Journal of managed care & specialty pharmacy最新文献

{"title":"Correction.","authors":"","doi":"10.18553/jmcp.2024.30.12.1487","DOIUrl":"10.18553/jmcp.2024.30.12.1487","url":null,"abstract":"","PeriodicalId":16170,"journal":{"name":"Journal of managed care & specialty pharmacy","volume":"30 12","pages":"1487"},"PeriodicalIF":2.3,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11607203/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142755109","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":"Area deprivation index impact on type 2 diabetes outcomes in a regional health plan.","authors":"Taylor N Laffey, David Marr, Ashley Modany, Molly McGraw, Tavvy Mounarath, Andrew Bryk, Nicholas Christian, Chester Good","doi":"10.18553/jmcp.2024.30.12.1375","DOIUrl":"10.18553/jmcp.2024.30.12.1375","url":null,"abstract":"<p><strong>Background: </strong>Rates of attainment of high-quality diabetes care have been shown to be lower for those living in more disadvantaged and rural areas. Diabetes management relies on access to care and is impacted by physical, social, and economic factors. Area deprivation index (ADI) is one way to quantify geographic disparities in aggregate. We aimed to investigate how ADI impacts outcomes in members with type 2 diabetes enrolled in a large, regional health plan.</p><p><strong>Objective: </strong>To evalute clinical and economic objectives. Clinical objectives included the percentage of members who achieved hemoglobin A1c (A1c) goal level of 7% or less, the percentage of members who received comorbidity-focused therapies, noninsulin diabetes medication adherence, and the frequency and type of health care services used. Economic outcomes included per member per month differences in total cost of care, pharmacy cost, medical cost, and diabetes-associated cost.</p><p><strong>Methods: </strong>This retrospective review of pharmacy and medical claims included 8,814 adult members with newly diagnosed type 2 diabetes enrolled in an integrated health plan during calendar year 2021. To be included, members were required to be at least 18 years of age, reside in Pennsylvania, and have continuous enrollment for 2 years prior to type 2 diabetes diagnosis. State-level ADI data were derived for each member and applied to the Census block group on file in the administrative claims data. The study population deciles were grouped into ADI quintiles for analysis. Multivariable regression models and descriptive statistics were used to evaluate the association between ADI and outcomes while controlling for confounding variables.</p><p><strong>Results: </strong>There were no statistically significant differences between any ADI quintile for achievement of A1c goal or receipt of comorbidity-focused therapy. Significant differences were identified between ADI quintiles 1 (least deprived) and 5 (most deprived) for obtainment of at least 1 A1c test during calendar year 2021 (72% vs 56%, <i>P</i> < 0.01) and adherence to noninsulin diabetes medications (70% vs 62%, <i>P</i> < 0.01). Significant differences were also identified for all-cause inpatient, outpatient, and unplanned health care service utilization. The difference in per member per month all-cause total cost of care was on average $363.50 less for those living in ADI quintile 1 vs those in quintile 5 (<i>P</i> < 0.01).</p><p><strong>Conclusions: </strong>Significant differences were identified between ADI quintiles 1 and 5 for noninsulin diabetes medication adherence, frequency of A1c test claims, all-cause health care service utilization, and total cost of care. There were no statistically significant differences between ADI quintiles for achievement of A1c goal or receipt of comorbidity-focused therapies.</p>","PeriodicalId":16170,"journal":{"name":"Journal of managed care & specialty pharmacy","volume":"30 12","pages":"1375-1384"},"PeriodicalIF":2.3,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11607216/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142755048","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":"Patient perceptions of their experience with comprehensive medication reviews: A framework for continued quality improvement.","authors":"Melissa Castora-Binkley, Shalini Selvarajah, Mariana Felix, Patrick J Campbell, Heather Black, Terri Warholak, David R Axon","doi":"10.18553/jmcp.2024.30.12.1385","DOIUrl":"10.18553/jmcp.2024.30.12.1385","url":null,"abstract":"<p><strong>Background: </strong>A comprehensive medication review (CMR) is an annual service offered to eligible Medicare Part D beneficiaries as a component of the Medication Therapy Management program. However, little is known about the most meaningful aspect of CMRs from the patient's perspective. This information is necessary to help improve the service.</p><p><strong>Objective: </strong>To conduct concept elicitation interviews with patients who recently received a CMR to guide quality improvement efforts.</p><p><strong>Methods: </strong>Those who recently received a telephonic CMR were invited to participate in semistructured interviews to provide their insights on the CMR service. An interview guide was used and contained the following 6 key questions (with additional probing questions) exploring: (1) overall experience, (2) medication knowledge, (3) concerns, (4) management, (5) satisfaction, and (6) experience. Interviews were transcribed and analyzed thematically.</p><p><strong>Results: </strong>Interviews were conducted with 42 patients and resulted in the identification of themes related to the CMR service that were most meaningful to patients. The resulting framework contained 3 themes related to the content of the CMR (eg, medication review), the characteristics of the pharmacy professional (eg, professionalism), and the interaction during the CMR (eg, the telephonic experience). Intrinsic patient factors (eg, prior experiences) were also identified as important to contextualize patients' experiences.</p><p><strong>Conclusions: </strong>The framework provides concrete examples of the need for continued quality improvement of the CMR service and can be illustrated using the structure-process-outcome model. Patient perspectives should be accounted for in future quality improvement activities.</p>","PeriodicalId":16170,"journal":{"name":"Journal of managed care & specialty pharmacy","volume":"30 12","pages":"1385-1394"},"PeriodicalIF":2.3,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11607213/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142755178","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":"Health care costs among patients with relapsed/refractory multiple myeloma treated with ixazomib or daratumumab in combination with lenalidomide and dexamethasone in the United States.","authors":"Sikander Ailawadhi, Mu Cheng, Maral DerSarkissian, Jonathan Dabora, Melanie Young, Stephen J Noga, Selina Pi, Melody Zhang, Azeem Banatwala, Mei Sheng Duh, Dasha Cherepanov","doi":"10.18553/jmcp.2024.24085","DOIUrl":"10.18553/jmcp.2024.24085","url":null,"abstract":"<p><strong>Background: </strong>Available treatments for relapsed/refractory multiple myeloma (RRMM) include multiclass triplet regimens such as lenalidomide and dexamethasone (Rd backbone) plus ixazomib (proteasome inhibitor [PI]; I) or daratumumab (monoclonal antibody; D). Although prior real-world studies compared PI-Rd triplets, this research extends those findings by comparing health care costs of a PI-based and a monoclonal antibody-based triplet, IRd and DRd, in patients with RRMM in the United States.</p><p><strong>Objective: </strong>To describe and compare all-cause and MM-related health care costs in patients with RRMM treated with IRd vs DRd.</p><p><strong>Methods: </strong>This retrospective longitudinal study used fully adjudicated US claims data from IQVIA PharMetrics Plus (January 1, 2015, to September 30, 2020) and included adult patients who initiated IRd or DRd as second line of therapy (LOT) or later. Index date was the treatment initiation date for each LOT; baseline was 6 months pre-index. MM-related and all-cause costs per patient per month were assessed during follow-up (2020 US dollars). For MM-related costs, treatment administration costs were excluded from outpatient (OP) costs and instead summed with pharmacy costs. Costs were compared using 2-part models and generalized linear models. Inverse probability of treatment weighting was used to adjust for imbalances in baseline confounders across treatment groups.</p><p><strong>Results: </strong>A total of 265 patients who initiated IRd or DRd were included in this analysis, contributing to 276 distinct LOTs (IRd: n = 153; DRd: n = 123). Baseline characteristics were similar between IRd and DRd cohorts after applying inverse probability of treatment weighting. Weighted (ie, adjusted) mean monthly MM-related total costs were significantly lower for the IRd cohort compared with the DRd cohort (-$8,141; <i>P</i> < 0.001). Total MM-related medical (-$4,764; <i>P</i> < 0.001), OP (-$3,152; <i>P</i> < 0.001), and pharmacy and OP treatment administration costs (-$3,563; <i>P</i> = 0.017) were also significantly lower for the IRd cohort.</p><p><strong>Conclusions: </strong>When comparing patients with MM in the IQVIA PharMetrics Plus commercial insurance database, which reflects the payer perspective, significant cost savings were observed for patients treated with IRd vs DRd owing to lower OP and pharmacy costs. These findings may help inform real-world treatment and reimbursement decisions for patients with RRMM.</p>","PeriodicalId":16170,"journal":{"name":"Journal of managed care & specialty pharmacy","volume":"30 12","pages":"1431-1441"},"PeriodicalIF":2.3,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11607204/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142755133","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of a human papillomavirus vaccination clinical program in a commercially insured population.","authors":"Karli Pelaccio, Millie Mo, Allison Olmsted, Kelly DeJager","doi":"10.18553/jmcp.2024.30.12.1405","DOIUrl":"10.18553/jmcp.2024.30.12.1405","url":null,"abstract":"<p><strong>Background: </strong>Human papillomavirus (HPV) results in 37,000 new cancers each year. HPV-attributable cancers are preventable through vaccination with the completion of the HPV series encouraged by age 13 years. Public uptake has been lower than expected. Blue Cross Blue Shield of Michigan (BCBSM) implemented clinical programs to address low vaccination rates.</p><p><strong>Objective: </strong>To compare the proportion of adolescent members who completed the HPV vaccine series before vs after implementation of clinical programs.</p><p><strong>Methods: </strong>Retrospective, observational study of BCBSM commercial medical claims for members aged 9 to younger than 14 years. Data were divided accordingly: (A) pre-intervention (2019), (B) academic detailing (2022), and (C) academic detailing and provider incentive (2023). Years 2020 and 2021 were excluded to avoid impact from the COVID-19 pandemic. The primary outcome compared the proportion of members who completed the HPV vaccine series for Cohorts B and C compared with Cohort A. Secondary outcomes included the proportion of members who completed the first dose, the time between the dose due date and when the dose was received, average age at series completion, and dose 1 and 2 completion by month. Data were assessed using chi-square and independent t-tests.</p><p><strong>Results: </strong>Member baseline characteristics were similar, with the majority aged 11 to younger than 13 years, male, White, and having an urban residence. For Cohorts A, B, and C, the proportion of HPV series completers were 15.3%, 15.2%, and 15.2%, respectively. The proportion of those who received only 1 dose was 15.8%, 15.6%, 15.5%, respectively. Cohorts B and C completed the series later compared with Cohort A, with the remaining time until due date as follows: 38 days (Cohort A), 8 days (Cohort B), and 4 days (Cohort C). Compared with Cohort A, Cohorts B and C had more members who received doses 1 and 2 more than 1 year apart: 8.1% (Cohort B) and 8.4% (Cohort C) compared with 6.3% (Cohort A). The average age of series completion was 12 years. August was the most popular month to receive doses 1 and 2 across all cohorts.</p><p><strong>Conclusions: </strong>The difference observed between cohorts for the proportion of members who completed the series was not statistically significant. Cohorts B and C completed the series later compared with Cohort A, and a higher proportion received doses 1 and 2 more than 1 year apart. Although the years 2020 and 2021 were not included, lasting impact from the pandemic may have influenced study results; however, BCBSM's efforts may have mitigated the impact of the national decrease seen in HPV vaccination among in-state members.</p>","PeriodicalId":16170,"journal":{"name":"Journal of managed care & specialty pharmacy","volume":"30 12","pages":"1405-1413"},"PeriodicalIF":2.3,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11607207/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142755145","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 burden of illness of metabolic dysfunction-associated steatohepatitis in a large managed care population: The ETHEREAL Study.","authors":"Michael Charlton, Ivy Tonnu-Mihara, Chia-Chen Teng, Ziqi Zhou, Feven Asefaha, Rakesh Luthra, Amy Articolo, Anthony Hoovler, Chioma Uzoigwe","doi":"10.18553/jmcp.2024.24106","DOIUrl":"10.18553/jmcp.2024.24106","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Metabolic dysfunction-associated steatohepatitis (MASH; formerly nonalcoholic steatohepatitis) is the inflammatory form of metabolic dysfunction-associated steatotic liver disease (formerly nonalcoholic fatty liver disease). MASH is a progressive disease associated with increased risk for many hepatic and extra-hepatic complications such as cirrhosis, hepatocellular carcinoma, the requirement for liver transplantation, and cardiovascular (CV)-related and kidney-related complications. It is important to understand the clinical and economic burden of MASH.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;To assess and compare the clinical and economic burdens of MASH in adults with the non-MASH population in a real-world setting.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This observational, retrospective study used the Healthcare Integrated Research Database (HIRD), which contains health care claims data for commercially insured and Medicare Advantage health plan members across the United States. All-cause, CV-related, and liver-related medical costs and health care resource utilization were evaluated in patients with at least 2 diagnoses of MASH during the patient identification period (October 1, 2016, to April 30, 2022) and compared with a non-MASH cohort 1:1 matched on age, Quan Charlson Comorbidity Index, region of residence, and health plan type and length of enrollment. Generalized linear regression with negative binomial and γ distribution models were used to compare health care resource utilization and medical costs, respectively, while controlling for confounders. Covariate-adjusted all-cause, CV-related, and liver-related hospitalization rate ratios and medical cost ratios were assessed and compared for the MASH and matched non-MASH cohorts.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;A total of 18,549 patients with MASH were compared with 18,549 matched patients in the non-MASH cohort. After adjusting for covariates, MASH was associated with significantly higher rates of hospitalization and higher medical costs compared with the non-MASH cohort. When compared with the non-MASH cohort, patients with MASH had 1.22 (95% CI = 1.15-1.30; &lt;i&gt;P&lt;/i&gt; &lt; 0.0001) times higher rates of all-cause hospitalization, 1.13 (95% CI = 1.03-1.24; &lt;i&gt;P&lt;/i&gt; = 0.008) times higher rates of CV-related hospitalization, and 7.22 (95% CI = 4.91-10.61; &lt;i&gt;P&lt;/i&gt; &lt; 0.0001) times higher rates of liver-related hospitalization. Similarly, all-cause medical costs were 1.26 (95% CI = 1.22-1.30; &lt;i&gt;P&lt;/i&gt; &lt; 0.0001) times higher, CV-related medical costs were 1.66 (95% CI = 1.59-1.73; &lt;i&gt;P&lt;/i&gt; &lt; 0.0001) times higher, and liver-related medical costs were 7.79 (95% CI = 7.42-8.17; &lt;i&gt;P&lt;/i&gt; &lt; 0.0001) times higher among patients with MASH.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Compared with those of the non-MASH cohort with similar age, Quan Charlson Comorbidity Index, health plan, region of residence, and duration of enrollment, patients with MASH had significantly higher all-cause, CV","PeriodicalId":16170,"journal":{"name":"Journal of managed care & specialty pharmacy","volume":" ","pages":"1414-1430"},"PeriodicalIF":2.3,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11607210/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142348304","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":"It is time for a more nuanced discussion about pharmacy benefit managers.","authors":"Susan A Cantrell","doi":"10.18553/jmcp.2024.24311","DOIUrl":"10.18553/jmcp.2024.24311","url":null,"abstract":"","PeriodicalId":16170,"journal":{"name":"Journal of managed care & specialty pharmacy","volume":" ","pages":"1345-1348"},"PeriodicalIF":2.3,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11607208/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142581393","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":"Estimating the economic impact of blister-packaging on medication adherence and health care costs for a Medicare Advantage health plan.","authors":"Eric P Borrelli, Peter Saad, Nathan Barnes, Doina Dumitru, Julia D Lucaci","doi":"10.18553/jmcp.2024.24179","DOIUrl":"10.18553/jmcp.2024.24179","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Medication nonadherence is a persistent challenge in the United States, leading to increased health care resource utilization (HCRU) and health care costs and worsened health outcomes. Medicare Star Ratings is a program developed by the Centers for Medicare and Medicaid Services (CMS) to evaluate Medicare health plan quality and performance. Three of the Medicare Part D Star Ratings quality measures assess medication adherence, showing the importance CMS places on improving medication adherence in older adults. Although a variety of medication adherence-enhancing interventions are available to help promote adherence among patients, one intervention that has shown success historically is blister-packaging.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To model the potential impact of blister-packaging chronic medications on HCRU and health care costs in the Medicare population.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;An economic model was developed to assess the potential impact of blister-packaging the 3 Medicare Star Ratings adherence measure medication classes: renin-angiotensin system antagonists (RASAs), statins, and noninsulin antidiabetics. The model perspective was that of a hypothetical Medicare Advantage health plan with a plan size of 100,000 members. A 12-month time horizon was used in the model. The dichotomous adherence threshold in the model was set at 80% or greater of the proportion of days covered (PDC). Literature-based references were used to inform both the impact of blister-packaging on the number of patients who become adherent as well as the impact of medication adherence on HCRU and health care costs for each of the medication classes. One-way sensitivity analyses and several scenario analyses were conducted to assess model uncertainty.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Owing to increased adherence from the blister-packaging intervention, the hypothetical health plan in the analysis saw 776 additional members adherent to RASAs, 1,651 additional members adherent to statins, and 414 additional members adherent to oral antidiabetics. Although medication expenditure increased for all 3 medication classes (RASAs: $274,963; statins: $730,083; oral antidiabetics: $100,529), medical costs decreased across all classes (RASAs: -$4,098,848; statins: -$5,549,699; oral antidiabetics: -$917,968). Total net health care costs decreased by $3,823,885 for RASAs (-$3.19 per member per month [PMPM]), $4,819,616 for statins (-$4.02 PMPM), and $817,438 for oral antidiabetics (-$0.68 PMPM). The entire Medicare Advantage population scenario analysis saw reductions in total health care costs of $1,081,394,737 for RASAs, $1,362,987,376 for statins, and $231,171,496 for oral antidiabetics.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Dispensing chronic medications with blister-packaging for Medicare Advantage health plan patients was modeled to reduce HCRU and health care costs. Future studies are needed to assess whether the impact of blister-pack","PeriodicalId":16170,"journal":{"name":"Journal of managed care & specialty pharmacy","volume":" ","pages":"1442-1454"},"PeriodicalIF":2.3,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11607205/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142289237","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":"Initiating continuous glucose monitoring is associated with improvements in glycemic control and reduced health care resource utilization for people with diabetes in a large US-insured population: A real-world evidence study.","authors":"Gregory J Norman, Joaquim Fernandes, Poorva Nemlekar, Sarah B Andrade, Laura Lupton, Alexa Berk","doi":"10.18553/jmcp.2024.24255","DOIUrl":"10.18553/jmcp.2024.24255","url":null,"abstract":"<p><strong>Objective: </strong>To examine the real-world impact of continuous glucose monitoring (CGM) use on glycemic management and health care resource utilization (HCRU) in people with diabetes in a large US-insured population.</p><p><strong>Methods: </strong>This retrospective observational study used Aetna administrative claims data from a cohort of fully insured commercial and Medicare Advantage beneficiaries with diabetes and with coverage for medical and pharmacy benefits. The index date was the first CGM pharmacy or medical claim observed between January 1, 2019, and December 31, 2021. Change in hemoglobin A1c was calculated using values from 3 months before and the latest values 10-12 months after the index date. HCRU was measured 12 months before and after the index date. Data were analyzed by the following patient groups: type 1 diabetes, type 2 diabetes (T2D) on intensive insulin therapy, T2D on basal-only insulin therapy, and T2D not on insulin therapy.</p><p><strong>Results: </strong>Data from 7,336 patients (74% T2D, mean age 57 years, 42% Medicare-insured, 54% male, 56% White) were analyzed. Beneficiaries with available A1c data (n = 1,063) showed a significant improvement in A1c after CGM initiation (-0.7%, <i>P</i> < 0.0001), including -0.9% change in the T2D not on insulin group (n = 264). For the overall cohort, the number of patients with diabetes-related hospitalizations and emergency department visits decreased significantly by 67% and 40%, respectively (<i>P</i> < 0.0001 for both).</p><p><strong>Conclusions: </strong>This study showed that CGM use was associated with clinically meaningful improvements in A1c and reduced HCRU, suggesting potential for population-level clinical benefits, especially for patients not using insulin.</p>","PeriodicalId":16170,"journal":{"name":"Journal of managed care & specialty pharmacy","volume":" ","pages":"1-10"},"PeriodicalIF":2.3,"publicationDate":"2024-11-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142644333","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":"Drugs anticipated to be selected for the Medicare Drug Price Negotiation Program in 2025.","authors":"Emma M Cousin, Sean D Sullivan, Ryan N Hansen, Nico Gabriel, Ayuri S Kirihennedige, Inmaculada Hernandez","doi":"10.18553/jmcp.2024.24167","DOIUrl":"10.18553/jmcp.2024.24167","url":null,"abstract":"<p><strong>Background: </strong>The Centers for Medicare and Medicaid Services (CMS) recently announced the Maximum Fair Price for the first 10 Medicare Part D drugs selected for price negotiation. By February 2025, CMS should announce the list of Part D drugs to be negotiated with implementation of the negotiated prices in 2027.</p><p><strong>Objective: </strong>To identify up to 15 Medicare Part D single-source drugs anticipated to be selected by CMS for price negotiation in 2025.</p><p><strong>Methods: </strong>We followed selection criteria identified in the Inflation Reduction Act and CMS guidance to identify drugs. We projected 2023 Part D gross spending using 2020-2022 data reported by CMS and linear prediction models. We ranked products according to the projected spending figure and identified those not eligible for selection because of (1) number of years since approval, (2) availability of a biosimilar or generic version, (3) approval for a single orphan indication, (4) whole human blood or plasma-derived, or (5) eligibility for the small biotech exception.</p><p><strong>Results: </strong>We identified 13 products likely subject to Medicare drug price negotiation, including 4 anticancer therapies, 3 noninsulin antidiabetic products, 2 inhalers, 1 antifibrotic therapy, 1 gastrointestinal agent, 1 enzyme replacement therapy, and 1 product indicated for dyskinesia. These 13 products each had projected annual gross Part D spending more than $1 billion. We identified 7 additional products with uncertainty to complete the list of 15, including an insulin, an antiviral, an antibiotic, an immunologic agent, an antidiabetic, and 2 cancer drugs. These products had projected gross Part D spending between $877 million and $1.399 billion. Twenty-two products with comparable levels of spending were deemed ineligible for selection because of availability of a generic or biosimilar version (10 products), insufficient years since approval (8 products), eligibility for the small biotech exception (3 products), and expected market discontinuation (1 product).</p><p><strong>Conclusions: </strong>Our identification of products anticipated to be selected for negotiation in 2025 (with implementation of negotiated prices in 2027) will help inform manufacturers, payers, patients, and policymakers of the products that will likely see a decrease in Medicare drug prices as result of negotiation. We identified 22 products with levels of spending that are comparable with those anticipated to be selected for negotiation but are not eligible, primarily because of generic or biosimilar availability or insufficient time on market.</p>","PeriodicalId":16170,"journal":{"name":"Journal of managed care & specialty pharmacy","volume":" ","pages":"1203-1210"},"PeriodicalIF":2.3,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11522450/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142289236","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}