≥15%) thresholds. Outcomes were compared using chi-square and t-tests.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;After matching, 10,702 naive and 5,577 non-naive patient pairs were included in each treatment group. Tirzepatide initiators demonstrated higher adherence (naive: 60% vs 45%; non-naive: 66% vs 48%) and persistence (naive: 62% vs 47%; non-naive: 68% vs 49%) than semaglutide initiators. A greater proportion of tirzepatide users achieved all A1c and weight outcomes, including the most stringent targets of A1c less than 5.7% (naive: 30% vs 18%; non-naive: 17% vs 6%) and weight loss greater than or equal to 15% (naive: 23% vs 10%; non-naive: 17% vs 5%). Tirzepatide also had lower T2D-Rx cost per responder for these most stringent endpoints: A1c less than 5.7% (naive: $45,300 vs $65,300; non-naive: $107,700 vs $270,300) and weight loss greater than or equal to 15% (naive: $62,900 vs $124,400; non-naive: $110,200 vs $326,800), as well as for most other weight loss thresholds. For less stringent A1c goals, T2D-Rx cost per responder was similar across tirzepatide and semaglutide.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;In this real-world analysis, tirzepatide demonstrated better adherence, persistence, and A1c and weight reductions and lower T2D-Rx cost per responder for the most stringent treatment targets than semaglutide in both GLP-1 RA-naive and non-naive patients with T2D. These findings support the clinical and economic value of tirzepatide for achi","PeriodicalId":16170,"journal":{"name":"Journal of managed care & specialty pharmacy","volume":"32 10","pages":"1173-1188"},"PeriodicalIF":3.3,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13621902/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149075023","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":"Diabetes-related acute care utilization following initiation of automated insulin delivery (AID): A comparison of a disposable tubeless AID system and durable tubed systems.","authors":"Joshua Weinstein, Duy Do, Kellee Miller, Dan Carlow","doi":"10.18553/jmcp.2026.26134","DOIUrl":"10.18553/jmcp.2026.26134","url":null,"abstract":"<p><strong>Background: </strong>Automated insulin delivery (AID) has quickly become a core pillar of standard of care for type 1 and insulin-requiring type 2 diabetes. Little evidence exists regarding rates of acute diabetes-related events requiring medical care and how they may differ across different AID systems.</p><p><strong>Objective: </strong>To assess whether new users of a disposable tubeless AID system experience different diabetes-related acute care needs compared with new users of durable tubed AID systems, which are largely reimbursed through durable medical equipment channels.</p><p><strong>Methods: </strong>In this retrospective cohort study of individuals with insulin-dependent diabetes in the Komodo Healthcare Map, individuals with preexisting use of continuous glucose monitoring were indexed on their first prescription fill for an insulin delivery system and observed until censoring or study end to ascertain their diabetes-related emergency department (ED) visits and inpatient hospital admissions. Index dates spanned August 1, 2022, through August 1, 2024, and study observation ended May 31, 2025. Rates of care utilization were modeled using Poisson regression, supplemented by stabilized inverse probability of treatment weighting, to estimate incidence rate ratios (IRRs) and differences per 1,000 person-years. Supplemental analyses were stratified by diabetes type.</p><p><strong>Results: </strong>Among initiators of AID systems (N = 223,515), initiation of disposable tubeless AID (n = 110,061) was associated with lower rates of diabetes-related ED visits (IRR = 0.956; 95% CI = 0.921-0.993; -11.4 events per 1,000 person-years) and inpatient hospital admissions (IRR = 0.930; 95% CI = 0.868-0.998; -3.6 events per 1,000 person-years) compared with those initiating other systems (n = 113,454). Disposable tubeless AID initiation was also associated with lower rates of both hyperglycemia- and hypoglycemia-related ED and inpatient care. Differences in inpatient hospital admissions were largely driven by individuals with type 2 diabetes. The largest observed differences between diabetes type subgroups were among those with type 2 diabetes, including a notable 29.8% lower rate of ED visits for hypoglycemia (IRR = 0.702; 95% CI = 0.603-0.816) among disposable tubeless AID initiators.</p><p><strong>Conclusions: </strong>Initiation of disposable tubeless AID was associated with lower rates of ED visits and inpatient hospital admissions, with the largest differences observed for hypoglycemia-related ED visits. Expanded access to disposable tubeless AID could reduce health care resource utilization, their potential corresponding costs of care, and the burden of acute diabetes-related events on patients living with insulin-requiring diabetes.</p>","PeriodicalId":16170,"journal":{"name":"Journal of managed care & specialty pharmacy","volume":" ","pages":"1238-1248"},"PeriodicalIF":3.3,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13621900/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148421672","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":"Characterizing and prioritizing unmet medical needs: Findings from a patient and family caregiver workshop.","authors":"Hanke Zheng, Silke C Schoch, Omar A Escontrías, R Brett McQueen, Michael J DiStefano, Antal Zemplenyi, Jonathan D Campbell","doi":"10.18553/jmcp.2026.32.10-c.s2","DOIUrl":"10.18553/jmcp.2026.32.10-c.s2","url":null,"abstract":"<p><strong>Background: </strong>Defining and measuring unmet medical needs (UMN) from all health care stakeholders is essential for optimizing health care resource allocation decisions and guiding research and development priorities to address them.</p><p><strong>Objective: </strong>To understand UMN experience and prioritize UMN elements from the perspective of patients and caregivers.</p><p><strong>Methods: </strong>The mixed-method study consisted of a qualitative listening workshop and a quantitative ranking exercise. Adult patients with self-reported chronic diseases or disabilities and unpaid family caregivers were recruited through patient advocacy organizations, physician specialty organizations, academic centers, and social media. We conducted a virtual listening workshop to solicit patients' and unpaid family caregivers' perceptions of UMN and what has impacted them the most. Recruited patients were those living with a chronic disease or disability, including cancer, autoimmune, mental health, and rare diseases. A presurvey was designed to capture demographic and other qualitative information. Coding was performed for transcript analysis and reviewed by the patient moderator for accuracy. Following the qualitative workshop, we conducted a quantitative prioritization exercise to identify the most important domains of UMN for patients and caregivers.</p><p><strong>Results: </strong>We recruited 22 patients and caregivers to participate in the workshop via patient advocacy organizations. The majority (90.5%) of participants were patients, with a few having dual roles as unpaid family caregivers (23.8%). Patients and caregivers defined UMN as gaps in access to appropriate and quality care, specialists, providers knowledgeable about the specifics of their needs, patient access to trusted information about the condition, mental health, and financial support. Perceptions of UMN that patients experienced and considered important included financial hardship, mental health, barriers to care, caregiving burden, employment impacts, and health care system challenges. The ranking exercise identified health care system functioning, economic burden, and impacts on quality of life as the top-priority UMN domains, followed by more traditional measures anchored in clinical effectiveness.</p><p><strong>Conclusions: </strong>Our exploratory findings support both the depth and breadth of UMN faced by patients and unpaid caregivers, highlighting that UMN experienced by and important to them is not limited to traditional clinical effectiveness but also includes additional patient-centered components. Given the exploratory nature of this study owing to its small sample size, these findings are limited in generalizability and should be interpreted as hypothesis generating rather than definitive. Decision-makers should expand existing UMN frameworks to capture the full spectrum of patient-centered unmet medical needs.</p>","PeriodicalId":16170,"journal":{"name":"Journal of managed care & specialty pharmacy","volume":"32 10-c Suppl","pages":"S2-S10"},"PeriodicalIF":3.3,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13622886/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149080979","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":"Themed issue on artificial intelligence in managed care pharmacy.","authors":"Amy M Miller, Emily Ortman, Eberechukwu Onukwugha, Callahan Clark, Laura E Happe","doi":"10.18553/jmcp.2026.32.9.1050","DOIUrl":"10.18553/jmcp.2026.32.9.1050","url":null,"abstract":"","PeriodicalId":16170,"journal":{"name":"Journal of managed care & specialty pharmacy","volume":"32 9","pages":"1050-1051"},"PeriodicalIF":3.3,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13505360/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148812818","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}