Journal of managed care & specialty pharmacy最新文献

{"title":"Economic value of ribociclib in early breast cancer in the United States.","authors":"Adam Brufsky, Sara M Tolaney, Vijayakrishna K Gadi, Xinglei Chai, Fan Yang, Weiye Chen, Wenxin Ma, Zheng-Yi Zhou, Vaidyanathan Ganapathy, Apeksha Patel, Gary Sopher, Emma Alexander, Vamsi Bollu, Louis P Garrison, Joseph A Sparano","doi":"10.18553/jmcp.2026.32.8.911","DOIUrl":"10.18553/jmcp.2026.32.8.911","url":null,"abstract":"<p><strong>Background: </strong>Many patients with hormone receptor-positive/human epidermal growth factor receptor 2-negative (HR+/HER2-) early breast cancer (eBC) experience recurrence despite treatment with adjuvant endocrine therapy; recurrences bear a substantial cost and can impact life expectancy and quality of life.</p><p><strong>Objective: </strong>To estimate the lifetime clinical and economic value of ribociclib for the treatment of patients with HR+/HER2- stage II/III eBC at high risk of recurrence including select node-negative and all node-positive patients.</p><p><strong>Methods: </strong>A 4-state Markov model comparing ribociclib+nonsteroidal aromatase inhibitor (NSAI) with NSAI alone estimated the expected lifetime costs and effectiveness for patients with eBC (mean age = 53 years). High risk of recurrence in HR+/HER2- eBC was based on the NATALEE trial criteria: all node-positive and node-negative patients with tumor size larger than 5 cm or 2-5 cm with Grade 3 or Grade 2 and high genomic risk. Model outcomes included invasive disease-free survival (IDFS), locoregional recurrence (LR), distant recurrence (DR), overall survival, adjuvant treatment costs, adverse event costs, disease management costs by health state, and DR treatment costs. Patient-level IDFS for the first 4.5 years observed in the NATALEE trial was parametrically extrapolated thereafter. DR and LR progression risks and treatment utilization patterns were obtained from the literature. Model outputs included total costs, quality-adjusted life-years (QALYs), life-years (LYs), equal-value LYs (evLYs), and the incremental cost-effectiveness ratio (ICER) of ribociclib+NSAI vs NSAI when using IDFS as the effectiveness outcome.</p><p><strong>Results: </strong>Ribociclib+NSAI improved IDFS (13.08 vs 11.09 years) and reduced DR (DR state = 1.28 vs 2.35 years), generating QALY gains of 0.68 (ribociclib+NSAI = 11.45; NSAI = 10.77), LY gains of 0.69 (ribociclib+NSAI = 14.98; NSAI = 14.29), and evLY gains of 0.75 (ribociclib+NSAI = 11.52; NSAI = 10.77). Total lifetime incremental costs were $52,385 (ribociclib+NSAI = $831,433; NSAI = $779,047). The ICER was $77,448/QALY, and the probability of ribociclib+NSAI being cost-effective was 68.5% at a willingness to pay of $150,000/QALY.</p><p><strong>Conclusions: </strong>Based on model estimation, ribociclib+NSAI is projected to be a cost-effective therapy in the United States vs NSAI alone by reducing the rate of high-cost metastatic recurrences and increasing QALYs.</p>","PeriodicalId":16170,"journal":{"name":"Journal of managed care & specialty pharmacy","volume":"32 8","pages":"911-922"},"PeriodicalIF":3.3,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13403262/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148592178","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 costs in patients with acute myeloid leukemia treated with posttransplant maintenance therapy.","authors":"Rachel Kneitel, Kyueun Lee, Noemi Kreif","doi":"10.18553/jmcp.2026.32.8.932","DOIUrl":"10.18553/jmcp.2026.32.8.932","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Allogeneic hematopoietic cell transplantation (allo-HCT) improves survival in patients with acute myeloid leukemia (AML); however, posttransplant relapse remains the most common cause of treatment failure and death. Limited data exist on posttransplant health care resource utilization (HCRU) and costs, particularly for patients initiating maintenance therapy.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To describe HCRU and costs among commercially insured patients, Medicaid enrollees from participating US states, and Medicare-eligible beneficiaries with employer-sponsored supplemental coverage who received maintenance therapy after allo-HCT compared with those receiving allo-HCT alone.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We conducted a retrospective cohort study of patients with AML who underwent allo-HCT using claims data from the Merative MarketScan database from October 1, 2015, to March 31, 2024. Patients receiving maintenance therapy were identified by a claim for 1 of the following agents after allo-HCT: azacitidine, decitabine, enasidenib, gemtuzumab ozogamicin, gilteritinib, glasdegib, ivosidenib, midostaurin, quizartinib, sorafenib, or venetoclax. Groups were balanced using inverse probability treatment weighting (IPTW) based on baseline characteristics. We assessed differences in all-cause monthly HCRU and costs. HCRU included emergency department (ED) visits, inpatient (IP) admissions, outpatient (OP) visits, and hospital length of stay throughout the 12-month follow-up period. Poisson and negative binomial regression models estimated event rates. Per patient per month mean costs were reported with SEs, and between-group differences were assessed using mean differences, bootstrapped 95% CIs, and &lt;i&gt;P&lt;/i&gt; values. Cumulative costs were summarized using the mean with bootstrapped 95% CIs and the median. IPTW-weighted mean monthly costs were also calculated for each cohort. Transfusion burden was also evaluated.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Of the 373 patients who met the inclusion criteria, 43 were prescribed maintenance therapy following allo-HCT. The maintenance therapy group demonstrated significantly higher HCRU across service types. Both office (incidence rate ratio [IRR] = 3.23, &lt;i&gt;P&lt;/i&gt; = 0.004) and OP visits (IRR = 4.26, &lt;i&gt;P&lt;/i&gt; &lt; 0.001) were more than tripled compared with the allo-HCT-only group, and IP admissions rose by 34% (IRR = 1.34, &lt;i&gt;P&lt;/i&gt; = 0.034). Specialist clinic and ED visit rates were higher but not statistically significant (IRR = 3.03, &lt;i&gt;P&lt;/i&gt; = 0.060 and IRR = 1.51, &lt;i&gt;P&lt;/i&gt; = 0.483, respectively). Health care costs transitioned from predominantly IP at transplant to mostly pharmacy-driven by month 4, with similar trends across both groups. The maintenance therapy group had significantly higher per patient per month pharmacy costs ($6,433.81 vs $3,132.51, &lt;i&gt;P&lt;/i&gt; = 0.002). Blood transfusion requirements were minimal in both groups. Weighted mean length of stay was significantly longer in ","PeriodicalId":16170,"journal":{"name":"Journal of managed care & specialty pharmacy","volume":"32 8","pages":"932-944"},"PeriodicalIF":3.3,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13403255/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148592225","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":"Advancing the measurement of caregiver impact: Data collection priorities aligned with caregiver, health technology assessment, and policy stakeholders.","authors":"Jason Resendez, Yadira Montoya, Benjamin G Cohen, Caroline Kacergis, Paul Steel, Brett McQueen, Stacey Kowal","doi":"10.18553/jmcp.2026.32.8.1018","DOIUrl":"10.18553/jmcp.2026.32.8.1018","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Family caregiving plays a central role in the US health care system, with substantial economic, health, and policy implications. In 2024, the estimated economic value of unpaid caregiving exceeded $1 trillion, with tens of millions of individuals providing care nationwide. However, caregiver impacts are inconsistently measured and rarely incorporated into clinical evidence, economic evaluations, and health technology assessments, limiting their use in coverage, formulary, and policy contexts. As a result, health care decision-making may not fully capture the broader benefits, costs, and tradeoffs of interventions that shift care responsibilities to families. Heterogeneity in measurement approaches and lack of consensus on which caregiver impacts are most relevant further constrain comparability and downstream application of available evidence.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To identify evidence gaps and priorities for caregiver impact data collection aligned with caregiver, health technology assessment, and policy stakeholders to support consistent, relevant evidence generation for value assessment and health care decision-making in the US.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We conducted a targeted literature review of US-focused studies that assessed caregiver impact using validated or adapted measurement tools, including peer-reviewed or gray literature reporting caregiver outcomes or measurement gaps. Findings informed a 6-hour, in-person, multistakeholder workshop with 11 participants representing academic research, patient and caregiver perspectives, and advocacy organizations. Participants reviewed and prioritized caregiver impact elements through an iterative ranking exercise and completed a structured voting exercise to identify priorities for advancing caregiving data collection and use.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The targeted literature review identified substantial heterogeneity in caregiver impact measurement, including variation in elements assessed, instruments used, timing, and reporting practices, with limited assessment across the patient journey. Ten caregiver impact elements were identified and subsequently refined to 8 prioritized elements through stakeholder consensus. Financial strain, physical health, and emotional strain emerged as the highest-priority elements. In the voting exercise, participants prioritized economic focus (eg, budget impact, cost consequences, and resource use), standardized metrics, and longitudinal or trajectory-based assessment as key opportunities to improve the usability of caregiver evidence.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Caregiver impacts remain underrepresented in US evidence frameworks owing to inconsistent measurement and lack of alignment on the most salient outcomes. Findings from this study highlight pragmatic, stakeholder-informed priorities to strengthen caregiver data collection and reporting. Adopting standardized core elements, validated instr","PeriodicalId":16170,"journal":{"name":"Journal of managed care & specialty pharmacy","volume":"32 8","pages":"1018-1028"},"PeriodicalIF":3.3,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13403257/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148592134","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 feasibility of health care databases for assessing the safety of switching between originator biologics and biosimilars.","authors":"Aaron B Mendelsohn, Terese A DeFor, Djeneba Audrey Djibo, Scott M Myers, Pamala A Pawloski, Catherine M Lockhart","doi":"10.18553/jmcp.2026.32.8.968","DOIUrl":"10.18553/jmcp.2026.32.8.968","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Real-world data (RWD) have received considerable attention recently, namely, with regard to their value in providing further evidence about the benefit-risk profile for medicinal products beyond clinical trial data. RWD may be particularly useful for establishing interchangeability and supporting switching decisions between originator biologics and their biosimilars.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To evaluate the fitness of 3 US health care databases-a national, commercial health plan, a regional integrated delivery network (IDN), and a multipayer, national claims-based database (henceforth, multipayer database)-for capturing data from clinical trials assessing interchangeability between originator biologics and biosimilars across multiple therapeutic areas.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We identified 8 clinical trials examining switching between originator biologics and biosimilars from the published literature and ClinicalTrials.gov. All variables representing inclusion/exclusion criteria, interventions, and outcomes from these trials were recorded and grouped into 8 categories: assessment, behavior, demographic, diagnostic, laboratory, procedure, treatment, and vital signs. The 3 databases were then individually evaluated based on the availability of variables identified from the clinical trials and by calculating the percentage of observed data in each database for all relevant variables across the clinical trials, overall and within the above categories.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The population size varied across the databases (4 million for the regional IDN through 170 million patient-lives in the multipayer database). All databases had complete (100%) capture for procedure, treatment, and vital signs data and performed well for capturing diagnostic information (78%-100%). Most demographic information (eg, age, sex) was captured; however, race and ethnicity was not available for all databases. Seventy-one percent of the behavior data (eg, whether the patient was sexually active) was captured by the commercial health plan and the regional IDN, but only 29% by the multipayer database. Assessment data (eg, survival, functional status) varied across the databases, with the regional IDN having 93% data capture vs 37% and 16% in the commercial health plan and multipayer database, respectively. Notable differences among the databases were also observed for laboratory data; the regional IDN had complete capture vs only 6% in the multipayer database.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Health care databases provide information such as diagnoses, treatments, and some outcomes that may be useful for generating real-world evidence relevant to biosimilar regulatory assessment. However, details on treatment effectiveness may be limited. Specific databases should be evaluated according to their unique attributes to select the most appropriate source(s) of information for a given research need. Further studies are","PeriodicalId":16170,"journal":{"name":"Journal of managed care & specialty pharmacy","volume":"32 8","pages":"968-978"},"PeriodicalIF":3.3,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13403258/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148592156","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":"Bundling medical and pharmacy benefits: Impact on medical costs.","authors":"Eric S Wilkinson, Guy David, Reetika Kumar, Philip A Saynisch, Aaron Smith-McLallen","doi":"10.18553/jmcp.2026.32.8.945","DOIUrl":"10.18553/jmcp.2026.32.8.945","url":null,"abstract":"<p><strong>Background: </strong>Employers are increasingly seeking strategies to manage rising health care costs, including bundling or carving out specific benefits like pharmacy coverage. Although some studies suggest that integrating medical and pharmacy benefits leads to reduced medical costs, the mechanism remains unclear.</p><p><strong>Objective: </strong>To evaluate the impact of bundling medical and pharmacy benefits on medical costs and utilization among self-funded employer groups and explore the potential role of population health management programs (PHMPs) as a mechanism for driving savings.</p><p><strong>Methods: </strong>This retrospective, propensity score-matched, longitudinal cohort analysis used administrative claims data from a large health plan in Southeastern Pennsylvania. Self-funded group plan participants were included in the analysis if they had integrated medical and pharmacy benefits in both 2022 and 2023 (integrated group) or if they lacked integrated benefits in either year (comparison group). We additionally required that these plan participants did not experience major changes to their population health management benefits. Doubly robust models, adjusting for concurrent risk scores, were used to compare changes in per-member per-month (PMPM) medical costs and per-1,000-members per-year utilization between the integrated and nonintegrated groups. Propensity score matching was employed to create balanced comparison groups.</p><p><strong>Results: </strong>Members with integrated pharmacy benefits experienced a statistically significant reduction of $32.48 PMPM (7.5%) in total medical cost growth relative to the nonintegrated benefits group. This reduction was largely driven by lower inpatient ($13.27 PMPM, 13.5%) and emergency department ($1.35 PMPM, 4.7%) spending. For members with a PHMP benefit, integrated pharmacy was associated with greater estimated savings ($39.28 PMPM, 9.0%) compared with those without integrated pharmacy. Additionally, members with integrated benefits were estimated to have a greater probability (10.9%) of outreach by a PHMP nurse compared with those without integrated pharmacy.</p><p><strong>Conclusions: </strong>Bundling medical and pharmacy benefits was associated with reduced medical cost growth, particularly in inpatient and outpatient settings. Coordination activities like PHMPs, enabled by data integration from bundled benefits, may be a key mechanism for achieving cost savings. These results support the consideration of benefit integration strategies for employers seeking to optimize health care spending and improve care management.</p>","PeriodicalId":16170,"journal":{"name":"Journal of managed care & specialty pharmacy","volume":"32 8","pages":"945-954"},"PeriodicalIF":3.3,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13403259/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148592182","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 Washington State Prescription Drug Affordability Board's selection of drugs for affordability review.","authors":"Douglas Barthold, Ryan Pistoresi, Marina Kawaguchi-Suzuki, Jingping Xing, Simon Borumand, Hung Truong, Gregory Gipson, Mike Neuenschwander","doi":"10.18553/jmcp.2026.32.7.847","DOIUrl":"10.18553/jmcp.2026.32.7.847","url":null,"abstract":"<p><strong>Background: </strong>The Washington State Prescription Drug Affordability Board (PDAB) is tasked with conducting affordability reviews to identify whether prescription drugs have excess costs, defined as either exceeding therapeutic value or being unsustainable to public and private health care systems. The PDAB also has the authority to set upper payment limits (UPLs). There has been limited reporting of the methods and decisions through which PDABs examine and choose drugs for affordability review.</p><p><strong>Objective: </strong>To describe the processes of identifying drugs eligible for affordability review and selecting drugs for affordability review.</p><p><strong>Methods: </strong>Branded drugs are eligible for affordability review if their wholesale acquisition cost (WAC) was at least $60,000 or their price increased above certain thresholds. Biosimilar products are eligible if their price was not at least 15% lower than the reference biologic product. Generic drugs are eligible if their WAC was at least $100 per 30-day supply and increased by at least 200% in a 12-month period. Eligible drugs were ranked according to 4 criteria with the following weights: total out-of-pocket costs (0.35), total costs (0.33), mean out-of-pocket costs among users (0.19), and total number of users (0.13).</p><p><strong>Results: </strong>290 drug products were eligible in the 2023 drug review cycle. The majority (n = 166) were branded drugs, which were eligible because their WAC for a course of treatment was at least $60,000. After the weighted ranking of eligible drugs, the board chose the top 4 drugs for affordability review: Enbrel, Xtandi, Humira, and Cabometyx.</p><p><strong>Conclusions: </strong>The selected drugs have high cost burden for patients and payers in Washington. Affordability reviews of these drugs will evaluate whether they have led or will lead to excess costs, which will inform PDAB decisions regarding the possible implementation of UPLs.</p>","PeriodicalId":16170,"journal":{"name":"Journal of managed care & specialty pharmacy","volume":"32 7","pages":"847-853"},"PeriodicalIF":3.3,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13293489/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148317504","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 comorbid depression, antidepressant adherence, and disease-modifying therapy adherence among Texas Medicaid patients with sickle cell disease.","authors":"Blessing I Okoye, Jamie C Barner, Hyeun Ah Kang, Kristin M Richards","doi":"10.18553/jmcp.2026.32.7.832","DOIUrl":"10.18553/jmcp.2026.32.7.832","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Depression is a common mental health comorbidity among patients with sickle cell disease (SCD) and is associated with increased health care utilization, increased costs, and poorer quality of life. Although depression and antidepressant adherence have been shown to be associated with medication adherence in other chronic conditions, research examining these associations in SCD is lacking.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To determine whether comorbid depression and antidepressant medication adherence are associated with adherence to SCD disease-modifying therapies (DMTs) among Texas Medicaid patients with SCD.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This retrospective study analyzed Texas Medicaid claims data (01/2016 to 08/2023) for individuals who had at least 3 medical claims for SCD, had at least 1 prescription claim for an SCD DMT, were aged 8 to 63 years, and were continuously enrolled for 6 months before and 12 months after the index date (first claim for an SCD DMT). In addition to the above, patients with depression had at least 1 medical claim for a depressive disorder, and those with treatment had at least 1 prescription claim for a selective serotonin reuptake inhibitor or serotonin-norepinephrine reuptake inhibitor. Adherence was measured using proportion of days covered (PDC). Descriptive and inferential statistics were used to describe and compare demographic and clinical characteristics and medication adherence between patients with SCD with or without comorbid depression. Multivariable logistic regression was used to determine the association between comorbid depression, antidepressant adherence, and SCD DMT adherence.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Among 1,005 patients with SCD (22.9 ± 11.7 years), 35.3% had comorbid depression. Mean PDC for each SCD DMT was 38.7 ± 26.7% (hydroxyurea), 37.5 ± 29.5% (L-glutamine), 33.9 ± 30.4% (crizanlizumab), and 60.9 ± 34.1% (voxelotor). Overall SCD DMT adherence was 11.7% (PDC ≥ 80%) and 17.2% (PDC ≥ 70%), and significantly lower among patients with comorbid depression compared with those without comorbid depression (7.6% vs 14.0%; &lt;i&gt;P&lt;/i&gt; = 0.0026). Among patients with SCD and comorbid depression with treatment, mean adherence to selective serotonin reuptake inhibitors and serotonin-norepinephrine reuptake inhibitors was 43.2 ± 29.1% and 42.3 ± 30.8%. Overall mean adherence to antidepressants was 43.3 ± 29.8%, and 20.5% (PDC ≥ 80%) and 23.5% (PDC ≥ 70%) of patients were adherent. After adjusting for covariates, the multivariable logistic regression model showed that compared with antidepressant-nonadherent patients, antidepressant-adherent patients had higher odds (adjusted odds ratio = 16.70; 95% CI = 3.97-70.31) of being adherent to SCD DMTs (PDC ≥ 70%) among patients with SCD and comorbid depression events.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;More than one-third of patients with SCD had depression, and depression was associated with lower SCD DMT adherence. Antid","PeriodicalId":16170,"journal":{"name":"Journal of managed care & specialty pharmacy","volume":"32 7","pages":"832-846"},"PeriodicalIF":3.3,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13293497/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148317535","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":"Primary adherence to medications for the treatment of major depressive disorder: A descriptive study using real-world data.","authors":"Ann Von Holle, Jeff T Mohl, Rachael B Zuckerman, Jennifer Obenrader, Elizabeth L Ciemins","doi":"10.18553/jmcp.2026.32.7.793","DOIUrl":"10.18553/jmcp.2026.32.7.793","url":null,"abstract":"<p><strong>Background: </strong>Primary adherence (PA) to a medication occurs when a patient fills a newly prescribed medication within a predefined window. Failing to fill a necessary medication can have adverse downstream clinical consequences and increased costs. The extent of PA to major depressive disorder (MDD)-related medications in the United States is not well understood.</p><p><strong>Objective: </strong>To describe overall primary adherence rates to MDD-related medications, both the initial prescription and at each subsequent switch in the patient's treatment journey.</p><p><strong>Methods: </strong>We used deidentified electronic health record (EHR) and claims data from the Optum Labs Data Warehouse, a national, longitudinal, real-world data asset containing data on more than 350 million patients. Within an index period (1/1/2021 to 12/31/2022), a PA event was recorded when a medication fill occurred within 30 days after the initial index prescription of a new medication class, where new classes were defined as having no prescription for that class in the preceding 180 days. A medication switch was defined as a prescription for a different medication than the immediately preceding prescribed medication. Patient characteristics and PA outcomes were summarized by (1) medication class, (2) counts of total medication switches during the index period, and (3) order of medication switches.</p><p><strong>Results: </strong>Overall, PA to the index medication was 75%. PA did not vary substantively across medication classes, ranging from 74% (tricyclic class) to 77% (atypical class). Approximately 15% of the sample switched MDD-related medications during the index period, and among this sample, PA to all medications decreased as the number of switches increased, declining from 59% for 1 prescription switch to less than 37% for 4 switches. Among patients with at least 1 switch, PA declined as the number of switches increased from the first switch (70%) to the fourth switch (57%).</p><p><strong>Conclusions: </strong>PA to initial prescriptions is relatively high although adherence declined with medication switching. This pattern represents a critical clinical vulnerability, which can be addressed through approaches such as education, medication regimen management, and follow-up visits with care providers to promote PA, increase treatment efficacy, and avoid adverse long-term outcomes. Future research should identify barriers to adherence during medication optimization and develop targeted interventions to sustain treatment persistence.</p>","PeriodicalId":16170,"journal":{"name":"Journal of managed care & specialty pharmacy","volume":"32 7","pages":"793-806"},"PeriodicalIF":3.3,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13293496/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148317472","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":"Principles and practices for successful gene therapy innovative contracting: Insights from a multistakeholder convening.","authors":"Tyler D Wagner, Jacqlyn W Riposo, Kendra M Gould, Jonathan D Campbell, James T Kenney, Theresa Schmidt","doi":"10.18553/jmcp.2026.25356","DOIUrl":"10.18553/jmcp.2026.25356","url":null,"abstract":"<p><strong>Background: </strong>Gene therapies (GTs) offer potentially 1-time, curative treatment approaches for inherited and other rare diseases, but their often high upfront costs and small patient populations challenge traditional reimbursement models. In response, US payers and manufacturers have increasingly implemented innovative contracts (ICs) tied to value and outcomes.</p><p><strong>Objective: </strong>To share key stakeholder experiences and identify opportunities for efficient and effective innovative contracting solutions for GTs.</p><p><strong>Methods: </strong>We used a 6-step multimethod approach, including a literature review, stakeholder interviews, framework development, a virtual convening of stakeholders, and a pre- and postconvening survey. We defined \"ICs\" as agreements between payers and manufacturers that use real-world outcomes to determine the total price paid for GTs, encompassing various contracting models (eg, rebates, warranties, and performance designs) and terminologies that link outcomes to pricing. We defined \"principles\" as elements of ICs for successful GT innovative contracting and \"practices\" as processes and steps for stakeholders to explore feasibility, negotiation, and execution of an IC for a GT. The consensus principles and practices include those that received at least 75.0% of the votes (9 of a possible 12 stakeholders) for minimal or no revisions, prioritizing the top 8 principles and practices with the highest consensus.</p><p><strong>Results: </strong>Eight principles of a possible 18 (44.4%) achieved 75.0% consensus with minimal to no revisions, and 7 of 26 possible practices (26.9%) achieved 100.0% consensus with minimal to no revisions. Principle topics included outcomes, duration, data collection, types of contracts, and patient costs. Practice topics included a focus on feasibility, negotiation, contract term, and evaluation. Stakeholders reviewed additional topics that did not ultimately reach consensus, including the role of patients and providers in innovative contracting.</p><p><strong>Conclusions: </strong>The mixed methods approach enabled the development of nuanced and contemporary principles and practices in innovative contracting for GTs. As more GTs are approved, there may be a need to refresh the principles and practices.</p>","PeriodicalId":16170,"journal":{"name":"Journal of managed care & specialty pharmacy","volume":" ","pages":"864-871"},"PeriodicalIF":3.3,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13293493/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147839000","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":"Improving adherence to guideline-based lipid-lowering therapy in people with hyperlipidemia using a targeted educational outreach approach.","authors":"Erin Conley, Susanna Chang, Laney K Jones, Bethany Kalich, Grant Patterson, Nick Payne, Sheriden Beard, Kizzy Steward Judie, Tina Kelley","doi":"10.18553/jmcp.2026.26004","DOIUrl":"10.18553/jmcp.2026.26004","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Elevated low-density lipoprotein cholesterol (LDL-C) leads to atherosclerotic plaque buildup and drives cardiovascular disease. Despite the availability of effective therapies for LDL-C reduction, elevated LDL-C is common in the United States.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To measure the success of a pharmacist-led telephonic outreach program designed to proactively address individuals with hyperlipidemia who were not being treated in accordance with cholesterol guidelines and collaborate with their primary care clinicians (PCCs) to increase guideline-based care.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;The 3-month outreach occurred from September through November 2023. Health plan members with 1 inpatient or 2 outpatient claims for hyperlipidemia within the previous year were determined using &lt;i&gt;International Classification of Diseases, Tenth Revision, Clinical Modification&lt;/i&gt; codes. Members not managed in accordance with the 2018 American Heart Association/American College of Cardiology (ACC)/Multisociety Guideline and 2022 ACC Expert Consensus Decision Pathway, based on available claims data, received a personalized action recommendation. The outreach team contacted the member and scheduled a phone call with a pharmacist. If the member agreed to the pharmacist's clinical recommendation, the outreach team contacted the member's PCC directly (by fax or e-mail). PCCs were responsible for the final clinical decision and action.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Of 14,979 members who met the inclusion criteria, 883 were selected at random for contact by the outreach team. Of these, 667 members (76%) accepted a call with a pharmacist and were considered the intervention group. An additional 5,266 members who were not contacted and did not share a PCC with someone in the intervention group were included as the control group. In the intervention group, 92.4% of members accepted the guideline-based hyperlipidemia recommendation, allowing the pharmacist to contact their PCC. The overall percentage of members moving toward guideline-recommended care in the intervention group (25.5%) was approximately twice that in the control group (11.1%). Members could undergo an LDL-C test if they had no LDL-C result available, initiated lipid-lowering therapy (LLT) if they were not already being treated for hypercholesterolemia, or intensified their existing statin regimen or added a nonstatin LLT. The difference in proportion of members remaining on no statin throughout the program was significantly lower in the intervention group (-7.9% [95% CI = -11.3% to -4.5%]) vs the control group. At the end of the pilot, 8.7% (58 of 667) of intervention group members received LLT in accordance with current guidelines vs 6.0% (316 of 5,266) in the control group.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;This study demonstrated that a health plan-driven, pharmacist-led, educational outreach program increased movement toward guideline-based LDL-C management i","PeriodicalId":16170,"journal":{"name":"Journal of managed care & specialty pharmacy","volume":" ","pages":"782-792"},"PeriodicalIF":3.3,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13293491/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147838930","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}