Journal of managed care & specialty pharmacy最新文献

{"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":"<p><strong>Background: </strong>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.</p><p><strong>Objective: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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%).</p><p><strong>Conclusions: </strong>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}

{"title":"The effectiveness and value of disease-modifying therapies for transthyretin amyloid cardiomyopathy.","authors":"Dmitriy Nikitin, Jason H Wasfy, Aaron N Winn, Finn Raymond, Kanya K Shah, Sodam Kim, Daniel R Touchette, Woojung Lee, Marina Richardson, David M Rind, Steven D Pearson, Foluso Agboola","doi":"10.18553/jmcp.2025.31.3.323","DOIUrl":"10.18553/jmcp.2025.31.3.323","url":null,"abstract":"","PeriodicalId":16170,"journal":{"name":"Journal of managed care & specialty pharmacy","volume":"31 3","pages":"323-328"},"PeriodicalIF":2.3,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11871155/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143531586","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":"Thanks to <i>JMCP</i> Peer Reviewers, 2024.","authors":"","doi":"10.18553/jmcp.2025.31.3.329","DOIUrl":"https://doi.org/10.18553/jmcp.2025.31.3.329","url":null,"abstract":"","PeriodicalId":16170,"journal":{"name":"Journal of managed care & specialty pharmacy","volume":"31 3","pages":"329-331"},"PeriodicalIF":2.3,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143531584","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":"The time is now: Addressing health inequities in the workforce.","authors":"Bruce W Sherman, Brian Sils, Kimberly Westrich","doi":"10.18553/jmcp.2025.24362","DOIUrl":"https://doi.org/10.18553/jmcp.2025.24362","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":" ","pages":"1-7"},"PeriodicalIF":2.3,"publicationDate":"2025-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143483484","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":"Correction.","authors":"","doi":"10.18553/jmcp.2025.31.2.226","DOIUrl":"10.18553/jmcp.2025.31.2.226","url":null,"abstract":"","PeriodicalId":16170,"journal":{"name":"Journal of managed care & specialty pharmacy","volume":"31 2","pages":"226"},"PeriodicalIF":2.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11801363/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143255885","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":"Emerging trends in public policy: Perspectives on the 2024 AMCP Foundation Survey.","authors":"Melissa J Andel, Daniel Tomaszewski","doi":"10.18553/jmcp.2025.31.2-a.s29","DOIUrl":"10.18553/jmcp.2025.31.2-a.s29","url":null,"abstract":"","PeriodicalId":16170,"journal":{"name":"Journal of managed care & specialty pharmacy","volume":"31 2-a Suppl","pages":"S29-S33"},"PeriodicalIF":2.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11785359/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143070881","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":"Emerging trends in therapeutics and diagnostics: Perspectives on the 2024 AMCP Foundation Survey.","authors":"Catherine M Lockhart, Michael Manolakis","doi":"10.18553/jmcp.2025.31.2-a.s15","DOIUrl":"10.18553/jmcp.2025.31.2-a.s15","url":null,"abstract":"","PeriodicalId":16170,"journal":{"name":"Journal of managed care & specialty pharmacy","volume":"31 2-a Suppl","pages":"S15-S19"},"PeriodicalIF":2.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11785362/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143070883","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":"Emerging trends in managed care pharmacy: A mixed-method study.","authors":"T Joseph Mattingly, Laura E Happe, Laura Cranston","doi":"10.18553/jmcp.2025.31.2-a.s2","DOIUrl":"10.18553/jmcp.2025.31.2-a.s2","url":null,"abstract":"<p><strong>Background: </strong>Over the past 5 years, managed care pharmacy has been shaped by a global pandemic, advancements in generative artificial intelligence (AI), Medicare drug price negotiation policies, and significant therapeutic developments. Collective intelligence methods can be used to anticipate future developments in practice to help organizations plan and develop new strategies around those changes.</p><p><strong>Objective: </strong>To identify emerging trends in managed care pharmacy.</p><p><strong>Methods: </strong>In this sequential mixed-method study, we invited experts to participate in a multidisciplinary advisory panel to develop a survey with 5 overarching domains. The qualitative analysis for our advisory panel meetings used a thematic analysis approach. To analyze the cross-sectional survey results, we used descriptive statistics and exploratory bivariate statistics to test for possible relationships with survey respondent demographics and likelihood predictions. To assess respondent opinions on the overall likelihood of an event occurring in the next 5 years, we combined \"Highly likely/Somewhat likely\" responses and compared with \"Highly unlikely/Somewhat unlikely\" responses.</p><p><strong>Results: </strong>Following our advisory panel focus groups, a total of 53 scenarios were developed for inclusion in the quantitative survey under the domains of (1) information technology, (2) therapeutics and diagnostics, (3) payment models, (4) pharmacy operations, and (5) public policy. A total of 1,238 individuals were invited to participate in the survey. Of eligible participants, 201 complete survey responses were received for a final response rate of 16.2%. Survey participants rated increased use of glucagon-like peptide-1 receptor agonists by at least 25%, at least 1 major data breach, more than 10 new orphan drug approvals, and AI use in more than half of prior authorization reviews as the most likely scenarios to occur in the next 5 years. Respondents identified the following broad issues as those most likely to impact their organizations (employers) in the next 5 years: federal and state policy changes impacting managed care, cell and gene therapies, impact of AI on managed care operations, and emerging payment models.</p><p><strong>Conclusions: </strong>This study provides valuable insights into the emerging trends that are expected to shape managed care pharmacy over the next 5 years. The integration of advanced technologies, such as AI, along with the increasing focus on specialty therapeutics, represents both opportunities and challenges for managed care organizations. However, areas with lower consensus highlight the need for caution in strategic planning.</p>","PeriodicalId":16170,"journal":{"name":"Journal of managed care & specialty pharmacy","volume":"31 2-a Suppl","pages":"S2-S10"},"PeriodicalIF":2.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11785360/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143070872","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":"Prevalence of obesity-related multimorbidity and its health care costs among adults in the United States.","authors":"Kyrian Ezendu, Gerhardt Pohl, Clare J Lee, Hui Wang, Xiaohong Li, Julia P Dunn","doi":"10.18553/jmcp.2025.31.2.179","DOIUrl":"10.18553/jmcp.2025.31.2.179","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Overweight and obesity are associated with many obesity-related complications (ORCs) and drive increased health care costs. However, data on the impact of obesity severity on multimorbidity and the effect of multimorbidity on cost and health care resource utilization (HCRU) in people with overweight or obesity are limited.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To determine in reference to obesity-related multimorbidity (1) if prevalence increases with higher levels of weight class, (2) if higher levels of weight class are associated with an increased risk of multimorbidity at an earlier age, and (3) how HCRU and health care costs are impacted, including if there is a beyond-additive effect on ORC-related costs.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This retrospective cross-sectional study used linked electronic health records (EHRs) and insurance claims from Optum's de-identified Market Clarity Data. Costs were considered from January 1 to December 31, 2019. Patients continuously insured in 2018 and 2019 with at least 1 recorded body mass index (BMI) in 2019 were included. The presence of 17 prespecified ORCs was determined from the database based on the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) diagnosis codes. ORC-related medical services costs were based on ICD-10-CM diagnosis codes in the primary position; pharmacy costs were based on National Drug Codes. Total health care costs were the sum of medical services and pharmacy costs. Weight classes were derived from the patients' median BMI in the EHR in 2019.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The prevalence of multimorbidity increased with increasing weight levels (12.3% in overweight and 33.4% in class 3 obesity for ages 19-40 years; 41.5% and 66.6% for ages 41-65 years; and 70.6%-85.9% for age ≥65 years). Ages for predicted 50% risk of having at least 2 ORCs were 59, 54, 49, and 43 years among patients with overweight and obesity classes 1, 2, and 3, respectively. The mean effect of multimorbidity on ORC-related costs was beyond additive in those with obesity, such that the ORC-related costs were about $1,082 (151%), $1,696 (218%), and $2,433 (264%) for class 1, class 2, and class 3 obesity, respectively. This effect was not present for overweight, for which the cost was $310 (42%). Individuals with multimorbidity had higher odds of emergency department visits (odds ratio [OR] = 1.74; 95% CI = 1.73-1.76) and inpatient hospitalization (OR = 3.32; 95% CI = 3.27-3.38).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;The prevalence of obesity-related multimorbidity increased with increasing weight classes within age groups. Obesity-related multimorbidity presented at an earlier age with higher weight class, such that the predicted probability of having obesity-related multimorbidity was more than a decade younger in class 2 and class 3 obesity compared with overweight. It was associated with increased HCRU and higher-than-expected costs ex","PeriodicalId":16170,"journal":{"name":"Journal of managed care & specialty pharmacy","volume":"31 2","pages":"179-188"},"PeriodicalIF":2.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11852798/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143255894","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":"Addition of continuous glucose monitoring to glucagon-like peptide 1 receptor agonist treatment for type 2 diabetes mellitus - An economic evaluation.","authors":"Eugene E Wright, Eden Miller, Anila Bindal, Yeesha Poon","doi":"10.18553/jmcp.2025.24253","DOIUrl":"10.18553/jmcp.2025.24253","url":null,"abstract":"<p><strong>Background: </strong>Both glucagon-like peptide 1 receptor agonists (GLP-1 RAs) and continuous glucose monitoring (CGM) have been shown to improve glycated hemoglobin A1c (A1c) levels among patients with type 2 diabetes mellitus (T2DM). Recently, a US real-world study found statistically significant improvements in A1c levels among patients using GLP-1 RA and a CGM device, compared with a matched cohort receiving only GLP-1 RA.</p><p><strong>Objectives: </strong>To assess the cost-effectiveness from a US payer perspective of initiating CGM (FreeStyle Libre Systems) in people living with T2DM using a GLP-1 RA therapy, compared with GLP-1 RA alone.</p><p><strong>Methods: </strong>A patient-level microsimulation model was run for 10,000 patients over a lifetime horizon with 3.0% discounting for costs and utilities. Patient characteristics were based on the overall population of the US real-world study and the subgroup of patients not using intensive insulin. The effect of CGM was modeled as a persistent reduction in A1c compared with GLP-1 RA alone (overall = 0.37%; patients not using intensive insulin = 0.34%). Costs ($2,023) and disutilities were applied to diabetes complications and acute diabetic events. Outcomes were assessed as quality-adjusted life years (QALYs).</p><p><strong>Results: </strong>The base-case incremental cost-effectiveness ratio (incremental costs/incremental QALYs) for GLP-1 RA plus CGM vs GLP-1 RA alone was $40,968/QALY in the overall cohort (cost = $484,180 vs $473,938; QALYs = 13.37 vs 13.12). Among patients not using intensive insulin, the incremental cost-effectiveness ratio was $43,095/QALY. Scenario analysis showed that the model results were robust to changing assumptions. Probabilistic sensitivity analysis showed that GLP-1 RA plus CGM had a 64% probability of being cost-effective at a willingness-to-pay threshold of $100,000 per QALY.</p><p><strong>Conclusions: </strong>From a US payer perspective, CGM is cost-effective when added to GLP-1 RA therapies for the treatment of T2DM, including for patients not using intensive insulin.</p>","PeriodicalId":16170,"journal":{"name":"Journal of managed care & specialty pharmacy","volume":" ","pages":"127-136"},"PeriodicalIF":2.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11852799/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143006297","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}