Journal of managed care & specialty pharmacy最新文献

{"title":"Cost per outcome of nivolumab + relatlimab vs BRAF + MEK inhibitor combinations for first-line treatment of <i>BRAF</i>-mutant advanced melanoma.","authors":"Kirollos S Hanna, Jennell Palaia, Divya Patel, Andriy Moshyk, Zheng-Yi Zhou, Fan Yang, Yiqiao Xin, Viviana Garcia-Horton","doi":"10.18553/jmcp.2025.25015","DOIUrl":"10.18553/jmcp.2025.25015","url":null,"abstract":"<p><strong>Background: </strong>The National Comprehensive Cancer Network guidelines list combination immunotherapy as the preferred first-line (1L) treatment for unresectable or metastatic melanoma over BRAF and MEK inhibitor (BRAFi/MEKi) therapy, regardless of <i>BRAF</i> mutation status. However, the economic impact of 1L treatment with nivolumab plus relatlimab (NIVO + RELA) vs BRAFi/MEKi therapies for <i>BRAF-</i>mutated advanced melanoma has not been assessed.</p><p><strong>Objective: </strong>To compare the health care costs, cost per progression-free life-year (PFLY), and cost per life-year (LY) of NIVO + RELA vs dabrafenib plus trametinib (DAB + TRAM), encorafenib plus binimetinib (ENCO + BINI), and vemurafenib plus cobimetinib (VEM + COBI) as 1L treatment for <i>BRAF</i>-mutated, unresectable or metastatic melanoma.</p><p><strong>Methods: </strong>A cost-per-outcome model compared the economic value of NIVO + RELA vs each BRAFi/MEKi therapy. Clinical inputs were derived from previous matching-adjusted indirect comparisons using individual patient data from the <i>BRAF</i>-mutant subgroup of RELATIVITY-047 and published data pooled from COMBI-d, COMBI-v, COLUMBUS, and coBRIM. LYs, PFLYs per investigator, and treatment duration were estimated using the restricted mean survival time. Health care costs (2024 US dollars), including drug acquisition and administration costs, disease management costs over the preprogression and postprogression periods, and adverse event management costs, were calculated over 5 years. Several scenario analyses were performed, including adding subsequent treatment costs.</p><p><strong>Results: </strong>Over 5 years, NIVO + RELA was associated with improved PFLYs and LYs compared with DAB + TRAM (mean PFLY: 1.94 vs 1.82 years, mean LY: 3.41 vs 2.77 years), ENCO + BINI (1.87 vs 1.78 years and 3.40 vs 2.91 years, respectively), and VEM + COBI (2.12 vs 1.80 years and 3.39 vs 2.63 years). The estimated total costs over 5 years were lower for NIVO + RELA vs DAB + TRAM ($300,479 vs $519,770), ENCO + BINI ($343,996 vs $572,556), and VEM + COBI ($296,361 vs $317,851). Main cost drivers were drug acquisition and administration costs. NIVO + RELA had lower costs per PFLY and per LY than DAB + TRAM ($155,107 vs $285,617 and $88,203 vs $187,699, respectively); ENCO + BINI ($183,628 vs $322,113 and $101,151 vs $196,924); and VEM + COBI ($139,688 vs $176,645 and $87,315 vs $121,086). The sensitivity analyses' results supported the base-case results.</p><p><strong>Conclusions: </strong>NIVO + RELA showed improved LYs and PFLYs at lower cost than all 3 BRAFi/MEKi comparators over 5 years. These results support the economic value of NIVO + RELA for patients with previously untreated, <i>BRAF</i>-mutated, unresectable or metastatic melanoma.</p>","PeriodicalId":16170,"journal":{"name":"Journal of managed care & specialty pharmacy","volume":" ","pages":"671-679"},"PeriodicalIF":2.3,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12204334/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144110895","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":"Changes in cost-related nonadherence among US adults with multiple chronic conditions from 2019 to 2023.","authors":"Alejandro Amill-Rosario, Julia F Slejko, Susan dosReis","doi":"10.18553/jmcp.2025.31.7.662","DOIUrl":"10.18553/jmcp.2025.31.7.662","url":null,"abstract":"<p><strong>Background: </strong>Cost-related nonadherence (CRN), that is, not taking medication as prescribed to save money, may remain disproportionately high among individuals with multiple chronic conditions, particularly during periods of economic stress, such as the COVID-19 pandemic. However, the impact of economic hardship 3 years after the pandemic on CRN levels among individuals with multiple chronic conditions is still largely unknown.</p><p><strong>Objective: </strong>To examine changes in CRN prevalence in 2020 (pandemic) and 2021 to 2023 (post-pandemic years 1, 2, and 3) relative to 2019 (pre-pandemic) among adults with multiple chronic conditions in the United States.</p><p><strong>Methods: </strong>This is a repeated cross-sectional study using data from the National Health Interview Survey, 2019-2023. Our study sample included 27,413 US adults aged 18 to 64 years with 2 or more of any of 14 chronic conditions and who were prescribed medication. CRN (dependent variable) is a binary measure with values \"1\" if respondents endorsed 1 of the 4 cost-saving behavior questions-not purchasing medicine refills, delaying refills, splitting pills, or skipping doses to save money-and \"0\" otherwise. Analyses include survey-weighted CRN prevalence estimates by year and linear probability models assessing prevalence changes in 2020-2023 relative to 2019, overall, and by multiple chronic conditions subgroups (2, 3, and ≥4 conditions).</p><p><strong>Results: </strong>The overall CRN prevalence in 2019 was 18.9%, 16.7% in 2020, 13.5% in 2021, 14.5% in 2022, and 15.5% in 2023. CRN decreased in all years relative to 2019 but only significantly by 2.2% (<i>P</i> = 0.001) in 2021 and by 1.4% (<i>P</i> = 0.049) in 2022. The subgroup analysis shows variation in these results, with a significant reduction in CRN in 2021, relative to 2019, limited to those who reported 3 chronic conditions.</p><p><strong>Conclusions: </strong>Fewer adults with multiple chronic conditions reported CRN 1 and 2 years after the pandemic relative to the pre-pandemic in the United States, but those with 4 or more conditions remain vulnerable after the pandemic.</p>","PeriodicalId":16170,"journal":{"name":"Journal of managed care & specialty pharmacy","volume":"31 7","pages":"662-670"},"PeriodicalIF":2.3,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12204332/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144505975","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":"Implementation of a nonstatin prior authorization checklist for patients with hypercholesterolemia: In 2 community health care systems.","authors":"Dana McCormick, Pam R Taub, Jeffrey Carter, Kathleen Moreo, Cherilyn L Heggen","doi":"10.18553/jmcp.2025.31.7.723","DOIUrl":"10.18553/jmcp.2025.31.7.723","url":null,"abstract":"<p><strong>Background: </strong>Health plans have acknowledged there is a significant unmet need to improve prior authorization (PA) processes to increase patient access to life saving nonstatin therapies. Outcomes from a series of regional working groups in the United States provided recommendations for developing standardized patient eligibility criteria and a checklist for streamlining the PA process.</p><p><strong>Objective: </strong>To (1) develop a standardized PA checklist to streamline collection of adequate PA documentation by prescribers, regardless of health insurance plan type, and (2) measure the impact of the PA checklist in clinical practice in a controlled observational study.</p><p><strong>Methods: </strong>A working group of thought leaders representing payers and providers was assembled by PRIME Education, in collaboration with the Academy of Managed Care Pharmacy, the American Society for Preventive Cardiology, and the Preventive Cardiovascular Nurses Association. The working group developed and finalized a PA checklist for PCSK9 inhibitors that was integrated into the electronic medical record for 2 large community health care systems with geographic representation of patients with cardiovascular disease: Random chart audits were conducted prior to (historical controls) and 6 months after (post-intervention) implementation of the checklist (n = 100 each set). Primary study endpoints were rates of approvals and time to approval/receipt of prescribed drug. Statistical analyses measured changes in PA documentation outcomes, including treatment history and authorization approvals/denials. Survey questions provided to health care provider teams before and after integration of the PA checklist measured changes in prescriber attitudes on effectiveness and efficiency of the PA checklist.</p><p><strong>Results: </strong>Following implementation of the PA checklist, a 19% absolute increase in initial PA approvals and a 2-day overall reduction in time-to-treatment with prescribed PCSK9 inhibitor therapy were observed. Documentation of side effects (54%; <i>P</i> < 0.0001), statin contraindications (31%; <i>P</i> < 0.0001), and prior lipid therapies failed (20%; <i>P</i> < 0.0001) also increased postimplementation. In surveys, prescribers reported greater efficiency and effectiveness of the PA process when using the standardized PA checklist.</p><p><strong>Conclusions: </strong>Time-to-treatment for nonstatin therapies for eligible patients with hypercholesterolemia was decreased in 2 community health systems following integration of a standardized PA checklist developed through a collaboration between patients and providers.</p>","PeriodicalId":16170,"journal":{"name":"Journal of managed care & specialty pharmacy","volume":"31 7","pages":"723-728"},"PeriodicalIF":2.3,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12204327/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144505978","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":"Clinical evaluation of zavegepant for the acute treatment of migraine.","authors":"Huiqiao Fan, Janette Wadolowski, Ryan Shan, Gianni J Contrera, Christina M Polomoff","doi":"10.18553/jmcp.2025.31.6.598","DOIUrl":"10.18553/jmcp.2025.31.6.598","url":null,"abstract":"<p><p>Zavegepant is the first intranasal calcitonin gene-related peptide receptor antagonist approved for the acute treatment of migraine and offers a new nonoral option for patients. This article reports the findings of a comprehensive literature review to assess zavegepant's safety and effectiveness. Evidence synthesis involved reporting findings from clinical trials and evaluating comparative effectiveness. This review was prepared by the University of Connecticut School of Pharmacy Academy of Managed Care Pharmacy (AMCP) Student Chapter. The student author group won the AMCP National Pharmacy and Therapeutics competition for their zavegepant product review in March 2024.</p>","PeriodicalId":16170,"journal":{"name":"Journal of managed care & specialty pharmacy","volume":"31 6","pages":"598-602"},"PeriodicalIF":2.3,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12123197/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144181852","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":"Social determinants of health and their impact on frontline treatment patterns among Medicare Advantage members with newly diagnosed multiple myeloma.","authors":"Alexjandro Daviano, Yihua Xu, Brandon T Suehs, Susan Wojcicki, Jennifer S Harper, Kimberly D Brunisholz","doi":"10.18553/jmcp.2025.31.6.603","DOIUrl":"10.18553/jmcp.2025.31.6.603","url":null,"abstract":"<p><strong>Background: </strong>To improve health inequities, it is necessary to understand the impact of social determinants of health (SDoH), or social risk factors, including race and economic status, on multiple myeloma (MM) treatment patterns.</p><p><strong>Objective: </strong>To identify SDoH factors leading to gaps in frontline treatment in Medicare beneficiaries with newly diagnosed MM (NDMM).</p><p><strong>Methods: </strong>This retrospective study used data from various sources, including claims data, individual-level SDoH measures (eg, race, dual-eligibility [DE] status for Medicare and Medicaid, low-income subsidy [LIS] status, and special needs plan eligibility) from the Humana Research database population during the time frame from 2016 to 2023, and community-level SDoH measures from the Agency for Healthcare Research Quality database. Treatment pattern outcomes included treatment within 90 days of first MM diagnosis, time from diagnosis to frontline treatment, frontline treatment regimen type, daratumumab-containing frontline regimens, and duration of frontline therapy. Multivariable regression was used to evaluate the association between SDoH factors and MM treatment patterns.</p><p><strong>Results: </strong>Of 4,483 individuals identified with NDMM, 31.9% were Black race and 24.1% had DE/LIS status. More than half of individuals in the study resided in areas that were above the national median for receiving public assistance, having less than high school education, having no health insurance, and having no Internet. In the overall cohort, 1,941 (43.3%) patients had no treatment within 12 months of diagnosis, 811 of whom had no evidence of symptomatic disease (ie, asymptomatic smoldering MM). Median time to treatment initiation (TTI) from diagnosis was 2.7 months, and 51.2% of patients received treatment within 90 days of diagnosis. Lower odds for treatment initiation within 90 days were observed for Black patients (vs White patients; odds ratio [OR] = 0.865 [CI = 0.752-0.995]), DE/LIS patients (vs non-DE/LIS; OR = 0.696 [CI = 0.599-0.809]), and by special needs plan enrollment (vs nonenrollment; OR = 0.717 [CI = 0.547-0.940]), but community-level SDoH was generally not independently associated with TTI. Among 2,523 patients who received frontline treatment within 12 months of diagnosis (treated cohort), TTI and duration of treatment were similar between the overall cohort and DE/LIS and non-White subgroups. Secular trends were observed in frontline treatment regimens, which were mostly triplets, and evolved over time to comprise fewer doublet regimens and more quadruplets, with an increase in daratumumab-based regimens.</p><p><strong>Conclusions: </strong>Inequities in timely frontline NDMM treatment were observed for non-White patients and those with DE/LIS status. Combinations of community-level SDoH, but no one single factor, may underlie these inequities.</p>","PeriodicalId":16170,"journal":{"name":"Journal of managed care & specialty pharmacy","volume":"31 6","pages":"603-612"},"PeriodicalIF":2.3,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12123199/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144181762","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":"Optimization of oncology biomarker testing in managed care: Best practices and consensus recommendations from an AMCP Market Insights program.","authors":"Diana Brixner, Terry Richardson, Catherine M Lockhart, Scott Ramsey, John Fox, Daryl Pritchard, Howard Mcleod, Laura Bobolts, Brian Bourbeau, Erin Crum","doi":"10.18553/jmcp.2025.31.6-a.s1","DOIUrl":"10.18553/jmcp.2025.31.6-a.s1","url":null,"abstract":"<p><p>Precision medicine in oncology using actionable molecular biomarkers to guide treatment selection has been associated with favorable outcomes; however, many potentially eligible patients do not receive it. This Academy of Managed Care Pharmacy Market Insights program sought to characterize unmet needs in biomarker testing among managed care stakeholders, to develop best practice and consensus recommendations to support addressing these needs, and to gain insights on potential quality measures related to biomarker testing. The program used a modified Delphi process and included in-depth interviews with expert panelists, a national survey of managed care professionals, and a consensus survey of experts. Areas of unmet need in biomarker testing identified were education, guidelines and protocols, timeliness, process, and equity. Twenty-two best practices were suggested by managed care experts and other stakeholders; 9 of these best practices achieved consensus. These consensus recommendations addressed biomarker test ordering and test performance, treatment decisions based on biomarker testing, cost-effectiveness of biomarker testing, and health disparities in access to biomarker testing. Opportunities for education and improvements in infrastructure to implement these recommendations were identified. Further investigation is needed to develop quality measures; although, valuable insights were gained.</p>","PeriodicalId":16170,"journal":{"name":"Journal of managed care & specialty pharmacy","volume":"31 6-a Suppl","pages":"S1-S14"},"PeriodicalIF":2.3,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12123195/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144182603","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":"Brand-to-brand nonmedical switching among interleukin-17 inhibitors or other biologics: Implications of a formulary change.","authors":"A Mark Fendrick, Manish Mittal, Yi Peng, Beverly Johns, Cynthia Holmes, Yifei Liu","doi":"10.18553/jmcp.2025.24317","DOIUrl":"10.18553/jmcp.2025.24317","url":null,"abstract":"<p><strong>Background: </strong>In 2021, a large pharmacy benefit management organization (PBM) changed preferred agents on its national formulary from one branded interleukin (IL)-17 inhibitor (TxA) to another (TxB), prompting a nonmedical switch (NMS) for patients using TxA.</p><p><strong>Objective: </strong>To evaluate the impact of this formulary change on treatment patterns among patients with psoriasis, psoriatic arthritis, or ankylosing spondylitis.</p><p><strong>Methods: </strong>Patients receiving TxA for at least 84 days and no other biologic from July 2020 to December 2020 were identified using PBM-specific data from the Symphony Health Analytics database. Two comparator groups were established: patients affected (PBM-1) and not affected (PBM-2) by the formulary change. Outcomes were (1) changes in monthly fills of TxA/TxB (July 2020 to June 2021; PBM-1 group only), (2) proportion of TxA-treated patients experiencing any medication discontinuation or switching (PBM-1 and PBM-2 groups), and (3) medication-taking behaviors (adherence, discontinuation, switching) among patients continuing TxA vs those that NMS to TxB (PBM-1 group only).</p><p><strong>Results: </strong>Demographics were similar for patients in PBM-1 (N = 1,703) and PBM-2 (N = 462). After the formulary change (January 2021 to June 2021), TxA prescription fills decreased 7% while TxB fills increased 8% in the PBM-1 group. Compared with patients not affected by the formulary change (PBM-2 group), significantly more patients in the PBM-1 group completely discontinued treatment (27% vs 14%). The PBM-1 vs PBM-2 group had significantly higher (<i>P</i> < 0.001) rates of switching to TxB (19% vs 1%) or another biologic (8% vs 2%). Following NMS from TxA to TxB, patients in the PBM-1 group had significantly (<i>P</i> < 0.05) lower adherence rates (46% vs 63%) and higher rates of subsequent switching (14% vs 6%) or absolute discontinuation (20% vs 14%) than those continuing TxA.</p><p><strong>Conclusions: </strong>Following the formulary change, more than 25% of patients exposed to the change experienced treatment discontinuation, nearly double the rate than those not exposed. This unfavorable finding, along with higher rates of nonadherence and subsequent switching, warrants careful monitoring of similar policy changes.</p>","PeriodicalId":16170,"journal":{"name":"Journal of managed care & specialty pharmacy","volume":" ","pages":"544-551"},"PeriodicalIF":2.3,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12123194/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144013854","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 familiarity with US biosimilar regulatory guidelines and interchangeability state laws among pharmacists and physicians treating immunological disorders.","authors":"You-Li Ling, Danielle Gentile, Angele Kotomale, Jason A Sharpe, Danielle Geli, David Gruben, Courtney Omary, Courtney Brackin, Mark Bailey","doi":"10.18553/jmcp.2025.31.6.552","DOIUrl":"10.18553/jmcp.2025.31.6.552","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;The US Food and Drug Administration (FDA) considers an interchangeable biosimilar to produce the same clinical result as the reference product in any given patient. Interchangeability standards indicate that the biosimilar can be automatically substituted by pharmacists for the reference product without the intervention of the prescribing health care provider, where state law permits. More research is needed to describe pharmacists' and physicians' perceptions and experience with biosimilars in real-world settings for immunological disorders.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To assess US providers' perceptions and decision-making around the prescribing and dispensing of biosimilars, including those with an interchangeability designation.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;US outpatient pharmacists and physicians who prescribe biologics for dermatological, gastroenterological, rheumatological, or other immunological disorders responded to a cross-sectional electronic survey. Respondents reported data on professional characteristics, pharmacy characteristics, familiarity with regulatory guidelines, workflow relevant to treatment substitutions, and perceived barriers to navigating the interchangeability designation and dispensing interchangeable biosimilars. Data were aggregated and summarized descriptively.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;One hundred fifty physicians and 99 pharmacists (total n = 249) from diverse practice settings responded to the survey. Continuing education units related to biosimilars were obtained by 65.7% of pharmacists and 50.7% of physicians. A higher percentage of pharmacists (35.4%) than physicians (20.0%) reported themselves as \"extremely familiar\" with pharmacy retention of communication records. A greater proportion of pharmacists (47.5%) than physicians (31.3%) were \"extremely likely\" to recommend a biosimilar product to new start patients (ie, never treated with a reference biologic and/or biosimilar). Among all providers, the barriers to biosimilars most often perceived to be \"extremely significant\" were payer coverage/formulary placement (51.0%) and cost to the patient (41.0%). The strategies that were reported as the highest likelihood of improving the uptake of interchangeable biosimilars (reported as either \"likely\" or -\"extremely likely\") were as follows: conducting studies and developing educational programs that assess outcomes of biosimilars and biosimilars with an interchangeability designation in clinical practice (82.3%), FDA guidance on biosimilars with an interchangeability designation for treatment-naive patients (81.9%), FDA guidance on biosimilars with an interchangeability designation for switching patients (81.6%), and educational programs on billing and reimbursement (79.1%).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Pharmacists reported higher rates of familiarity and training with biosimilars and recommendation of biosimilars to patients than physicians. A diverse sample ","PeriodicalId":16170,"journal":{"name":"Journal of managed care & specialty pharmacy","volume":"31 6","pages":"552-564"},"PeriodicalIF":2.3,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12123193/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144179919","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":"Reductions in medical visits and hospitalizations following berotralstat initiation in patients with hereditary angioedema in the United States.","authors":"Sandra C Christiansen, Lorena Lopez-Gonzalez, Sean D MacKnight, François Laliberté, Colleen Spencer, Julien Boudreau, Sandra Nestler-Parr, Douglas T Johnston, Patrick Gillard, Bruce L Zuraw","doi":"10.18553/jmcp.2025.31.6.578","DOIUrl":"10.18553/jmcp.2025.31.6.578","url":null,"abstract":"<p><strong>Background: </strong>Hereditary angioedema (HAE) is a rare disease characterized by unpredictable recurrent, debilitating, and potentially fatal attacks of subcutaneous and submucosal tissue swelling.</p><p><strong>Objective: </strong>To evaluate all-cause, angioedema-related, and HAE attack-related medical visits and hospitalizations before and after initiation of berotralstat long-term prophylaxis (LTP) for patients with HAE in the United States.</p><p><strong>Methods: </strong>This retrospective pre-post analysis used Komodo's Healthcare Map claims data to identify patients who initiated berotralstat (December 2020 to December 2022). The first entry for berotralstat dispensing was defined as the index date. Inclusion criteria comprised patients aged at least 12 years at index with at least 6 months of continuous insurance eligibility pre-index and evidence consistent with HAE pre-index (<i>International Classification of Diseases, Tenth Revision, Clinical Modification</i> diagnosis codes D84.1, D68.2, or T78.3x; medication use [on-demand or LTP]; or presence of diagnostic HAE laboratory tests). Rates of all-cause, angioedema-related, and HAE attack-related medical visits per person-year were compared post-index vs pre-index using rate ratios with 95% CIs and <i>P</i> values from generalized estimating equation Poisson regression models with robust SEs. Study limitations included the inability to distinguish HAE types and the uncertainty of whether a dispensed medication was consumed or taken as prescribed.</p><p><strong>Results: </strong>The study population included 260 patients treated with berotralstat (mean age = 39.7 years; 74.2% female). After berotralstat initiation, there were significant decreases in the rates of all-cause health care resource utilization (HRU): all-cause inpatient (IP) visits decreased by 34% (<i>P</i> = 0.037) and all-cause outpatient/emergency department (OP/ED) visits decreased by 14% (<i>P</i> = 0.005). There were also significant decreases in rates of angioedema-related HRU (IP visits: 52%, <i>P</i> = 0.001; OP/ED visits: 44%, <i>P</i> < 0.001) as well as HAE attack-related HRU (IP visits: 60%, <i>P</i> < 0.001; OP/ED visits: 50%, <i>P</i> < 0.001). Use of on-demand medications decreased significantly after berotralstat initiation (32%, <i>P</i> = 0.002). Results were similar among subgroups of patients defined by HAE treatment history, including patients who were LTP-experienced (n = 126) and LTP-naive but on-demand treatment-experienced (n = 67).</p><p><strong>Conclusions: </strong>Prophylactic treatment of HAE with berotralstat was associated with significant reductions in all-cause HRU, including decreases to angioedema-related and HAE attack-related medical visits, hospitalizations, and administration of on-demand treatment.</p>","PeriodicalId":16170,"journal":{"name":"Journal of managed care & specialty pharmacy","volume":"31 6","pages":"578-589"},"PeriodicalIF":2.3,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12123198/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144182380","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of pharmacist-physician collaborative care on hemoglobin A1c and blood pressure quality measure achievement in primary care.","authors":"Tyler D Wagner, Dave L Dixon, Yongyun Shin, Mikhail Dozmorov, Kerri T Musselman, Tonya M Buffington, Haroon Hyder, Bryan Kirschner, Resa M Jones, Teresa M Salgado","doi":"10.18553/jmcp.2025.31.6.565","DOIUrl":"10.18553/jmcp.2025.31.6.565","url":null,"abstract":"<p><strong>Background: </strong>Multidisciplinary primary care models incorporating pharmacists have emerged to improve glycemic control in patients with uncontrolled type 2 diabetes mellitus (T2DM). Healthcare Effectiveness Data and Information Set (HEDIS) measures establish quality benchmarks for comprehensive diabetes care and guide reimbursement. Large-scale research on the effect of pharmacist interventions to improve these quality measures in primary care remains limited.</p><p><strong>Objective: </strong>To evaluate the effectiveness of a pharmacist-physician collaborative care (PPCC) model on comprehensive diabetes care quality measure achievement compared with standard care (SC).</p><p><strong>Methods: </strong>This retrospective cohort study included adults aged 18 to 75 years with uncontrolled T2DM receiving care in primary care clinics at a community-based health system in Virginia from July 1, 2018, to December 31, 2019. Patients were in one of 2 groups: (1) the intervention group (PPCC), where embedded pharmacists provided diabetes management under a collaborative practice agreement, and (2) the comparator group receiving SC in clinics without pharmacists. The SC group was created via 1:2 propensity score matching. Generalized linear mixed models assessed the association between group and quality measure achievement. Primary outcomes included glycated hemoglobin (hemoglobin A1c) (≤9%, ≤8%, ≤7%) and blood pressure control (<140/90 mm Hg), per the last recorded value in 2019.</p><p><strong>Results: </strong>The sample (N = 1,293) had a mean age of 57 years, was 56% female, and 45% each White and Black. The PPCC group (n = 431) was more likely to achieve A1c control compared with the SC group (n = 862) (A1c <9%: odds ratio [OR] = 3.68, 95% CI = 2.31-5.84; A1c <8%: OR = 3.53, 95% CI = 2.12-5.89; A1c <7%: OR = 4.61, 95% CI = 2.48-8.56; all <i>P</i> < 0.01). Similarly, the PPCC group was more likely to achieve blood pressure control less than 140/90 mm Hg (OR = 1.49, 95% CI = 1.01-2.22; <i>P</i> = 0.04).</p><p><strong>Conclusions: </strong>Patients in the PPCC group were more likely to meet comprehensive diabetes care quality measures compared with SC. These results underscore the value of pharmacists in diabetes management in primary care and their contribution to value-based care.</p>","PeriodicalId":16170,"journal":{"name":"Journal of managed care & specialty pharmacy","volume":"31 6","pages":"565-577"},"PeriodicalIF":2.3,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12123200/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144181181","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}