Journal of managed care & specialty pharmacy最新文献

{"title":"Optimizing maribavir management: The role of health system specialty pharmacies in access, monitoring, and waste reduction.","authors":"Dustin R Donald, Autumn D Zuckerman, Kevin Dee, Nicolas Gargurevich, Leena Choi, Strong Oboh, Chelsea P Renfro","doi":"10.18553/jmcp.2025.31.10.997","DOIUrl":"10.18553/jmcp.2025.31.10.997","url":null,"abstract":"<p><strong>Background: </strong>Cytomegalovirus (CMV) infection is a common complication in transplant recipients, with refractory or resistant infections making up a subset of this population. Maribavir, indicated for CMV infection that is refractory to first-line treatments, is a high-cost, limited-distribution specialty medication that requires frequent laboratory monitoring to assess efficacy.</p><p><strong>Objective: </strong>To evaluate outcomes of health system specialty pharmacy (HSSP) management of maribavir including waste and cost avoidance, medication access, and pharmacist interventions during treatment.</p><p><strong>Methods: </strong>This study was a single-center, retrospective cohort analysis of patients prescribed maribavir from April 1, 2022, to August 1, 2024. Included patients were prescribed maribavir for posttransplant CMV infection/disease that was refractory to treatment with ganciclovir, valganciclovir, cidofovir, or foscarnet. Outcomes included the number of dispenses that were reduced by pharmacist interventions that led to medication waste avoidance and the cost avoidance of these interventions, time to medication access, and the number of pharmacist interventions recommending laboratory tests or medication discontinuation during treatment. Descriptive statistics were used for analysis. To estimate costs avoided by pharmacy and payer, cost avoidance was calculated by multiplying the 14-day supply of maribavir that was not dispensed during the final treatment course because of pharmacist intervention by the average wholesale price (AWP), AWP minus 20% (AWP-20%), and wholesale acquisition cost (WAC).</p><p><strong>Results: </strong>Included patients (N = 33) were predominately male (64%) with a median age of 62 years (interquartile range [IQR] = 50-66 years). Five patients were required to repeat treatment with maribavir multiple times because of CMV reactivation totaling 41 unique instances of maribavir use. The most common transplant type was kidney (n = 11), and all patients were donor CMV positive (n = 33). 29 patients were able to fill with the institution's HSSP with 36 instances of maribavir use and 113 fills of maribavir. Of these 36 instances, 12 (33%) had the final dispense of the treatment course reduced because of pharmacist intervention, amounting to a cost avoidance range of $143,421 (AWP-20%) to $179,276 (AWP). Maribavir insurance prior approval (PA) was required for 31 (76%) instances of medication use, with median PAs occurring the same day as referral (IQR = 0-2). Of the 41 instances of maribavir use, 8 (20%) required an intervention from the pharmacist recommending CMV laboratory testing be completed.</p><p><strong>Conclusions: </strong>Pharmacists successfully obtained timely insurance PAs for maribavir. During treatment, pharmacists reduced unnecessary fills, resulting in large cost and waste avoidance. Future research is needed to evaluate the long-term effects of interventions by specialty pharmac","PeriodicalId":16170,"journal":{"name":"Journal of managed care & specialty pharmacy","volume":"31 10","pages":"997-1005"},"PeriodicalIF":2.9,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12467757/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145149383","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: Navigating the rapidly changing landscape of ER+/HER2- metastatic breast cancer.","authors":"Bridget Flavin, Denise Wolff, Laura Bobolts, Gaurang Gandhi, Ryan Haumschild, Neil Iyengar, Michael Kobernick, Rebecca Lich, Bhavesh Shah","doi":"10.18553/jmcp.2025.31.10-b.s1","DOIUrl":"10.18553/jmcp.2025.31.10-b.s1","url":null,"abstract":"<p><p>Breast cancer is the most common cancer diagnosed in women in the United States, and its impact on both patients and their caregivers, particularly in advanced or metastatic disease, is substantial. Additionally, for the most common breast cancer subtype (estrogen receptor [ER]+/human endothelial growth factor receptor 2 [HER2]-), the treatment landscape for metastatic disease is continuously evolving, making appropriate therapy sequencing challenging. To discuss navigating the rapidly changing landscape of ER+/HER2- metastatic breast cancer (mBC), AMCP Market Insights virtually convened an expert panel of managed care stakeholders in February 2025. Key insights from the discussion on ER+/HER2- mBC included addressing the patient care journey, maintaining high-quality care, managing the impact to payers, evaluating new and emerging therapies, and looking toward the future. Suggested payer best practices in ER+/HER2- mBC also emerged from the discussion.</p>","PeriodicalId":16170,"journal":{"name":"Journal of managed care & specialty pharmacy","volume":"31 10-b Suppl","pages":"S1-S14"},"PeriodicalIF":2.9,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12467767/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145149408","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 bispecific antibodies with a focus on follicular lymphoma and diffuse large B-cell lymphoma.","authors":"Bridget Flavin, Denise Wolff, Laura R Bobolts, Tara Graff, Kirollos Hanna, Ryan Haumschild, Timothy Mok, Bhavesh Shah","doi":"10.18553/jmcp.2025.31.10-c.s1","DOIUrl":"10.18553/jmcp.2025.31.10-c.s1","url":null,"abstract":"<p><p>Bispecific antibodies (bsAbs) are an emerging treatment modality particularly in hematologic malignancies such as the non-Hodgkin lymphomas follicular lymphoma (FL) and diffuse large B-cell lymphoma (DLBCL). Although bsAbs offer opportunities in the treatment of these conditions, they also present challenges, and additional longer-term data are needed to determine their optimal role. To discuss managed care approaches to bsAbs with a focus on FL and DLBCL, AMCP Market Insights virtually convened an expert panel of managed care stakeholders in April 2025. Key insights from the discussion included that clinical efficacy is a primary consideration when evaluating the role of bsAbs in FL and DLBCL and that ongoing data collection is necessary for increased certainty in long-term outcomes, treatment comparisons, and real-world experience. Other insights related to treatment choice, site-of-care considerations, the evolving place of bsAbs in FL and DLBCL therapy, economic factors, and social determinants of health and equity. Suggested payer best practices for bsAbs in FL and DLBCL also emerged from the discussion.</p>","PeriodicalId":16170,"journal":{"name":"Journal of managed care & specialty pharmacy","volume":"31 10-c 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/PMC12467760/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145149416","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":"Selected drugs, therapeutic alternatives, and price benchmarks for IPAY 2027 Medicare drug price negotiation.","authors":"Sean D Sullivan, Emma M Cousin, Kevin H Li, Nico Gabriel, Kristi Martin","doi":"10.18553/jmcp.2025.25199","DOIUrl":"10.18553/jmcp.2025.25199","url":null,"abstract":"<p><strong>Background: </strong>On or before November 1, 2025, the Centers for Medicare & Medicaid Services (CMS) will report the agreed-upon negotiated prices (maximum fair prices [MFPs]) for the second round of up to 15 Medicare Part D drugs selected for price negotiation (Initial Price Applicability Year 2027).</p><p><strong>Objective: </strong>To propose guideline-recommended therapeutic alternatives and estimate price benchmarks that may be considered by CMS for negotiation.</p><p><strong>Methods: </strong>We identified US Food and Drug Administration (FDA)-approved indications for the 15 drugs selected for negotiation. We used 2022 Medicare claims data to identify drug-specific beneficiary utilization. Medical claims with <i>International Classification of Diseases, Tenth Revision, Clinical Modification</i> diagnosis codes for each indication were evaluated to estimate relative indication-specific utilization. We examined published clinical guidelines to identify and propose therapeutic alternatives for each drug and the most prevalent, FDA-approved indication. For negotiation price benchmarks, we report (1) the list price, (2) the estimated net price after manufacturer discounts, (3) the minimum statutory discount, and (4) the ceiling of the MFP. All price benchmarks were estimated at the product level, for a 30-day equivalent dosing, using Medicare Part D dashboard and IQVIA data. We also estimated net prices for the proposed therapeutic alternatives.</p><p><strong>Results: </strong>Four drugs were identified to have 1 (deutetrabenazine, linaclotide, and nintedanib-esylate) or no (rifaximin) therapeutic alternative. Eight of the 15 selected drugs will have the ceiling price set by the minimum statutory discount. Four products (acalabrutinib, semaglutide, linagliptin, and sitagliptin/metformin) will include therapeutic alternatives and MFPs from the first round of negotiation. The selection of therapeutic alternatives and estimation of price benchmarks by CMS will set the initial conditions for subsequent price negotiation.</p><p><strong>Conclusions: </strong>These analyses identify the likely ceiling price and various initial price offer scenarios for the second round of Medicare price negotiation. We report price benchmarks and likely therapeutic alternatives to improve transparency around the opaque CMS negotiation process.</p>","PeriodicalId":16170,"journal":{"name":"Journal of managed care & specialty pharmacy","volume":" ","pages":"968-981"},"PeriodicalIF":2.9,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12467749/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145040420","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":"A systematic review of the applications of the real option value of medical technologies in oncology.","authors":"Kwame Adjei, Vakaramoko Diaby, Meng Li, Fatimah Sherbeny, Sandra Suther, Askal A Ali","doi":"10.18553/jmcp.2025.31.10.1062","DOIUrl":"10.18553/jmcp.2025.31.10.1062","url":null,"abstract":"<p><strong>Background: </strong>Real option value (ROV) offers an innovative paradigm to evaluate the dynamic value of medical technologies, particularly in cancer, by capturing the value of extending patient survival to access future innovations. Despite its potential, the application of ROV in medical technologies in oncology remains underexplored.</p><p><strong>Objective: </strong>To synthesize existing evidence on the application of ROV in medical technologies in oncology.</p><p><strong>Methods: </strong>A comprehensive search of PubMed, ScienceDirect, and Web of Science was conducted to identify peer-reviewed studies published in English from January 2000 to May 2024. In the search query, a combination of keywords related to \"real option value\" and \"cancer\" was used. Key data extracted included study characteristics, objectives, ROV modeling technique, and primary findings. The Consolidated Health Economic Evaluation Reporting Standards 2022 checklist was used for quality assessment of the studies.</p><p><strong>Results: </strong>A total of 13 of 165 studies assessed the ROV of medical therapies, with a primary focus on melanoma, lung cancer, and prostate cancer. ROV was modeled from the ex post and ex ante perspectives. The methodologies employed vary, with common forecasting approaches including the Lee-Carter model to project future decreases in mortality rates, fitting Cox proportional regression models on administrative claims data, or estimating the approval likelihood of early pipeline drugs based on data from early randomized clinical trials.</p><p><strong>Conclusions: </strong>The ROV represents a critical dimension in evaluating medical technologies in oncology, where innovation is rapid. The implications of ROV extend beyond oncology, with the potential to influence funding, pricing, and access decisions in other disease areas as well. However, challenges such as oversimplification of assumptions for forecasting, methodological consistency, and lack of standardized framework remain pervasive. This systematic review underscores the need to integrate ROV into Health Technology Assessment practices to inform resource allocation and policy decisions.</p>","PeriodicalId":16170,"journal":{"name":"Journal of managed care & specialty pharmacy","volume":"31 10","pages":"1062-1074"},"PeriodicalIF":2.9,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12467752/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145149390","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 real-world evidence standards: Overcoming barriers to using real-world evidence in US payer decision-making.","authors":"Catherine M Lockhart, Elizabeth Powers, Brian Sweet, Patrick P Gleason, Diana Brixner","doi":"10.18553/jmcp.2025.25108","DOIUrl":"https://doi.org/10.18553/jmcp.2025.25108","url":null,"abstract":"<p><strong>Background: </strong>US payers are interested in incorporating real-world evidence (RWE) into their pharmaceutical coverage and reimbursement decisions. One barrier to using RWE to inform decisions is the lack of standards for RWE assessment and interpretation specific to US payer needs.</p><p><strong>Objective: </strong>To develop RWE standards supporting US payer decision-making through a framework outlining study types and potential endpoints important to US payers throughout a product's lifecycle and a set of criteria, tailored to US payer needs, for assessing and applying RWE.</p><p><strong>Methods: </strong>The Academy of Managed Care Pharmacy (AMCP) Research Institute, in partnership with IQVIA, convened a multistakeholder group of RWE experts to complete a survey and participate in a series of workshops with the goal of developing RWE standards tailored to payer decision-making needs. Informed by a targeted literature search, we created an initial list of RWE assessment criteria relevant to payers and refined by consensus and a framework describing RWE appropriate to different product lifecycle stages from pre- to postapproval.</p><p><strong>Results: </strong>A total of 36 payers completed the survey, and few (18%) reported regularly using RWE as part of their decision process; however, most (80%) were interested in using it. There was consensus on the need for a set of payer-specific standards. Through 2 focus groups and an AMCP Partnership Forum, participants vetted, refined, and finalized this payer-specific framework and developed a checklist that comprised a total of 29 RWE assessment criteria across 6 categories. This framework and set of criteria became the final AMCP RWE standards.</p><p><strong>Conclusions: </strong>The AMCP RWE standards provide a tool to facilitate payer-specific assessments of RWE and guidance for designing RWE studies and communicating results that will be most impactful for payer formulary and coverage decisions.</p>","PeriodicalId":16170,"journal":{"name":"Journal of managed care & specialty pharmacy","volume":" ","pages":"1-7"},"PeriodicalIF":2.9,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145080888","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-world economic burden of disease recurrence in patients with muscle-invasive bladder cancer: A population-level claims-based analysis.","authors":"Patrick Squires, Erin E Cook, Yan Song, Ching-Yu Wang, Anya Xinyi Jiang, Adina Zhang, Shravanthi M Seshasayee, Aljosja Rogiers, Haojie Li, Ronac Mamtani","doi":"10.18553/jmcp.2025.25106","DOIUrl":"https://doi.org/10.18553/jmcp.2025.25106","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Bladder cancer is a common cancer with significant morbidity, mortality, and economic cost. Muscle-invasive bladder cancer (MIBC) is typically managed with radical cystectomy (RC). Despite its curative intent, a considerable proportion of patients experience recurrence after RC. The economic impact of recurrence among patients with surgically resected MIBC has not been described.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To assess health care resource utilization (HCRU) and costs among patients with surgically resected MIBC in the United States, including the impact of disease recurrence.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;In this retrospective, observational study, the Surveillance, Epidemiology, and End Results-Medicare database (2007-2020) was used to identify patients diagnosed with T2-T4aN0M0 or T1-T4aN1M0 MIBC who underwent RC in the United States. Index date was the date of RC. Patients were stratified by whether they experienced recurrence following surgical resection. The index date for patients with recurrence was defined as 30 days prior to recurrence, and for patients without recurrence, the index date was drawn from a distribution to match the time window between surgical resection and the index date in the recurrence cohort. Patients were followed from the index date until the end of data availability, continuous enrollment, or death. Rates of HCRU per patient per year (PPPY) and mean health care costs per patient per month (PPPM; in 2022 USD) were summarized and compared between cohorts.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;A total of 1,149 patients met selection criteria. Patients had a median of 2.6 years of follow-up. Demographic and clinical characteristics were generally similar between patients with (n = 503) and without recurrence (n = 602), with few exceptions. Patients with recurrence (compared with those without) were more likely to have had stage IIIA disease (47.9% vs 32.7%) and a proxy for cisplatin contraindications (54.1% vs 47.5%, both &lt;i&gt;P&lt;/i&gt; &lt; 0.05), which included renal insufficiency, peripheral neuropathy, sensorineural hearing loss, or cardiac disease. Following index, patients with surgically resected MIBC had 3.5 all-cause inpatient admissions, 1.0 all-cause emergency department (ED) visits, and 25.8 all-cause outpatient visits PPPY. Patients with recurrence had higher rates of all-cause HCRU than patients without recurrence after index, including inpatient admissions (adjusted incidence rate ratio: 2.4), ED visits (2.7), and outpatient visits (2.0; all &lt;i&gt;P&lt;/i&gt; &lt; 0.001). The total all-cause medical costs PPPM were $11,250 and were higher for patients with vs without recurrence ($10,030 vs $3,343; adjusted cost difference: $7,191), largely because of higher inpatient admissions costs ($6,654 vs $2,102; adjusted cost difference: $4,542; both &lt;i&gt;P&lt;/i&gt; &lt; 0.001).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Surgically resected MIBC was associated with a substantial economic burden with disease recurrence ","PeriodicalId":16170,"journal":{"name":"Journal of managed care & specialty pharmacy","volume":" ","pages":"1-11"},"PeriodicalIF":2.9,"publicationDate":"2025-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145080938","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":"Cost-per-responder analysis of daratumumab, bortezomib, lenalidomide, and dexamethasone vs bortezomib, lenalidomide, and dexamethasone among transplant-eligible patients with newly diagnosed multiple myeloma.","authors":"Santosh Gautam, Laura Morrison, Philippe Thompson-Leduc, Bronwyn Moore, Gordon Wong, Brian Macomson, Vipin Khare, Niodita Gupta-Werner, Rohan Medhekar","doi":"10.18553/jmcp.2025.25142","DOIUrl":"https://doi.org/10.18553/jmcp.2025.25142","url":null,"abstract":"<p><strong>Background: </strong>The phase 3 PERSEUS trial demonstrated superior efficacy of daratumumab (D), bortezomib (V), lenalidomide (R), and dexamethasone (d) induction/consolidation followed by DR maintenance (DVRd/DR) vs VRd induction/consolidation followed by R maintenance (VRd/R) in transplant-eligible patients with newly diagnosed multiple myeloma.</p><p><strong>Objective: </strong>To assess the economic value associated with achieving and sustaining minimal residual disease (MRD)-negative status with DVRd/DR vs VRd/R.</p><p><strong>Methods: </strong>A model of cost per patient with MRD-negative status was developed from a US mixed-payer perspective (60% Medicare, 40% commercial) using PERSEUS trial data. Model inputs included costs for first-line (1L) and second-line (2L) treatment, autologous stem cell transplant, medical care, adverse event management, and MRD testing. Outcomes included the cost per MRD-negative patient, calculated using the cost per treated patient and cumulative proportion of patients achieving MRD-negative status at 48 months after randomization, and cost per patient sustaining MRD negativity for at least 12 months during maintenance, calculated using maintenance treatment costs and the proportion of patients who converted from MRD-positive at the end of consolidation to achieving sustained MRD-negative status during maintenance. Costs were reported in 2025 US dollars.</p><p><strong>Results: </strong>At 48 months, the total cost per patient with MRD-negative status was lower with DVRd/DR compared with VRd/R ($519,999 less). Key drivers of these cost savings included the lower maintenance treatment costs per MRD-negative patient ($106,707 less) and the lower 2L treatment costs per MRD-negative patient ($434,184 less) with DVRd/DR compared with VRd/R. The lower maintenance treatment costs with DVRd/DR were attributable to the higher proportion of patients achieving MRD-negative status. The lower 2L treatment costs with DVRd/DR were attributable to the lower proportion of patients initiating 2L (9.4%) compared with VRd/R (26.8%). Among patients who were MRD-positive at the end of consolidation, the cost per patient achieving sustained MRD-negative status was lower with DVRd/DR vs VRd/R, resulting in savings of $961,880. This was primarily attributable to a higher proportion of patients achieving sustained MRD-negative status with DVRd/DR (44.2%) than with VRd/R (22.6%) during the maintenance phase.</p><p><strong>Conclusions: </strong>The cost per MRD-negative patient and the cost per patient achieving sustained MRD negativity during maintenance were lower with DVRd/DR compared with VRd/R. These findings demonstrate the cost savings associated with the use of DVRd induction/consolidation followed by DR maintenance for transplant-eligible patients with newly diagnosed multiple myeloma, supplementing the superior efficacy benefits relative to VRd induction/consolidation demonstrated in the PERSEUS trial.</p>","PeriodicalId":16170,"journal":{"name":"Journal of managed care & specialty pharmacy","volume":" ","pages":"1-10"},"PeriodicalIF":2.9,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145069775","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":"Cost-related barriers to medication use among diverse participants with obesity-associated asthma.","authors":"Luyu Xie, Joohan Kim, Jaime P Almandoz, Folashade Afolabi, Tanya Martinez Fernandez, Andrew Gelfand, Joshua M Liao, Sarah E Messiah","doi":"10.18553/jmcp.2025.31.9.937","DOIUrl":"https://doi.org/10.18553/jmcp.2025.31.9.937","url":null,"abstract":"<p><strong>Background: </strong>Individuals with obesity-associated asthma (OAA) have worse health outcomes than those with asthma and healthy weight (no OAA). The impact of cost barriers on medication use and how it varies by racial and ethnic groups is unclear.</p><p><strong>Objective: </strong>To assess the impact of cost barriers on medication use in OAA across racial and ethnic groups.</p><p><strong>Methods: </strong>This cross-sectional study included adults with asthma who participated in the All of Us program between May 2017 and August 2024. OAA was defined as having both asthma (confirmed by the electronic health record) and obesity (body mass index [BMI]≥30 kg/m²). Main measures included self-reported cost-related barriers to medication use.</p><p><strong>Results: </strong>A total of 21,108 patients (mean age 58.9 years, 73.6% female, 11.9% Hispanic/Latinx, 67.2% non-Hispanic White, 13.0% non-Hispanic Black, 1.5% non-Hispanic Asian, and 6.3% other) were included, with 51.7% having OAA (mean BMI of 38.6 kg/m²). Individuals with OAA had higher odds of experiencing cost-related barriers (adjusted odds ratio [aOR] range = 1.12-1.31, all <i>P</i> < 0.05) vs those without OAA. Despite greater affordability challenges, non-Hispanic Black (aOR = 0.82, 95% CI = 0.69-0.96, <i>P</i> = 0.013) and Hispanic individuals (aOR = 0.80, 95% CI = 0.65-0.98, <i>P</i> = 0.033) with OAA were less likely to skip medications compared with non-Hispanic White individuals. Both groups were also less likely to request lower-cost alternatives (aOR = 0.72, 95% CI = 0.64-0.82, <i>P</i> < 0.001; aOR = 0.65, 95% CI = 0.55-0.77, <i>P</i> < 0.001, respectively).</p><p><strong>Conclusions: </strong>Significant disparities exist in cost-related barriers among individuals with OAA from different ethnic backgrounds. This highlights the need for tailored health care interventions that address the specific needs of diverse populations, aiming to reduce health disparities and improve asthma outcomes.</p>","PeriodicalId":16170,"journal":{"name":"Journal of managed care & specialty pharmacy","volume":"31 9","pages":"937-948"},"PeriodicalIF":2.9,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12397981/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144957220","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":"A structured approach for identifying disease analogs for pulmonary arterial hypertension.","authors":"Karim El-Kersh, Nadine Zawadzki, Anna Watzker, Shurui Zhang, Dhruv Dalal, Dominik Lautsch, Jason Shafrin","doi":"10.18553/jmcp.2025.24354","DOIUrl":"10.18553/jmcp.2025.24354","url":null,"abstract":"<p><p>Drug manufacturers often use disease analogs to describe diseases-particularly rare diseases-to payers, policymakers, and stakeholders. However, these comparisons are typically anecdotal. We propose a 4-step, systematic approach to identify disease analogs based on prespecified metrics and apply it to a rare disease, pulmonary arterial hypertension (PAH), as a case study. When there is limited knowledge of a rare disease, such as PAH, the application of the systematic disease analog approach presented can help managed care pharmacists leverage their existing knowledge and perspectives applied to other conditions to inform coverage, tier placement, and pricing decisions.</p>","PeriodicalId":16170,"journal":{"name":"Journal of managed care & specialty pharmacy","volume":" ","pages":"909-921"},"PeriodicalIF":2.9,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12397978/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144753557","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}