Journal of managed care & specialty pharmacy最新文献

{"title":"Out-of-pocket costs for direct oral anticoagulants and prescription abandonment among patients with nonvalvular atrial fibrillation or venous thromboembolism.","authors":"Maryia Zhdanava, Veronica Ashton, Jill Korsiak, Fengyi Jiang, Dominic Pilon, Mark Alberts","doi":"10.18553/jmcp.2025.31.4.366","DOIUrl":"10.18553/jmcp.2025.31.4.366","url":null,"abstract":"<p><strong>Background: </strong>Direct oral anticoagulants (DOACs) are used to prevent thrombosis in patients with nonvalvular atrial fibrillation (NVAF) and venous thromboembolism (VTE). Despite their clinical benefits, some patients abandon their DOAC prescription.</p><p><strong>Objective: </strong>To retrospectively evaluate the association between patient out-of-pocket (OOP) costs and abandonment of the first DOAC prescription among patients with NVAF or VTE in the United States.</p><p><strong>Methods: </strong>Data from Symphony Health, an ICON plc Company, PatientSource (April 1, 2017, to October 31, 2020) were used to select patients with NVAF or VTE with an approved or abandoned claim for a DOAC (apixaban, dabigatran, rivaroxaban). OOP costs (2021 US dollars) of the index claim were described by abandonment status, and multivariable logistic regression models were used to evaluate the association between OOP costs of the index DOAC claim and abandonment. Analyses were performed in patients with NVAF and VTE separately.</p><p><strong>Results: </strong>Among 753,755 patients with NVAF, 88.5% had an approved index DOAC claim and 11.5% had an abandoned index DOAC claim. Among 308,429 patients with VTE, 91.5% had an approved index DOAC claim and 8.5% had an abandoned index DOAC claim. Mean OOP costs of the index DOAC claim were lower in those with an approved than abandoned claim (NVAF approved vs abandoned: $79 vs $175; VTE approved vs abandoned: $65 vs $133). Among patients with NVAF, 21.4% of those with an approved claim and 9.1% of those with an abandoned claim had no OOP costs, 58.7% (approved) and 49.0% (abandoned) had OOP costs greater than $0 to less than $100, and 19.9% (approved) and 41.9% (abandoned) had OOP costs greater than or equal to $100; among patients with VTE, 27.8% (approved) and 15.6% (abandoned) had no OOP costs, 58.4% (approved) and 54.8% (abandoned) had OOP costs greater than $0 to less than $100, and 13.8% (approved) and 29.6% (abandoned) had OOP costs greater than or equal to $100. In multivariable models, the risk of abandonment increased by 21% (NVAF) and 17% (VTE) for each $100 in OOP costs (both <i>P</i> < 0.001). Relative to patients with no OOP costs, patients with OOP costs greater than $0 to less than $50 were 86% (NVAF) and 55% (VTE) more likely to abandon their index DOAC, patients with OOP costs greater than $50 to less than $100 were 80% (NVAF) and 111% (VTE) more likely to abandon their index DOAC, and patients with OOP costs greater than or equal to $100 were 332% (NVAF) and 244% (VTE) more likely to abandon their index DOAC (all <i>P</i> < 0.001).</p><p><strong>Conclusions: </strong>Among patients with NVAF or VTE, OOP costs of the first DOAC claim greater than or equal to $100 were associated with the highest risk of abandoning the first DOAC prescription.</p>","PeriodicalId":16170,"journal":{"name":"Journal of managed care & specialty pharmacy","volume":"31 4","pages":"366-376"},"PeriodicalIF":2.3,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11953867/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143730363","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":"The effectiveness and value of tabelecleucel for the treatment of Epstein-Barr virus-positive posttransplant lymphoproliferative disease.","authors":"Avery McKenna, Grace A Lin, Woojung Lee, Finn Raymond, Marina Richardson, Foluso Agboola","doi":"10.18553/jmcp.2025.31.4.429","DOIUrl":"10.18553/jmcp.2025.31.4.429","url":null,"abstract":"","PeriodicalId":16170,"journal":{"name":"Journal of managed care & specialty pharmacy","volume":"31 4","pages":"429-434"},"PeriodicalIF":2.3,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11953852/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143730367","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":"Treatment patterns, health care resource utilization, and costs of chimeric antigen receptor T-cell vs standard therapy for relapsed/refractory mantle cell lymphoma in the United States.","authors":"Karl M Kilgore, Philip K Chan, Christie Teigland, Sally W Wade, Iman Mohammadi","doi":"10.18553/jmcp.2025.31.3.262","DOIUrl":"10.18553/jmcp.2025.31.3.262","url":null,"abstract":"<p><strong>Background: </strong>Standard of care (SOC) for relapsed/refractory mantle cell lymphoma (R/R MCL) has included chemoimmunotherapy and targeted therapies (eg, Bruton tyrosine kinase inhibitors [BTKis]). The approval of novel chimeric antigen receptor T-cell (CAR T) therapy in 2020 expanded therapeutic options.</p><p><strong>Objective: </strong>To compare real-world patient characteristics, treatment patterns, health care resource utilization (HRU), and costs in traditional Medicare and commercially insured patients with R/R MCL treated with CAR T vs non-CAR T SOC (non-CAR T).</p><p><strong>Methods: </strong>Adult patients with R/R MCL who had received 2 or more lines of therapy (LOTs) and continuously enrolled in their health plan between July 1, 2016, and December 31, 2021 (Medicare), or June 30, 2023 (commercial), were stratified into non-CAR T and CAR T cohorts based on therapy received during the study period after MCL diagnosis. Index date was 2L initiation for the non-CAR T cohort and CAR T infusion date for the CAR T cohort. Outcomes included time to next treatment (TTNT), treatment-free interval, MCL-related HRU (inpatient days, emergency department visits, and outpatient visits), and costs (medical and pharmacy).</p><p><strong>Results: </strong>2,835 non-CAR T and 122 CAR T patients were included. Compared with non-CAR T patients, CAR T patients were more often commercially insured (27% vs 17.3%; P < 0.01), younger (median age 69 vs 74; P < 0.0001), and male (75.4% vs 64.4%; P = 0.012). Median follow-up after index was 209.5 (CAR T) and 413 (non-CAR T) days. More than one-third (36.9%) of non-CAR T patients received 3L or higher LOT after index and median TTNT decreased with LOT from 689 days (2L) to 184 days (6L). In contrast, only 15% of CAR T patients required additional LOT, and median TTNT post-CAR T was not reached. Duration of treatment-free interval similarly declined with LOT for non-CAR T patients, and the CAR T interval was significantly longer than all non-CAR T LOT. Use of targeted therapies in non-CAR T increased sequentially by LOT (2L: 76%; 6L: 93.2%; BTKi 2L: 26.8%; BTKi 6L: 34.1%). Following CAR T, 9% of patients received targeted therapy, predominantly lenalidomide based. All MCL-related HRU and medical and pharmacy costs were lower post-CAR T than post-index non-CAR T.</p><p><strong>Conclusions: </strong>Non-CAR T was associated with a greater use of post-index LOT, which also had shorter TTNT and treatment-free intervals. This suggests frequent and earlier progression as patients cycle through non-CAR T therapies. Standardized costs were higher in post-index non-CAR T vs post-CAR T episode periods. This suggests that earlier adoption of CAR T may reduce cycling through increasingly more expensive and less effective non-CAR T LOTs, potentially reducing HRU and financial burdens on patients with R/R MCL and the health system.</p>","PeriodicalId":16170,"journal":{"name":"Journal of managed care & specialty pharmacy","volume":"31 3","pages":"262-276"},"PeriodicalIF":2.3,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11871159/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143531540","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":"Cost-effectiveness of caplacizumab in immune thrombotic thrombocytopenic purpura in the United States.","authors":"Sean D Sullivan, Shruti Chaturvedi, Preety Gautam, Alix Arnaud","doi":"10.18553/jmcp.2025.31.3.277","DOIUrl":"10.18553/jmcp.2025.31.3.277","url":null,"abstract":"<p><strong>Background: </strong>Immune thrombotic thrombocytopenic purpura (iTTP) is a rare, life-threatening thrombotic microangiopathy. Caplacizumab is the only treatment approved by the European Medicines Agency and the US Food and Drug Administration for iTTP, to be given in combination with plasma exchange therapy (PEX) and immunosuppression (IS). The National Institute for Health and Care Excellence's independent appraisal committee assessed the cost-effectiveness of caplacizumab and concluded that the addition of caplacizumab to PEX+IS is cost-effective under a patient access scheme in the United Kingdom.</p><p><strong>Objective: </strong>To assess the cost-effectiveness of caplacizumab in iTTP from the US payer perspective.</p><p><strong>Methods: </strong>The National Institute for Health and Care Excellence's model was adapted to the US setting using US costs and discount rates. In contrast to previous cost-effectiveness analyses that accounted only for acute outcomes, our model consisted of a 3-month decision tree for an acute iTTP episode, followed by a Markov model to project long-term costs and outcomes (time horizon: up to 55 years; 3-monthly cycles).</p><p><strong>Results: </strong>Patients taking caplacizumab with PEX+IS experienced an incremental gain of 2.96 life years (LYs) and 1.75 quality-adjusted LYs relative to PEX+IS alone, at an increased lifetime cost of $256,000. The incremental cost-effectiveness ratio was $86,400 per LY and $146,300 per quality-adjusted LY gained.</p><p><strong>Conclusions: </strong>Considering willingness-to-pay thresholds of $150,000 to $200,000, the addition of caplacizumab to PEX+IS may be cost-effective compared with PEX+IS alone for the treatment of iTTP in a US setting.</p>","PeriodicalId":16170,"journal":{"name":"Journal of managed care & specialty pharmacy","volume":"31 3","pages":"277-288"},"PeriodicalIF":2.3,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11871163/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143531523","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":"Poster Abstracts - Academy of Managed Care Pharmacy 2025.","authors":"","doi":"10.18553/jmcp.2025.31.3-a.s1","DOIUrl":"https://doi.org/10.18553/jmcp.2025.31.3-a.s1","url":null,"abstract":"<p><p>The AMCP Poster Abstract Program provides a forum for authors to share their research with the managed care pharmacy community. Authors submit their abstracts to AMCP, and each abstract is reviewed by a team of peer reviewers and editors. All accepted abstracts are presented as posters at AMCP's Annual and Nexus meetings. These abstracts are also available through the AMCP meeting app. This JMCP supplement publishes all abstracts that were peer reviewed and accepted for presentation at AMCP 2025. Abstracts submitted in the Student and Encore categories did not undergo peer review; therefore, these abstracts are not included in the supplement.</p>","PeriodicalId":16170,"journal":{"name":"Journal of managed care & specialty pharmacy","volume":"31 3-a Suppl","pages":"S1-S140"},"PeriodicalIF":2.3,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143649082","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":"Use of health technology assessments in specialty drug coverage decisions by US commercial health plans.","authors":"Daniel E Enright, Emma G van Duijnhoven, Daniel A Ollendorf, James D Chambers","doi":"10.18553/jmcp.2025.31.3.289","DOIUrl":"10.18553/jmcp.2025.31.3.289","url":null,"abstract":"<p><strong>Background: </strong>Health technology assessment (HTA) involves a formal review of the clinical, economic, and societal implications of health technologies. Internationally, HTA supports decisions regarding access to novel therapeutics. However, the role of HTA in the decision-making processes of US-based health care payers remains unclear.</p><p><strong>Objective: </strong>To assess how frequently US commercial health plans reference HTAs in their specialty drug coverage policies.</p><p><strong>Methods: </strong>Using the Tufts Medical Center Specialty Drug Evidence and Coverage database, we reviewed the evidence cited in the publicly available specialty drug coverage policies of 17 US commercial health plans. We assessed the frequency of HTA citations and characterized them by (1) country of origin, (2) publishing organization, (3) whether it addressed a treatment's cost-effectiveness, (4) disease category addressed, and (5) whether it assessed orphan or nonorphan treatments.</p><p><strong>Results: </strong>HTAs accounted for 450 of the 14,033 citations in our analysis (3.2%), with the frequency of HTA citations varying across health plans (0.1% to 7.4% of cited evidence). Ex-US HTAs were cited more frequently than US-based HTAs (65.3%). However, a single health plan accounted for the majority of HTA citations (57.1%) and ex-US citations (76.2%). Most cited HTAs included cost-effectiveness assessments (78.7%). The 3 disease categories for which plans most often cited HTAs were neurological disorders (24.8%), musculoskeletal disorders (21.5%), and cancers (14.6%). Health plans cited HTAs for nonorphan drugs more often than for orphan drugs (59.4%).</p><p><strong>Conclusions: </strong>HTAs represented a small portion of the evidence cited by health plans in specialty drug coverage decisions, with significant variation in citation frequency across plans. Plans cited both US and ex-US HTAs, and most cited HTAs included a cost-effectiveness assessment. These findings suggest that health plans may consider the information provided by HTAs when formulating coverage policies.</p>","PeriodicalId":16170,"journal":{"name":"Journal of managed care & specialty pharmacy","volume":"31 3","pages":"289-295"},"PeriodicalIF":2.3,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11871157/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143530988","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":"Evaluating the uptake of a Global Initiative for Asthma guideline update in a commercially insured, value-based care population.","authors":"Lindsey M McInturff, Spenser Smith","doi":"10.18553/jmcp.2025.31.3.245","DOIUrl":"10.18553/jmcp.2025.31.3.245","url":null,"abstract":"<p><strong>Background: </strong>Asthma is one of the most common chronic respiratory disease states in the United States and poses a large economic burden. The Global Initiative for Asthma updated its clinical guidelines to recommend low-dose inhaled corticosteroids (ICSs)-formoterol as the preferred reliever option in the treatment of asthma. Randomized controlled trials show lower exacerbation rates in patients using an ICS-formoterol inhaler as a reliever compared with patients using a short-acting β₂-agonist-based reliever. There are minimal real-world data examining how this update impacts clinical outcomes and costs.</p><p><strong>Objective: </strong>To evaluate real-world asthma-specific outcomes and costs before and after members adopt a preferred treatment plan aligning with the updated Global Initiative for Asthma guideline recommendations and evidence.</p><p><strong>Methods: </strong>This retrospective, observational cohort study was performed using claims data for commercially insured members initiating an ICS-formoterol inhaler for asthma. The population included members aged 6-65 years with an asthma diagnosis, 2 or more pharmacy claims for an albuterol inhaler, and 1 or more pharmacy claims for an ICS-formoterol inhaler. The index date was the first pharmacy claim for an ICS-formoterol inhaler. All members were continuously enrolled during the 24-month study period, consisting of a 12-month preperiod and postperiod based on the index date. The primary clinical outcome was mean annual asthma exacerbations. The primary cost outcomes include the difference among mean annual asthma-specific pharmacy, medical, and total costs per member with asthma. A paired Wilcoxon signed rank test was used for statistical analysis.</p><p><strong>Results: </strong>Claims for 590 members were included in the analysis. The population consisted of 55.9% women with a mean age of 39 years. The mean annual asthma exacerbations decreased 25.6% from the preperiod to the postperiod (0.347 vs 0.258; <i>P</i> = 0.028). Mean asthma-specific pharmacy and total asthma costs significantly increased from the preperiod to the postperiod $474 vs $1,796 (<i>P</i> < 0.001) and $1,505 vs $2,567 (<i>P</i> < 0.001), respectively. The mean asthma-specific medical costs significantly decreased in the postperiod compared with the preperiod ($1,031 vs $771; <i>P</i> = 0.031).</p><p><strong>Conclusions: </strong>In this descriptive study, initiators of ICS-formoterol experienced a decrease in asthma exacerbations and an increase in professional visits. Initiators also had higher mean asthma-specific pharmacy and total costs, but lower mean asthma-specific medical costs. Health plans can take additional steps to promote implementation of updated guidelines. Pursuing clinical programs to further reduce asthma exacerbations would benefit members, providers, and the health plan.</p>","PeriodicalId":16170,"journal":{"name":"Journal of managed care & specialty pharmacy","volume":"31 3","pages":"245-252"},"PeriodicalIF":2.3,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11871162/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143531567","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":"The impact of patient characteristics and social drivers of health factors on oral oncolytic adherence.","authors":"Nikki Uyehara, Valerie Nguyen, Stacey Yu, Yingjie Weng, Ashley Son, Priyanka Patneedi, Sheila Haidar, Serena Evans, Elizabeth Oyekan, Neera Ahuja","doi":"10.18553/jmcp.2025.31.3.306","DOIUrl":"10.18553/jmcp.2025.31.3.306","url":null,"abstract":"<p><strong>Background: </strong>Oral oncolytic medication adherence is crucial for effective cancer treatment, yet adherence rates vary widely (16%-100%) depending on cancer subtypes, assessment methodologies, and patient contexts. The increased use of oral medications for various cancer types, although often advantageous over traditional parenteral infusions, has transferred the responsibility of medication administration and management to patients. As such, Stanford Specialty Pharmacy uses a team of pharmacists and liaisons who proactively follow-up with patients before each refill to track adherence and make recommendations where required. Although this program is a step forward in bettering patient outcomes, it does not address the root cause of medication nonadherence. It is vital to better understand trends associated with oral oncolytic medication adherence to better support patients with adherence.</p><p><strong>Objective: </strong>To conduct a retrospective analysis of patient records at Stanford Health Care (SHC) Specialty Pharmacy to probe correlations between patient characteristics, social determinants and drivers of health, and adherence to oral oncolytic medications to better support patients with their medication adherence.</p><p><strong>Methods: </strong>This population included patients aged at least 18 years who had an oral oncolytic dispensed from SHC Specialty Pharmacy between May 2022 and April 2023, with patient characteristics and adherence data taken from patients' electronic health records. Medication nonadherence was defined as a proportion of days covered less than 80%. Using multivariable mixed-effects logistic regression, the rate of nonadherence was compared across several patient characteristics, including age, race and ethnicity, and geographic residence.</p><p><strong>Results: </strong>Among 939 patients, 73.75% demonstrated medication adherence, highlighting a high adherence rate within the SHC Specialty Pharmacy cohort. Smoking was significantly associated with 395% higher odds of nonadherence (95% CI = 1.07 - 14.6; P = 0.04) compared with smoking abstinence, whereas patients with obesity presented 59% lower odds of nonadherence compared with patients with normal weight (95% CI = 0.24-0.69; P < 0.001). Additionally, trends in primary language, race and ethnicity, and geographic residence in relation to medication adherence were seen.</p><p><strong>Conclusions: </strong>These findings show multiple patient characteristics that are associated with oral oncolytic adherence. These identified patterns and additional studies will better inform targeted interventions for achieving equitable care and enhancing access to effective cancer treatments, leading to improved patient outcomes.</p>","PeriodicalId":16170,"journal":{"name":"Journal of managed care & specialty pharmacy","volume":"31 3","pages":"306-320"},"PeriodicalIF":2.3,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11871160/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143531538","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":"Receipt of Medicare Part D comprehensive medication reviews in older adults with dementia.","authors":"Antoinette B Coe, Jonathan Martindale, Julie P W Bynum","doi":"10.18553/jmcp.2025.31.3.296","DOIUrl":"10.18553/jmcp.2025.31.3.296","url":null,"abstract":"<p><strong>Background: </strong>Older adults with Alzheimer disease and related dementias (ADRDs) are at high risk for medication-related problems. Comprehensive medication reviews (CMRs), required in Medicare Part D medication therapy management (MTM) programs, aim to optimize medication use and reduce adverse events. Individual factors related to MTM eligibility and CMR receipt among beneficiaries with ADRD are unknown.</p><p><strong>Objective: </strong>To examine MTM eligibility and CMR receipt among older adults with ADRD compared with those without.</p><p><strong>Methods: </strong>This retrospective, cross-sectional study included 2014 Health and Retirement Study participants aged at least 65 years, with continuous Medicare fee-for-service and Part D coverage. Outcomes were MTM eligibility and CMR receipt in 2014 or 2015. Our primary independent variable was presence of diagnosed ADRD. Covariates included sociodemographic characteristics, health conditions, and functional limitations. Weighted descriptive and bivariate statistics and multivariable logistic regression were used.</p><p><strong>Results: </strong>We included 14,778,506 older adults and 10.1% had ADRD. Those with ADRD were older (mean age [SE] = 83 [0.6] vs 75 [0.2] years; <i>P</i> < 0.001), had a higher proportion of Black (11.6% vs 6.3%) and Hispanic (5.7% vs 4.7%) race and ethnicity (<i>P</i> = 0.008), and had higher MTM eligibility (25.3% vs 14.8%; <i>P</i> < 0.001) compared with those without ADRD. Older adults with ADRD were more likely to be eligible for MTM (odds ratio [OR] = 1.95, 95% CI = 1.41-2.70) but not after adjusting for covariates (adjusted OR = 1.41, 95% CI = 0.88-2.27). Overall, 16.9% received a CMR. CMR receipt was lower in those with ADRD compared with those without (10.4% vs 18.2%), but not significantly different (<i>P</i>  = 0.12). ADRD status was not associated with CMR receipt (OR = 0.52, 95% CI = 0.23-1.21, adjusted OR = 0.75, 95% CI = 0.25-2.29).</p><p><strong>Conclusions: </strong>Older adults with ADRD were not more likely to be MTM eligible or receive a CMR compared with those without ADRD. Strategies to improve MTM program design are needed to increase CMR receipt among older adults with ADRD.</p>","PeriodicalId":16170,"journal":{"name":"Journal of managed care & specialty pharmacy","volume":"31 3","pages":"296-305"},"PeriodicalIF":2.3,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11871161/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143531581","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":"Integrated health system pharmacy role in adherence, persistence, and adverse effect management for oral chronic lymphocytic leukemia therapy.","authors":"Houston Wyatt, Stephanie White, Hannah Holloway, Josh DeClercq, Autumn D Zuckerman, Leena Choi, Mei Xue, Karen Carr, Swetha Challgulla, Keri Yang, Chelsea Renfro","doi":"10.18553/jmcp.2025.31.3.253","DOIUrl":"10.18553/jmcp.2025.31.3.253","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Oral oncolytic therapy for the management of chronic lymphocytic leukemia (CLL) or small lymphocytic leukemia (SLL), such as ibrutinib, acalabrutinib, and venetoclax, have vastly changed CLL treatment. Although effective, adverse effects of these agents remain challenging. Pharmacists have an important role in managing oral chemotherapy, educating patients, and intervening to reduce adverse effects.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To evaluate medication utilization patterns (adherence, persistence, discontinuation, and switching therapy) and pharmacists' management of adverse effects in patients initiated on an oral oncolytic therapy for CLL/SLL at an integrated health system specialty pharmacy.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This single-center, retrospective review of data collected from electronic health records and a specialty pharmacy management system was conducted at the institution's outpatient oncology and hematology clinics from January 1, 2019, through June 30, 2022. Patients were included if they were prescribed acalabrutinib, ibrutinib, or venetoclax for treatment of CLL/SLL. Patients were followed through December 2022, with all patients having at least 6 months of follow-up. Primary outcomes were adherence (calculated as proportion of days covered [PDC] for patients with ≥3 fills), persistence (defined as absence of a ≥30-day gap in treatment), discontinuation or therapy switch, and reasons for discontinuation or therapy switch. A secondary analysis evaluated pharmacist interventions and intervention outcomes for patient-reported adverse effects. Descriptive statistics were used for analyses.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;There were 145 patients included in the study; among the 137 with at least 3 fills, the median PDC was 0.98 (interquartile range [IQR] 0.90-1.00) and 51 patients (37%) were found to be nonpersistent with median time to nonpersistence of 10 (IQR 6-19) months. Among 53 patients (39%) who discontinued therapy, common reasons included adverse effects (n = 26, 49%) and disease progression (n = 25, 47%). Common reasons for switching therapy among patients with a switch (n = 25; 17%) included adverse effects (n = 18, 72%) and progressive disease (n = 8, 32%). Pharmacists completed 141 interventions in 69 patients (43%) and most often acted by reviewing or updating the patient's chart (n = 85, 60%) and counseling patients (n = 50, 35%). Intervention outcomes included identified issue resolved (n = 79, 56%), follow-up care scheduled (n = 9, 6%), medication administration held (n = 2, 1%), dose adjustment made (n = 4, 3%), or medication discontinued (n = 4, 3%).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;In a population of patients initiating oral CLL/SLL therapy through an integrated health system specialty pharmacy, adherence and persistence to therapy was high. Adverse effects were attributed in 36% of therapy discontinuations and 72% of therapy switches, indicating a continued opportunity fo","PeriodicalId":16170,"journal":{"name":"Journal of managed care & specialty pharmacy","volume":"31 3","pages":"253-261"},"PeriodicalIF":2.3,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11871158/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143531570","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}