Journal of managed care & specialty pharmacy最新文献

{"title":"Comparing demographic/clinical characteristics, health care resource utilization, and costs among patients with type 2 diabetes and established atherosclerotic cardiovascular disease with and without the use of cardioprotective medications.","authors":"Tyler J Dunn, Yiwen Cao, Lin Xie, Mico Guevarra, Joanna Mitri","doi":"10.18553/jmcp.2025.24251","DOIUrl":"10.18553/jmcp.2025.24251","url":null,"abstract":"<p><strong>Background: </strong>Type 2 diabetes (T2D) causes increased health care resource utilization (HCRU) and costs in the United States. People with T2D are more likely to have atherosclerotic cardiovascular disease (ASCVD), which is associated with significant morbidity and mortality. Medical associations recommend cardioprotective antidiabetic medications, including sodium-glucose cotransporter-2 inhibitors (SGLT2is) and glucagon-like peptide 1 receptor agonists (GLP-1 RAs), to reduce the risk of cardiovascular events in patients with T2D with established, or a high risk of, ASCVD, but not all eligible patients receive these medications.</p><p><strong>Objective: </strong>To describe demographic/clinical characteristics and antidiabetic medication prescription patterns and compare HCRU and costs among patients with T2D and ASCVD with or without SGLT2i and/or GLP-1 RA use.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study using the Merative MarketScan database of longitudinal US health care claims data with patients enrolled from July 1, 2014, to December 31, 2022. Patients with T2D and ASCVD receiving SGLT2is and/or GLP-1 RAs (case cohort) were compared with patients with T2D and ASCVD not receiving SGLT2is and/or GLP-1 RAs (control cohort) during a 12-month baseline period pre-index and a 12-month follow-up period post-index. The index date was SGLT2i/GLP-1 RA prescription for the case cohort and random health care visit for the control cohort. Baseline patient characteristics are reported before propensity score matching (PSM); HCRU and medical costs are reported after PSM.</p><p><strong>Results: </strong>Before PSM, each cohort included 3,386 patients; after PSM, each cohort included 2,351 patients. Patients in the case cohort were significantly more likely to experience myocardial infarction (case, 26.2%; control, 21.5%; P < 0.001) or peripheral artery disease (case, 28.6%; control, 26.1%; P < 0.024) during the baseline period. Patients in the case cohort had significantly lower baseline Charlson Comorbidity Index scores than patients in the control cohort (case, 1.8; control, 2.1; P < 0.001). Patients in the case cohort had significantly fewer all-cause inpatient visits per patient (case, 0.4; control, 0.6; P < 0.001) and all-cause emergency department visits per patient (case, 0.9; control, 1.0; P = 0.024). Patients in the case cohort had significantly lower all-cause inpatient costs (case, $13,977; control, $22,056; P < 0.001), other all-cause outpatient costs (case, $16,504; control, $24,739; P < 0.001), and all-cause total medical costs including pharmacy costs (case, $51,143; control, $58,648; P = 0.01) in the 12-month follow-up period.</p><p><strong>Conclusions: </strong>Patients with T2D and ASCVD receiving SGLT2is and/or GLP-1 RAs within 12 months of ASCVD diagnosis may benefit from lower HCRU and costs.</p>","PeriodicalId":16170,"journal":{"name":"Journal of managed care & specialty pharmacy","volume":" ","pages":"117-126"},"PeriodicalIF":2.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11852797/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143006509","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":"Antidepressant adherence using group-based trajectory modeling among postpartum women with Texas Medicaid.","authors":"Emma L Pennington, Jamie C Barner, Carolyn M Brown, Leticia R Moczygemba, Divya A Patel, Tyler J Varisco","doi":"10.18553/jmcp.2025.31.2.167","DOIUrl":"10.18553/jmcp.2025.31.2.167","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Mental health conditions are among the most frequent underlying causes of pregnancy-related death, and antidepressants may have a positive impact. However, adherence is suboptimal, and little is known regarding antidepressant adherence trajectories among postpartum women in the United States.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To describe antidepressant use among postpartum women with Texas Medicaid and determine factors associated with adherence trajectories.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This retrospective analysis of Texas Medicaid claims (January 1, 2018, to June 30, 2022) included women aged 12 to 55 years with at least 1 delivery, who were continuously enrolled 84 days before and 12 months after delivery, and who received an antidepressant within 90 days after delivery. The index date was the first dispensing of an antidepressant after delivery. The dependent variable was antidepressant adherence, defined as the proportion of days covered (PDC) and measured in 30-day increments for 270 days after antidepressant initiation. The independent variables were guided by the Andersen Behavioral Model and included predisposing (age and race and ethnicity), enabling (urbanicity, prenatal care, and postpartum care), and need (baseline depression/anxiety, baseline substance use disorder [SUD], cesarean delivery, preterm birth, and pregnancy complications) factors. Group-based trajectory modeling (GBTM) was used to identify antidepressant adherence trajectory groups. Multinomial logistic regression was used to identify factors associated with adherence trajectory group membership.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The included patients (N = 15,667) had a mean ± SD age of 27.4 ± 5.9 years, and 41.7% were White. Most resided in urban counties (78.0%) and had 6.4 ± 3.5 prenatal visits, 3.1 ± 2.8 postpartum visits, and 1.4 ± 0.9 pregnancy complications. Nearly half (49.8%) had baseline depression/anxiety, 17.2% had baseline SUD, 37.4% had cesarean delivery, and 13.9% had preterm birth. At 270 days after antidepressant initiation, mean ± SD adherence was 43.9 ± 29.5, and the adherence rate (PDC ≥ 80) was 15.9%. During the 270 days follow-up, mean ± SD persistence without a 30-day gap was 103 ± 85.2 days, and the persistence rate (proportion persisting 180 days without a 30-day gap) was 22.1%. GBTM revealed 5 membership groups: consistent high (19.0%), fluctuating (22.5%), slowly decreasing (13.3%), and rapidly decreasing (21.8%) adherence and early and consistent nonadherence (23.4%). Patterns emerged with decreasing adherence at 2, 3, and 6 months after initiation. Increasing age, non-Black race, urban residence, increasing postpartum care visits, and baseline depression/anxiety were associated with the consistent high-adherence trajectory compared with most lower-adherence trajectories. However, baseline SUD and preterm birth were associated with membership in the less-adherent compared with the consistently adherent trajecto","PeriodicalId":16170,"journal":{"name":"Journal of managed care & specialty pharmacy","volume":"31 2","pages":"167-178"},"PeriodicalIF":2.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11852796/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143255869","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":"Pharmacist vs physician management of e-visit requests for COVID-19 medication: A randomized clinical trial.","authors":"Tracy A Lieu, E Margaret Warton, Andrew deLaunay, Stephanie Prausnitz, Milton Chan, Michelle R Mancha, Thao Huynh, Eric Smallberg, Charles Quesenberry, Kristine Lee, Mary Reed","doi":"10.18553/jmcp.2025.31.2.189","DOIUrl":"10.18553/jmcp.2025.31.2.189","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Electronic visits (e-visits), defined as structured asynchronous electronic messages between patients and clinicians requiring clinical decision-making, are being increasingly used to enhance access to outpatient health care services, but the primary care physicians who typically manage them face work overflow. Pharmacists have been proposed to manage e-visits that lead to prescription requests, but scant evidence exists about the effectiveness of this approach.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To compare pharmacist management of structured asynchronous e-visit requests for COVID-19 medication with physician management regarding quality of care, timeliness, and patient care experience.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This cluster-randomized clinical trial included adults from 17 medical facilities of Kaiser Permanente Northern California who made e-visits requesting COVID-19 medication (nirmatrelvir-ritonavir) from October 9 to December 11, 2023. In the Pharmacist Care group, a regional team of pharmacists managed e-visits for COVID-19 medication; in the Physician Care group, pools of adult and family medicine physicians managed these visits. The primary outcome was whether a patient with 1 or more potential serious drug-drug interactions received counseling via an electronic secure message. Secondary outcomes included prescribing rates, time to the prescription, and patient perceptions of care quality.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Among the 1,753 eligible patients (mean age = 52.2 [SD = 15.9] years; 57.7% female), 642 received Pharmacist Care and 1,111 received Physician Care. The percentage of patients with a potential drug-drug interaction who were sent counseling messages by the clinician did not differ between the Pharmacist Care (76 of 79 [96.2%]) and Physician Care groups (193 of 201 [96.0%]) (risk difference [RD] = 0.18%; 95% CI = -4.8% to 5.2%). The pharmacist and physician groups had similar rates of prescribing (87.4% vs 84.4%; RD = 2.9; 95% CI = -0.4 to 6.3). Pharmacist Care compared with Physician Care had faster mean time from the initial e-visit submission to the resulting prescription (1.0 vs 2.5 hours; RD = -1.5; 95% CI = -1.9 to -1.2). Pharmacist Care took more clinician time per visit than Physician Care (10.7 vs 4.2 minutes), resulting in higher estimated cost ($11.40 vs $6.70). After the study period, the pharmacist team made protocol changes to improve workflow efficiency, and a follow-up analysis 12 months later found significant reductions in per-visit time (to 5.7 minutes) and estimated cost (to $6.03) under Pharmacist Care. Patient perceptions of care did not differ significantly between groups.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Pharmacist care and physician care for patient e-visits for COVID-19 medication both yielded high quality of care, with no significant group differences. Evaluation of pharmacist care may be warranted for other e-visits designed to facilitate medication presc","PeriodicalId":16170,"journal":{"name":"Journal of managed care & specialty pharmacy","volume":"31 2","pages":"189-197"},"PeriodicalIF":2.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11801361/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143255890","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":"Real-world evidence: A new era is upon us.","authors":"Brian T Sweet","doi":"10.18553/jmcp.2025.31.2.225","DOIUrl":"10.18553/jmcp.2025.31.2.225","url":null,"abstract":"","PeriodicalId":16170,"journal":{"name":"Journal of managed care & specialty pharmacy","volume":"31 2","pages":"225"},"PeriodicalIF":2.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11801362/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143255896","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 pharmacy operations: Perspectives on the 2024 AMCP Foundation Survey.","authors":"Brian Nightengale, Todd Huseby","doi":"10.18553/jmcp.2025.31.2-a.s25","DOIUrl":"10.18553/jmcp.2025.31.2-a.s25","url":null,"abstract":"","PeriodicalId":16170,"journal":{"name":"Journal of managed care & specialty pharmacy","volume":"31 2-a Suppl","pages":"S25-S28"},"PeriodicalIF":2.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11785363/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143070880","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 characteristics and use for bevacizumab in ophthalmology and oncology in a distributed research network.","authors":"Jenice S Ko, Aaron B Mendelsohn, Kimberly Daniels, Ainhoa Gomez-Lumbreras, James Marshall, Cara McDermott, Pamala A Pawloski, Gary C Yee, Catherine M Lockhart","doi":"10.18553/jmcp.2025.31.2.157","DOIUrl":"10.18553/jmcp.2025.31.2.157","url":null,"abstract":"<p><strong>Background: </strong>Although bevacizumab and its biosimilars are commonly used, there are limited real-world data on bevacizumab use in the United States, especially biosimilar bevacizumab used in ophthalmologic conditions.</p><p><strong>Objective: </strong>To evaluate use patterns and patient characteristics for the originator bevacizumab relative to its biosimilars for labeled and off-label oncology and ophthalmology conditions and characterize adverse events in patients using bevacizumab for oncologic indications.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study with the Biologics and Biosimilars Collective Intelligence Consortium-distributed database to identify patients aged 21 years and older who received bevacizumab between January 1, 2010, and June 30, 2021. Oncology indications included colon, lung, and gynecologic (cervical, uterine, and ovarian) cancers. Ophthalmologic indications included neovascular age-related macular degeneration (AMD), retinal vein occlusion (RVO), choroidal neovascularization (CNV), and proliferative diabetic retinopathy (PDR). We also captured patients' demographic and clinical characteristics.</p><p><strong>Results: </strong>Total bevacizumab product (originator and biosimilars) use increased over time for RVO, CNV, and PDR starting in 2015 but decreased for AMD after 2016. For ophthalmology, bevacizumab product users were primarily male (56.8%), had a mean age of 62.9 years (SD = 0.08), and had a mean Charlson/Elixhauser combined comorbidity score ranging from 0.7 (CNV) to 2.7 (PDR). Bevacizumab users for oncology indications were mostly female (61.8%), had a mean age of 62.9 years (SD = 12.2), and had a mean Charlson/Elixhauser combined comorbidity score of 7.4 (SD = 3.0). Oncologic biosimilar product use increased over time between 2019 and 2020 as follows: colon cancer, 6.2% to 49.4%; lung cancer, 1.9% to 36.2%; and gynecologic cancer, 2.4% to 38.1%.</p><p><strong>Conclusions: </strong>Bevacizumab product use increased across most indications during the study period. Use for biosimilars increased in later years relative to the originator once available on the market. Limited data are available on real-world biosimilar use in the United States; future research should include monitoring for use and adverse events of these products.</p>","PeriodicalId":16170,"journal":{"name":"Journal of managed care & specialty pharmacy","volume":"31 2","pages":"157-166"},"PeriodicalIF":2.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11852795/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143255889","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":"Real-world treatment and health care utilization among patients with Duchenne muscular dystrophy by race and ethnicity in a Medicaid population.","authors":"Nathaniel Posner, Janna Manjelievskaia, Anna K Talaga, Megan Richards, Carolyn R Lew, Valeria Merla, Jose Maria Jimenez Alvir, Stanley F Nelson","doi":"10.18553/jmcp.2025.31.2.205","DOIUrl":"10.18553/jmcp.2025.31.2.205","url":null,"abstract":"<p><strong>Background: </strong>Duchenne muscular dystrophy (DMD) is a rare neuromuscular disorder, and data on the impact of patients' race on treatment outcomes and health care resource utilization are lacking.</p><p><strong>Objective: </strong>To describe the real-world treatment and health care utilization among patients with DMD, by race, in a Medicaid population.</p><p><strong>Methods: </strong>This was a retrospective cohort study of patients with DMD in the Merative Multi-State Medicaid Database between January 2017 and June 2021. Patients with DMD were identified using a validated algorithm and included male patients with at least 2 DMD diagnoses (earliest DMD diagnosis date = index date), aged 40 years or younger, with at least 12 months of continuous enrollment prior to index date, and with at least 12 months (or evidence of death) following the index date were selected. Demographics, clinical characteristics, treatment utilization, and health care utilization and costs were reported by race and ethnicity in the 12-month baseline and 12-month follow-up periods.</p><p><strong>Results: </strong>A total of 561 patients were included in the study, of which 360 (64.2%) were White, 50 (8.9%) were Black, 33 (5.9%) were Hispanic, and 118 (21.0%) were of other/unknown race and ethnicity. The median age on the index date was 16, 13, 14, and 15 years among the race and ethnicity categories, respectively. In the follow-up, period clinical characteristics were similar across cohorts. Corticosteroids were the most commonly received treatment, with the highest use among Hispanic patients (73%) and lowest use among Black patients (52%). A third of patients treated with corticosteroids received deflazacort, with similar utilization across groups. Exon-skipping therapy use was rare, with 3% utilization overall, and highest use among White patients (4.2%). In both the baseline and follow-up periods, differences in health care costs were not statistically significant. White patients had the highest total costs in the follow-up period (mean [SD] = $108,895 [$346,934]) compared with $59,501 [$85,758] in the Black cohort, $61,199 [$67,021] in the Hispanic cohort, and $65,247 [$119,733] in the unknown/other cohort. Differences in total health care costs were driven by outpatient pharmacy costs, likely because of the larger proportion of White patients having a prescription for an exon-skipping therapy.</p><p><strong>Conclusions: </strong>Differences were seen across race and ethnicities in select clinical characteristics, DMD treatments, and health care utilization and costs in a Medicaid population.</p>","PeriodicalId":16170,"journal":{"name":"Journal of managed care & specialty pharmacy","volume":"31 2","pages":"205-213"},"PeriodicalIF":2.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11852792/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143255898","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":"Call for the alignment of Medicare Part D formularies with clinical treatment guidelines for asthma.","authors":"Amelia Lao, Anusha McNamara, Lenny Lok Shun Chan, David Smith","doi":"10.18553/jmcp.2025.31.2.200","DOIUrl":"10.18553/jmcp.2025.31.2.200","url":null,"abstract":"<p><p>The Global Initiative for Asthma, the most widely cited international guidelines for asthma management, currently recommends the use of maintenance and reliever therapy with an inhaled corticosteroid-formoterol inhaler based on evidence showing reductions in asthma exacerbations and hospitalizations vs short-acting relievers alone. A review of Medicare Part D plans based on a Kaiser Family Foundation report reveals that the formulary design of many plans is not aligned with this recommendation, resulting in restricted prescriber adherence to the guidelines and limited patient access to standard-of-care treatments. To improve clinical outcomes, it is key that Medicare Part D plans minimize barriers to access through prioritization of inhaled corticosteroid-formoterol regimens as preferred formulary agents.</p>","PeriodicalId":16170,"journal":{"name":"Journal of managed care & specialty pharmacy","volume":"31 2","pages":"200-204"},"PeriodicalIF":2.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11852788/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143255884","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 cemiplimab plus chemotherapy vs pembrolizumab plus chemotherapy as first-line treatment for advanced non-small cell lung cancer.","authors":"Xiangzhong Xue, Surachat Ngorsuraches, Brandon Johnson, Jingyi Zheng, Jingjing Qian","doi":"10.18553/jmcp.2025.31.2.137","DOIUrl":"10.18553/jmcp.2025.31.2.137","url":null,"abstract":"<p><strong>Background: </strong>In 2022, the US Food and Drug Administration approved cemiplimab in combination with chemotherapy (CCT) as a first-line treatment for advanced non-small cell lung cancer (aNSCLC). However, whether CCT presents a cost-effective alternative to the previously preferred first-line treatment, pembrolizumab plus chemotherapy (PCT), remains uncertain.</p><p><strong>Objective: </strong>To evaluate the cost-effectiveness of CCT vs PCT as the first-line treatment for aNSCLC from a US health care payer perspective.</p><p><strong>Methods: </strong>A 3-state partitioned survival model with a 10-year horizon was constructed. Clinical data were derived from the EMPOWER-Lung 3, KEYNOTE-407, and KEYNOTE-189 trials. Costs and quality of life were obtained from published 2024 US list prices and literature. The cost, quality-adjusted life-years (QALYs) gained, and incremental cost-effectiveness ratio (ICER) were calculated. All outcomes were discounted at a rate of 3% per year. Scenario analyses, deterministic and probabilistic sensitivity analyses, and subgroup analyses were performed for patients with different programmed death ligand 1 (PD-L1) levels.</p><p><strong>Results: </strong>In the base-case analysis, the total cost of PCT was $207,926 with 1.609 QALYs, whereas CCT had a total cost of $175,247 with 1.657 QALYs. Results from the scenario analyses were consistent with the base-case analysis, indicating that CCT was a dominant treatment strategy over PCT (ICER =-$675,304 per QALY). The cost of pembrolizumab highly impacted the ICER. At a willingness-to-pay threshold of $150,000 per QALY, CCT would be accepted as a cost-effective option 96.9% of the time. In subgroup analyses, CCT remained a dominant alternative to PCT for patients with PD-L1 levels of at least 50% and 1%-49%.</p><p><strong>Conclusions: </strong>This cost-effectiveness analysis suggests that CCT is a dominant first-line treatment option for aNSCLC with PD-L1 levels of at least 1% compared with PCT.</p>","PeriodicalId":16170,"journal":{"name":"Journal of managed care & specialty pharmacy","volume":"31 2","pages":"137-146"},"PeriodicalIF":2.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11855296/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143255886","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":"Getting to specialty treatment in dermatologic inflammatory conditions: Treatment requirements and patient journey.","authors":"Matthew G Bowles, Autumn D Zuckerman, Josh DeClercq, Leena Choi, Mackenzie Ellis, Chelsea P Renfro","doi":"10.18553/jmcp.2025.31.2.147","DOIUrl":"10.18553/jmcp.2025.31.2.147","url":null,"abstract":"<p><strong>Background: </strong>Many payers and pharmacy benefit managers (PBMs) use step therapy requirements and formulary alternatives to reduce prescription spending. The clinical utility and ultimate therapy outcomes for patients participating in these programs is an area of needed research.</p><p><strong>Objective: </strong>To evaluate medication outcomes and time requirements to access therapy in patients required to use a step therapy or formulary alternative after being prescribed a specialty medication for psoriasis (PsO) or atopic dermatitis (AD).</p><p><strong>Methods: </strong>A single-center, retrospective review of data collected from electronic health records and the specialty pharmacy patient management system was conducted. Patients were included if they had a referral for a specialty medication by a dermatology provider for PsO or AD that was discontinued because of the payer/PBM requiring step therapy or formulary alternative use from January 2021 to June 2022. The primary outcome was the number of days from the time of patient referral for specialty medication until the second specialty medication referral. Secondary outcomes included the number of patients that failed step therapy or formulary alternative and were referred back to the specialty pharmacy as well as the number of patients not started on a specialty medication and the reason.</p><p><strong>Results: </strong>The included patients (N = 83) were predominantly White (75%) and female (61%) with a median age of 50 years (interquartile range [IQR] = 37-61 years). 51% of patients had an indication of AD. 62 patients were required to use step therapy, and 21 were required to use a formulary alternative. Of the patients required to use step therapy, 37 (60%) had a second referral for a specialty medication because of failing step therapy requirements, with a median time to a second referral of 75 days (IQR = 27-135). The remaining 25 patients were not started on a specialty medication: 5 patients (8%) benefited from and remained on step therapy, 15 (24%) were lost to follow-up, 3 (5%) decided not to start step therapy, and 2 (3%) were referred for psoriatic arthritis evaluation. All patients required to use a formulary alternative initiated specialty medication with a median time from the initial referral to second referral of 3 days (IQR = 1-9 days).</p><p><strong>Conclusions: </strong>Most patients required to complete nonspecialty step therapy ultimately initiated specialty medications after a lengthy delay, demonstrating the potential impact of step therapy requirements on initiating clinically appropriate treatment for AD and PsO. Further research assessing the financial burden and clinical impact of requiring step therapy before specialty medications is warranted.</p>","PeriodicalId":16170,"journal":{"name":"Journal of managed care & specialty pharmacy","volume":"31 2","pages":"147-156"},"PeriodicalIF":2.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11852794/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143255887","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}