Journal of managed care & specialty pharmacy最新文献

{"title":"Health care costs and resource utilization among patients with myasthenia gravis in the United States.","authors":"Sun A Choi, Daniel R Touchette, Kibum Kim","doi":"10.18553/jmcp.2025.31.5.472","DOIUrl":"https://doi.org/10.18553/jmcp.2025.31.5.472","url":null,"abstract":"<p><strong>Background: </strong>Myasthenia gravis (MG) is a rare neuromuscular disorder with an estimated prevalence of 37 per 100,000 individuals in the United States. Despite patients with MG using a wide range of health care services, there is a lack of information regarding health care costs and health care resource utilization (HCRU).</p><p><strong>Objective: </strong>To gain insight into the health care cost and HCRU associated with an MG diagnosis from the US payer perspective.</p><p><strong>Methods: </strong>Patients with MG, defined by at least 2 claims for MG diagnoses, were identified from a commercial and Medicare claims database between 2016 and 2021. Controls who were never diagnosed with MG were matched at a 10:1 ratio with each patient with MG based on baseline demographic and clinical characteristics. The primary outcomes were 1-year total health care costs associated with MG diagnosis, and the secondary outcomes were 1-year HCRU associated with MG diagnosis. Difference-in-difference estimates from a multivariable linear regression model were used to report adjusted health care costs and HCRU.</p><p><strong>Results: </strong>The final analytic cohort included 3,700 patients with MG and 37,000 controls. On average, patients were aged 54 years, with 60% being female. The difference-in-difference estimates of the total health care cost for MG diagnosis in commercial and Medicare patients were $25,799 and $4,927, respectively (<i>P</i> < 0.01). MG diagnosis had significant impacts on HCRU across all health care settings.</p><p><strong>Conclusions: </strong>We quantified a significant increase in health care costs and HCRU in the first year following diagnosis of MG compared with the matched cohort. Future studies can further investigate long-term health care costs associated with patients with MG.</p>","PeriodicalId":16170,"journal":{"name":"Journal of managed care & specialty pharmacy","volume":"31 5","pages":"472-481"},"PeriodicalIF":2.3,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12039500/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143996606","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Trends in first-line glucose-lowering medication use among US adults with type 2 diabetes from 2019 to 2023.","authors":"Duy Do, Tiffany Lee, Samuel Peasah, Angela Inneh, Urvashi Patel, Chester Good","doi":"10.18553/jmcp.2025.31.5.520","DOIUrl":"https://doi.org/10.18553/jmcp.2025.31.5.520","url":null,"abstract":"<p><strong>Background: </strong>The introduction of newer classes of glucose-lowering therapies has dramatically altered the diabetes therapeutic landscape. However, little is known about trends in the use of first-line glucose-lowering therapies over time.</p><p><strong>Objective: </strong>To describe trends in the use of first-line glucose-lowering therapies from 2019 to 2023 among patients with type 2 diabetes (T2D) and changes over time in the demographic and clinical characteristics of patients initiating these therapies.</p><p><strong>Methods: </strong>This retrospective study identified patients aged 18 years and older from the Komodo Healthcare Map database who filled any glucose-lowering medication between January 2019 and May 2023. The prevalence of first-line glucose-lowering therapy use among patients with T2D was calculated in each month. Pearson χ² and Kruskal-Wallis rank sum tests were used to compare patients' demographic and clinical characteristics such as cardiovascular disease, heart failure, or chronic kidney disease by type of first-line glucose-lowering medication.</p><p><strong>Results: </strong>The study cohort of 964,914 patients was predominantly made up of female patients (68%) and had a mean age of 54 (SD = 13). The majority of patients initiated metformin before 2022 (74%-83%), followed by insulin (6%-11%), sulfonylureas (3%-7%), glucagon-like peptide 1 receptor agonists (GLP-1RAs) (2%-5%), sodium-glucose cotransporter 2 inhibitor (SGLT2is) (1%-4%), and dipeptidyl peptidase-4 inhibitors (1%-3%). From January 2022 to May 2023, first-line use of GLP-1RAs and SGLT2is increased from 6% and 4% to 18% and 7%, respectively. In contrast, first-line use of metformin, sulfonylureas, and dipeptidyl peptidase-4 inhibitors declined from 76%, 4%, and 2% to 64%, 2%, and 1% over the same period, respectively. Relative to 2019-2021, first-line GLP-1RA users in 2022-2023 were likely to be younger, female, and covered by Medicaid and to have fewer comorbidities as determined by the Charlson Comorbidity Index. In contrast, first-line SGLT2i users were more likely to be older and to have more comorbidities over the same period.</p><p><strong>Conclusions: </strong>This study shows a significant shift in the use of first-line glucose-lowering therapies from metformin to GLP-1RAs and SGLT2is. The proportion of first-line GLP-1RA and SGLT2i users with cardiovascular disease, heart failure, or chronic kidney disease has increased significantly over time, aligning with guidelines from the American Diabetes Association. Further studies are merited to evaluate the cost-benefit implications of this shift in first-line glucose-lowering use.</p>","PeriodicalId":16170,"journal":{"name":"Journal of managed care & specialty pharmacy","volume":"31 5","pages":"520-526"},"PeriodicalIF":2.3,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12039499/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144022794","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":"Number needed to treat and associated cost analysis of zanubrutinib vs ibrutinib in chronic lymphocytic leukemia.","authors":"Asher Chanan-Khan, Kirollos Hanna, Mei Xue, Marjan Massoudi, Mark Balk, Ray Gani, Hossein Zivari Piran, Keri Yang","doi":"10.18553/jmcp.2025.24330","DOIUrl":"https://doi.org/10.18553/jmcp.2025.24330","url":null,"abstract":"<p><strong>Background: </strong>Zanubrutinib, a Bruton tyrosine kinase inhibitor, is an approved treatment for chronic lymphocytic leukemia (CLL).</p><p><strong>Objective: </strong>To compare zanubrutinib vs ibrutinib for relapsed refractory (R/R) CLL by calculating the number needed to treat (NNT) to avoid 1 progression or death and the associated cost impact.</p><p><strong>Methods: </strong>An NNT analysis was conducted to estimate the number of patients with R/R CLL that need to be treated to prevent 1 progression or death. Clinical efficacy data were derived from the ALPINE trial, with 24-month progression-free survival (PFS) data from the final analysis of the ALPINE trials used for the base-case analysis. An economic analysis was conducted from a US payer perspective to assess the cost impact associated with NNT, incorporating costs of direct treatment, adverse event management, medical resources utilization, and subsequent treatment. It quantified the PFS-based NNT, the incremental cost per treated patient, and incremental cost per additional patient experiencing progression or death. Deterministic sensitivity analyses were performed to evaluate parameter uncertainties and identify key drivers. Scenario analyses explored different PFS estimates.</p><p><strong>Results: </strong>In the base-case analysis, treating 8 patients with zanubrutinib instead of ibrutinib prevented 1 progression or death. The total costs per patient treated with zanubrutinib and ibrutinib were $399,928 and $447,059, respectively, with cost savings of $47,132 per zanubrutinib-treated patient. Drug costs and PFS are the major impact factors on the incremental cost per patient. In the scenario analyses, the NNT ranged from 8 to 12, with cost savings of $46,105-$52,860 per zanubrutinib-treated patient. In a hypothetical 100-patient clinical practice, zanubrutinib could prevent approximately 13 progression or death events.</p><p><strong>Conclusions: </strong>Zanubrutinib may offer more favorable clinical outcomes with cost savings compared with ibrutinib for R/R CLL treatment from a US payer perspective. Additionally, cost savings could be realized from the Enhancing Oncology Care model, a value-based payment structure that incentivizes providers to deliver high-quality care while reducing overall health care spending.</p>","PeriodicalId":16170,"journal":{"name":"Journal of managed care & specialty pharmacy","volume":"31 5","pages":"482-490"},"PeriodicalIF":2.3,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12040489/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143967899","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association between statin discontinuation after proprotein convertase subtilisin/kexin type 9 inhibitor initiation and subsequent atherosclerotic cardiovascular disease events.","authors":"Samuel K Peasah, Tiffany Lee, Duy Do, Yan Huang, Angela Inneh, Urvashi Patel, Aryan N Aiyer, Chester B Good","doi":"10.18553/jmcp.2025.31.4.377","DOIUrl":"10.18553/jmcp.2025.31.4.377","url":null,"abstract":"<p><strong>Background: </strong>Clinical guidelines recommend the use of proprotein convertase subtilisin/kexin type 9 inhibitors (PCSK9is) in patients with atherosclerotic cardiovascular disease (ASCVD) and nonoptimal low-density lipoprotein.</p><p><strong>Objective: </strong>To evaluate the association between discontinuation of statin use after PCSK9i initiation and subsequent ASCVD events.</p><p><strong>Methods: </strong>This pre-post retrospective comparative study used national administrative data of adult statin medication users (age ≥18 years) with an index PCSK9i claim (January 1, 2019, to April 30, 2021), prior ASCVD diagnosis, and a 2-year follow-up period. Proportions and probability of ASCVD events post-index (PCSK9i) vs pre-index (PCSK9i) for patients who discontinued statins (discontinued cohort) and those who continued statins (continued cohort) were compared. Propensity score weighting was used to balance patient baseline characteristics. Multivariate Poisson regression and time-to-event Cox regression models were used to assess the association between statin discontinuation and ASCVD events.</p><p><strong>Results: </strong>There were 294 and 46 patients in the continued and discontinued cohorts, respectively. Unweighted results showed that patients in the continued cohort were more likely to receive high-intensity statins (32% vs 22%; <i>P</i> = 0.4) and have a Charlson Comorbidity Index score of 3 or more (62% vs 54%; <i>P</i>  =  0.5) at baseline. Baseline statin adherence was lower in the discontinued cohort (6.7% vs 59%; <i>P</i> < 0.001) but 30% each in the propensity 1:1 matched cohort. The 2 cohorts (after matching) had similar ASCVD event prevalence (discontinued cohort: 24% vs continued cohort: 26%) in the baseline and the same lower prevalence (6.5% each; <i>P</i> > 0.9) in the 24-month follow-up period. The odds of any ASCVD event post-index was comparable between the 2 cohorts (reference: continued cohort; odds ratio = 1.88; 95% CI = 0.28-14.6; <i>P</i> = 0.51). There were no statistically significant differences between the 2 groups in the Cox regression (<i>P</i> = 0.47).</p><p><strong>Conclusions: </strong>Post-ASCVD event rates were significantly lower in both cohorts, but discontinuation of statins was not associated with unfavorable ASCVD outcomes.</p>","PeriodicalId":16170,"journal":{"name":"Journal of managed care & specialty pharmacy","volume":"31 4","pages":"377-385"},"PeriodicalIF":2.3,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11953866/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143730305","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Economic impact of sotagliflozin among patients with heart failure and type 2 diabetes: Budget impact analysis from the US payer perspective.","authors":"Jason Shafrin, Shanshan Wang, Jaehong Kim, Slaven Sikirica","doi":"10.18553/jmcp.2025.31.4.386","DOIUrl":"10.18553/jmcp.2025.31.4.386","url":null,"abstract":"<p><strong>Background: </strong>Heart failure (HF) is a leading cause of mortality in the United States, often complicated by comorbidities like diabetes mellitus. These patients face high hospitalization risks, impacting clinical outcomes and health care resources. The Effect of Sotagliflozin on Cardiovascular Events in Patients with Type 2 Diabetes Post Worsening Heart Failure (SOLOIST-WHF) trial showed that sotagliflozin, a sodium-glucose cotransporter inhibitor, reduced rehospitalizations in patients with HF and diabetes mellitus. Although clinically beneficial, the economic impact of sotagliflozin from a payer perspective remains unclear, warranting further pharmacoeconomic analysis to guide managed care decisions.</p><p><strong>Objective: </strong>To quantify the budget impact of sotagliflozin for US payers over a 5-year time horizon.</p><p><strong>Methods: </strong>A payer-perspective budget impact model was developed to assess the financial impact of incorporating sotagliflozin for the treatment of patients recently hospitalized for HF with comorbid type 2 diabetes (T2D) over 5 years to US payer health plans. The study used a population reflecting the SOLOIST-WHF clinical trial, with economic parameters adjusted by payer mix (all payer, commercial, Medicare, and Medicaid). Health care resource utilization included hospitalization, emergency department (ED) visit, and adverse events' care. Economic outcomes examined the medical and pharmacy budget impact for payers at the per-user, per member per month (PMPM), and total plan costs levels.</p><p><strong>Results: </strong>For a hypothetical 1-million-member all-payer plan, 1,516 patients hospitalized for HF with comorbid T2D would be eligible for sotagliflozin. For all-payer plans, annual per-user costs increased by $4,996 because of higher pharmacy costs ($8,260) but were partially offset by lower medical costs (-$2,608) because of reduced rehospitalization and ED visits from sotagliflozin. PMPM total budget impact of sotagliflozin would be $0.08 PMPM in year 1 and $0.38 in year 5, corresponding with total plan cost of $75,736 in year 1 and $378,681 by year 5. Commercial payer PMPM costs were lower ($0.02 in year 1; $0.11 in year 5), and higher for Medicare ($0.23 PMPM in year 1, increasing to 1.13 PMPM in year 5). Breakeven rebate rates ranged between 31.5% and 79.4%.</p><p><strong>Conclusions: </strong>Although sotagliflozin increases pharmacy costs for recently hospitalized HF patients with T2D, approximately 21%-68% of pharmacy costs were offset from reduced rehospitalization and ED visits.</p>","PeriodicalId":16170,"journal":{"name":"Journal of managed care & specialty pharmacy","volume":"31 4","pages":"386-395"},"PeriodicalIF":2.3,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11953859/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143730308","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 resource utilization and direct costs incurred over 12 months by patients with migraine initiating self-injectable calcitonin gene-related peptide monoclonal antibodies: A US real-world study.","authors":"Oralee J Varnado, Brenna Brady, Anthony Zagar, Yvonne Robles, Alan Ó Céilleachair, Margaret Hoyt","doi":"10.18553/jmcp.2025.31.4.351","DOIUrl":"10.18553/jmcp.2025.31.4.351","url":null,"abstract":"<p><strong>Background: </strong>Calcitonin gene-related peptide monoclonal antibodies (CGRP mAbs) are approved for migraine prevention. Limited information is available comparing the health care resource utilization (HCRU) and direct costs associated with initiating different CGRP mAbs.</p><p><strong>Objective: </strong>To compare all-cause and migraine-related HCRU and direct costs in US patients with migraine initiating the self-injectable CGRP mAbs, galcanezumab, fremanezumab, or erenumab.</p><p><strong>Methods: </strong>This retrospective cohort study used data from Merative Marketscan Commercial and Medicare Databases. Adults with at least 1 claim (first claim=index) for the above CGRP mAbs between May 2018 and September 2020 (index period), with continuous enrollment for 12 months pre-index (baseline [BL]) and post-index (follow-up [FU]) were included. Patients with a claim for index drug during BL were excluded. Mean HCRU and mean total costs (inpatient, outpatient, and outpatient pharmacy costs) were evaluated over 12 months post-index. Propensity score matching was used to balance the galcanezumab vs fremanezumab (2:1) and galcanezumab vs erenumab (1:1) cohorts. <i>P</i> values of <0.05 were considered statistically significant.</p><p><strong>Results: </strong>After matching, patient demographics and clinical characteristics were similar between galcanezumab vs fremanezumab (n=2,674 sets) and galcanezumab vs erenumab (n=3,503 sets) cohorts. Relative to BL, numerically lower all-cause and migraine-related HCRU (inpatient and outpatient visits) were observed in all cohorts over the 12-month post-index period, whereas outpatient pharmacy HCRU was numerically higher. All-cause and migraine-related total costs (mean) were higher over the FU period in all cohorts (all <i>P</i> < 0.001). Mean all-cause and migraine-related cost increases were numerically similar for galcanezumab vs fremanezumab ($503 vs $518 [<i>P</i>=0.825] and $467 vs $468 [<i>P</i>=0.990]), and for galcanezumab vs erenumab ($504 vs $499 [<i>P</i>=0.934] and $462 vs $443 [<i>P</i>=0.375]). Outpatient pharmacy costs contributed greatly to migraine-related costs, whereas all-cause costs were greatly driven by outpatient costs.</p><p><strong>Conclusions: </strong>HCRU and direct cost differences observed at 12 months following initiation of self-injectable CGRP mAbs for migraine prevention were numerically similar across cohorts for patients treated with galcanezumab, fremanezumab, and erenumab. More work should be done to learn if these drugs perform differently with respect to other important factors not examined here.</p>","PeriodicalId":16170,"journal":{"name":"Journal of managed care & specialty pharmacy","volume":"31 4","pages":"351-365"},"PeriodicalIF":2.3,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11953855/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143730355","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":"Determining health care cost drivers in older Hodgkin lymphoma survivors using interpretable machine learning methods.","authors":"Zasim Azhar Siddiqui, Yves Paul Mbous, Sabina Nduaguba, Traci LeMasters, Virginia G Scott, Jay S Patel, Usha Sambamoorthi","doi":"10.18553/jmcp.2025.31.4.406","DOIUrl":"10.18553/jmcp.2025.31.4.406","url":null,"abstract":"<p><strong>Background: </strong>The cost of health care for patients with Hodgkin lymphoma (HL) is projected to rise, making it essential to understand expenditure drivers across different demographics, including the older adult population. Although older HL patients constitute a significant number of HL patients, the literature on health care expenditures in older HL patients is lacking. Predictive capabilities of machine learning (ML) methods enhance our ability to leverage a data-driven approach, which helps identify key predictors of expenditures and strategically plan future expenditures.</p><p><strong>Objective: </strong>To determine the leading predictors of health care expenditures among older HL survivors across prediagnosis, treatment, and posttreatment phases of care.</p><p><strong>Methods: </strong>The study uses a retrospective research design to identify the incident cases of HL diagnosed between 2009 and 2017 using Surveillance, Epidemiology, and End Results-Medicare data. Three phases of cancer care (prediagnosis, treatment, and posttreatment) were indexed around the diagnosis date, with each phase divided into 12 months of baseline and 12 months of follow-up. ML methods, including XGBoost, Random Forest, and Cross-Validated linear regressions, were used to identify the best regression model for predicting Medicare and out-of-pocket (OOP) health care expenditures. Interpretable ML SHapley Additive exPlanations method was used to identify the leading predictors of Medicare and OOP health care expenditures in each phase.</p><p><strong>Results: </strong>The study analyzed 1,242 patients in the prediagnosis phase, 902 in the treatment phase, and 873 in the posttreatment phase. XGBoost regression outperformed Random Forest and Cross-Validated linear regression models with overall performance in predicting Medicare expenditures, with R-squared (root mean square error) values of 0.42 (1.39), 0.43 (0.56), and 0.46 (0.90) across the 3 phases of care, respectively. Interpretable ML methods highlighted baseline expenditures, number of prescription medications, and cardiac dysrhythmia as the leading predictors for Medicare and OOP expenditures in the prediagnosis phase. Chemotherapy and immunotherapy and surgical treatment and immunotherapy were the leading predictors of expenditures in the treatment and posttreatment phases, respectively.</p><p><strong>Conclusions: </strong>As ML applications increase in predicting health care expenditure, researchers should consider implementing models in different phases of care to identify the changes in the predictors. Leading predictors of health care expenditures can be targeted for informed policy development to address financial hardship in HL survivors.</p>","PeriodicalId":16170,"journal":{"name":"Journal of managed care & specialty pharmacy","volume":"31 4","pages":"406-420"},"PeriodicalIF":2.3,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11953870/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143730306","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":"Group-based trajectory modeling to identify longitudinal patterns and predictors of adherence among older adults on concomitant triple therapy (oral antidiabetic, renin-angiotensin-system antagonists, statins).","authors":"Sai S Cheruvu, Bilqees Fatima, Susan Abughosh","doi":"10.18553/jmcp.2025.31.4.396","DOIUrl":"10.18553/jmcp.2025.31.4.396","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Diabetes, hypertension, and hyperlipidemia frequently co-occur in older adults, significantly increasing their risk for cardiovascular disease, a leading cause of mortality in the United States. Managing these conditions often requires concomitant triple therapy, which includes antihypertensives, oral antidiabetics, and statins. Although medication adherence is critical for reducing cardiovascular risk, adherence to complex regimens is often suboptimal in older populations, further complicating disease management. Medicare's STAR metrics assess adherence to these medications as a measure of care quality. Traditional methods, like the proportion of days covered (PDC), provide single adherence estimates, but fail to capture the dynamic nature of adherence over time. Group-based trajectory modeling (GBTM) offers a more comprehensive approach, graphically depicting patterns of adherence behavior. This study seeks to understand longitudinal patterns and predictors of adherence of concurrent triple therapy among elderly patients under Managed Care using GBTM.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To evaluate adherence patterns to concurrent triple therapy (antidiabetic, antihypertensive, and lipid-lowering medications) among older patients using GBTM and identify predictors associated with each adherence trajectory.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Patients on concurrent triple therapy were identified using a Texas Medicare Advantage dataset from July 2016 to December 2016. Patients included had an overlap of 30 days of triple therapy, a second prescription of each component of triple therapy within the identification period, and a 12-month follow-up after the triple therapy. Monthly adherence was measured using PDC during follow-up. Patients were defined as adherent if they had at least 80% (24 out of the 30 days) covered for all 3 medications. The monthly PDC was incorporated into a logistic GBTM to provide distinct patterns of adherence. Two to five adherence groups were estimated using the second-order polynomial function of time. Predictors of adherence were identified using multinomial logistic regression, guided by the Anderson Behavioral Model.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Of the 7,847 patients included, the following 4 distinct adherence trajectories were identified: adherent (42.5%), gaps in adherence (28.9%), gradual decline (13.4%), and rapid decline (15.3%). Female patients had higher odds of being in the gaps in adherence or rapid decline groups compared with males. Low-income subsidy recipients were less likely to experience rapid decline. Prior hospitalizations increased the likelihood of rapid decline in adherence.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;This study identified heterogeneous adherence patterns among older adults on triple therapy for cardiovascular disease risk factors. Targeted interventions tailored to specific adherence trajectories are needed to improve medication adherence and health outcom","PeriodicalId":16170,"journal":{"name":"Journal of managed care & specialty pharmacy","volume":"31 4","pages":"396-405"},"PeriodicalIF":2.3,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11953873/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143730349","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 time is now: Addressing health inequities in the workforce.","authors":"Bruce W Sherman, Brian Sils, Kimberly Westrich","doi":"10.18553/jmcp.2025.31.4.421","DOIUrl":"10.18553/jmcp.2025.31.4.421","url":null,"abstract":"<p><p>As a major provider of health insurance for working-age Americans, employers can play a significant role in improving the health equity of their employees and family members. In this commentary, we describe how different stakeholders, including employers, their employees, clinicians, and health systems and health plans, each contribute to the observed inequities. Other systems-level factors, including racism, implicit bias, medical mistrust, health literacy limitations, and health care access and affordability concerns have been also shown to contribute to inequitable outcomes. Opportunities exist for employers to improve health equity among their benefits-enrolled employees and family members using data-driven approaches to ensure that benefits are more equitable in scope, access, and affordability. As an illustrative example of employer strategic considerations, we describe opportunities to identify and address inequities in prescription medication use. Additionally, employers can, and perhaps should, advocate for transparency in community-based health system and health plan reporting regarding health inequities and progress toward more equitable health care utilization and outcomes. Employers can also advocate for the delivery of more patient-centered, systems-based solutions, such as enhanced primary care and/or worksite clinics, and give consideration to establishing health equity performance-based incentives in their health care contracting. Further research in the employer setting can help to expand the adoption of a best-practices approach to achieving more equitable health outcomes.</p>","PeriodicalId":16170,"journal":{"name":"Journal of managed care & specialty pharmacy","volume":"31 4","pages":"421-427"},"PeriodicalIF":2.3,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11953865/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143730271","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":"Frequency of first generic drugs approved through \"skinny labeling,\" 2021 to 2023.","authors":"Therese J Ziaks, Chukwubuikem M Akanegbu, Alexander C Egilman, Aaron S Kesselheim","doi":"10.18553/jmcp.2025.31.4.343","DOIUrl":"10.18553/jmcp.2025.31.4.343","url":null,"abstract":"<p><strong>Background: </strong>Brand-name drug manufacturers receive a market exclusivity period following US Food and Drug Administration (FDA) approval, which can be extended through obtaining additional patents such as method-of-use patents. The skinny labeling pathway, in which the FDA approves generic prescriptions that carve out patent-protected indications from their labeling, has helped promote competition and timely market entry of low-cost generic prescriptions for many decades.</p><p><strong>Objective: </strong>To determine how the use of the skinny labeling pathway by generic prescription drug manufacturers has changed in recent years.</p><p><strong>Methods: </strong>Based on FDA-curated lists, we assessed the proportion of FDA-approved first generic prescriptions using the skinny labeling pathway from 2021 to 2023. We also examined whether the use of the pathway changed after a 2021 federal court decision (<i>GlaxoSmithKline v. Teva</i>) increased the risk of legal liability for generic manufacturers marketing skinny label generic prescriptions.</p><p><strong>Results: </strong>From 2021 to 2023, 42.9% of 21 susceptible brand-name drugs required a skinny labeled generic prescription, including 5 (56%) in 2021, 3 (43%) in 2022, and 1 (20%) in 2023.</p><p><strong>Conclusions: </strong>Previous literature found 43% of brand-name drugs experienced skinny labeling generic prescription competition in a 2015-2019 sample, which is consistent with the rate of skinny labeled generic prescription entry early in our sample. Then, the proportion of first generic prescriptions approved with a skinny label decreased annually from 2021 to 2023. Applying this 2021 <i>GlaxoSmithKline v. Teva</i> methodology in subsequent years can help determine whether the judicial decision has had a sustained chilling effect on generic prescription manufacturers' use of skinny labeling, resulting in delayed generic prescription competition as a result of fewer generic prescriptions entering the market.</p>","PeriodicalId":16170,"journal":{"name":"Journal of managed care & specialty pharmacy","volume":"31 4","pages":"343-350"},"PeriodicalIF":2.3,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11953849/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143730310","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}