Journal of managed care & specialty pharmacy最新文献

{"title":"Incremental health care resource utilization, costs, and predictors of high costs in generalized myasthenia gravis.","authors":"Kavita Grover, Kavita Gandhi, Porpong Boonmak, Martin Cloutier, Geoffroy Coteur, Maryia Zhdanava, Anabelle Tardif-Samson, Antoine C El Khoury, Yuxi Wang, Zia Choudhry, Nicholas J Silvestri","doi":"10.18553/jmcp.2026.32.7.820","DOIUrl":"10.18553/jmcp.2026.32.7.820","url":null,"abstract":"<p><strong>Background: </strong>The management of patients with generalized myasthenia gravis (gMG) is complex and often involves substantial health care expenses. As the treatment paradigm continues to evolve, understanding the economic burden of gMG must also reflect the availability and increasing use of newly approved and advanced therapies in a diverse patient population.</p><p><strong>Objective: </strong>To estimate incremental health care resource utilization (HRU) and costs associated with gMG compared with non-MG controls and identify predictors of high health care costs in gMG in an insured US population cohort.</p><p><strong>Methods: </strong>Adults with newly diagnosed gMG were identified from Komodo Research data (January 1, 2017, to September 30, 2023). Characteristics of adults without MG were weighted using entropy balancing to match the gMG cohort. The index date was the first MG diagnosis by a neurologist for the gMG cohort and a random date for the non-MG cohort. Annual per patient HRU and health care costs were compared between the weighted cohorts. Predictors of high health care costs were evaluated among the gMG cohort using a logistic regression model.</p><p><strong>Results: </strong>After weighting, among 6,195 patients in the gMG cohort and 226,008 in the non-MG cohort, the mean age was 61.1 years, 49.1% were female, 53.4% were covered by commercial insurance, 41.0% were covered by Medicare Advantage, and 5.6% were covered by Medicaid. The gMG cohort (mean follow-up  =  32.7 months) compared with the non-MG cohort (mean follow-up = 31.3 months) had 2.4, 1.6, and 1.9 times more inpatient days, emergency department visits, and outpatient visits annually, respectively (all <i>P</i> < 0.001). Mean annual all-cause total health care costs in the gMG cohort were $43,872 higher than in the non-MG cohort ($58,341 vs $14,469; <i>P</i> < 0.001); 59.3% of the difference was driven by pharmacy costs (mostly immunoglobulin). Prediagnosis weakness and fatigue symptoms, exacerbation or crisis, and use of immunoglobulin were important factors significantly associated with high health care costs in the gMG cohort (all <i>P</i> < 0.001).</p><p><strong>Conclusions: </strong>Despite advances in treatment, the economic burden of gMG remains substantial. Association of high health care costs with early symptoms and disease exacerbations underscores the need for more effective intervention strategies to improve disease control and reduce HRU and costs in patients with gMG.</p>","PeriodicalId":16170,"journal":{"name":"Journal of managed care & specialty pharmacy","volume":"32 7","pages":"820-831"},"PeriodicalIF":3.3,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13293495/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148317488","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":"US commercial health plan use of corticosteroids in step therapy protocols: Frequency and clinical appropriateness.","authors":"Yichen Lin, Lu Shi, Molly Beinfeld, Renee Campbell, James Chambers","doi":"10.18553/jmcp.2026.32.7.773","DOIUrl":"10.18553/jmcp.2026.32.7.773","url":null,"abstract":"<p><strong>Background: </strong>Commercial health plans may include corticosteroids in step therapy protocols for specialty drugs as part of use management. However, alignment with regulatory and clinical guidance is not well characterized.</p><p><strong>Objective: </strong>To assess how corticosteroids are incorporated into plan-imposed step therapy protocols and evaluate alignment with US Food and Drug Administration (FDA) labeling, clinical guidelines, and pivotal trials.</p><p><strong>Methods: </strong>We analyzed coverage policies from 18 large US commercial health plans in the Tufts Medical Center Specialty Drug Evidence and Coverage Database, reflecting policies active as of August 2024. We identified drug-indication pairs for which at least 1 plan included corticosteroids in step therapy. For each drug-indication pair, we reviewed FDA labeling to determine whether prior corticosteroid failure was consistent with FDA-recommended use. When corticosteroid use was not specified by FDA labels, we examined pivotal clinical trials and clinical guidelines to assess support for corticosteroid use in step therapy. We also examined how health plans operationalized corticosteroid use (eg, systemic vs local use, single vs multiple steps, etc).</p><p><strong>Results: </strong>We identified 201 specialty drug-indication pairs and 2,767 corresponding coverage policies for which at least 1 plan included corticosteroids in step therapy. Of these drug-indication pairs, 33 (16.4%) had an FDA label indication recommending prior corticosteroids use, whereas 168 (83.6%) did not. Among 2,210 coverage policies for the 168 pairs without FDA label-indicated prior corticosteroid use, 952 (43.1%) included corticosteroids in step therapy protocols. In 21% (200/952) of these policies, corticosteroid use was a mandatory step, whereas the remaining 79% (752/952) allowed patients to meet the requirement by failing alternative agents (eg, immunomodulators). In total, 63.8% (607/952) specified the use of corticosteroids to be systemic. Few protocols defined dosage requirements (7.9%, 75/952) or treatment failure criteria (3.8%, 36/952). Among policies in which FDA labeling did not specify prior corticosteroid use, plans were significantly more likely to include corticosteroids in step therapy when corticosteroid use was an eligibility criterion in pivotal clinical trials (<i>χ</i>² [1, N = 2,198] = 31.2; <i>P</i> < .001) or strongly recommended in clinical guidelines (<i>χ</i>² [1, N = 1,434] = 128.0; <i>P</i> < .001). Inclusion also varied across plans, ranging from 15% to 74% of policies without FDA label-indicated corticosteroid use.</p><p><strong>Conclusions: </strong>Commercial health plans frequently include corticosteroids in step therapy, including when not specified in FDA labeling. Substantial variation in implementation highlights opportunities to improve transparency and consistency.</p>","PeriodicalId":16170,"journal":{"name":"Journal of managed care & specialty pharmacy","volume":"32 7","pages":"773-781"},"PeriodicalIF":3.3,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13294546/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148317482","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":"Timing of health technology assessment in the United States: An evaluation of ICER reviews over 8 years.","authors":"Abigail C Wright, Avery McKenna, Belén Herce-Hagiwara, Foluso Agboola","doi":"10.18553/jmcp.2026.32.7.872","DOIUrl":"10.18553/jmcp.2026.32.7.872","url":null,"abstract":"<p><strong>Background: </strong>The Institute for Clinical and Economic Review (ICER) aims to publish health technology assessment (HTA) reports at or near the time of drug approval by the US Food and Drug Administration (FDA) to provide a timely, independent evaluation of the benefits, risks, and economic considerations surrounding a new therapy.</p><p><strong>Objective: </strong>To evaluate the timelines of ICER reports to inform pricing and coverage decisions, using FDA approval and list price announcement dates as a benchmark. With these data, we evaluated the availability of clinical evidence, specifically completion of pivotal trials and publication in peer-reviewed journals, at the time of ICER's review.</p><p><strong>Methods: </strong>We included drugs that were the primary intervention of interest in ICER reviews between 2017 and 2024. We extracted information on regulatory approval and list price announcements, and publication dates of ICER reports. We also extracted dates of publication of the pivotal trials that informed each ICER assessment to evaluate the time span between trial completion and publication.</p><p><strong>Results: </strong>Our analysis of 73 ICER drug assessments showed that, on average, the launch price is announced on the same day as FDA approval. The majority of the ICER draft, evidence, and final assessments were published on or before the FDA approval and price announcement date (82%, 61%, 55%, respectively). In terms of data availability, the median time from primary trial completion to peer-review publication was 15 months. There were an average of 2 pivotal trials per drug assessment. The majority (71%) of the pivotal trials informing ICER assessments were published in peer-reviewed journals before the completion of the ICER draft assessment, although these publications were, on average, published approximately 1 month prior to the completion of the assessments.</p><p><strong>Conclusions: </strong>The majority of ICER drug assessments are published before FDA approval and price announcements, making them available for early decision-making at the time of drug launch. However, data availability is still a major challenge in making HTA available immediately after approval. Prioritizing early sharing of clinical trial data would foster timely and robust HTA, ensure clinical decisions and coverage policies are well informed, and improve early patient access.</p>","PeriodicalId":16170,"journal":{"name":"Journal of managed care & specialty pharmacy","volume":"32 7","pages":"872-877"},"PeriodicalIF":3.3,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13293490/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148317517","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":"AMCP Market Insights: Managed care considerations in Barth syndrome.","authors":"Bridget Flavin, Hilary J Vernon, W Todd Cade, Zachary Contreras, Michael Kobernick, Farzana Rahman, Terry Richardson, Denise Wolff","doi":"10.18553/jmcp.2026.32.7-b.s1","DOIUrl":"10.18553/jmcp.2026.32.7-b.s1","url":null,"abstract":"<p><p>Barth syndrome is an ultrarare, complex, multisystem, X-linked metabolic and neuromuscular disease, which poses significant and wide-ranging burden to patients and caregivers. Pharmacologic management focuses on treatment of disease manifestations and prevention of secondary complications. Elamipretide, the first treatment indicated specifically for improving muscle strength in Barth syndrome, was approved in 2025 via accelerated approval warranting guidance for payers. To discuss managed care considerations in Barth syndrome including management of elamipretide, AMCP Market Insights virtually convened an expert panel of managed care stakeholders in March 2026. This article provides a qualitative summary of the panel discussion along with key insights and suggested payer practices meant to support informed coverage decisions and guide future work such as collaboration, research, and advocacy. Key insights highlight that there are unique challenges in generating clinical trial evidence for treatments in ultrarare conditions, which leads to difficulties determining the value of these treatments and differences in whether they are covered among payers. Additionally, there are numerous elements of care to which patients with Barth syndrome and their caregivers need equitable access, which is complicated by involving multiple specialists and fragmentation. Suggested payer practices involve education, care delivery, and coverage and benefit design.</p>","PeriodicalId":16170,"journal":{"name":"Journal of managed care & specialty pharmacy","volume":"32 7-b Suppl","pages":"S1-S10"},"PeriodicalIF":3.3,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13307510/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148338972","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 patterns, resource use, and costs in human epidermal growth factor receptor 2-negative advanced gastric/gastroesophageal junction cancer in the United States in the immune checkpoint inhibitor era.","authors":"Ziyan Chen, Wei Song, Jenna Abdelhadi, Hongbo Yang, Adina Zhang, Jennifer Wang, Grace Chen, Akeem Yusuf, Istvan Majer","doi":"10.18553/jmcp.2026.32.7.807","DOIUrl":"10.18553/jmcp.2026.32.7.807","url":null,"abstract":"<p><strong>Background: </strong>Since 2021, new therapies including immune checkpoint inhibitors (ICIs) have been approved in the United States for human epidermal growth factor receptor 2 (HER2)-negative advanced gastric or gastroesophageal junction cancer (G/GEJC) in biomarker-selected populations. However, recent data on treatment patterns, health care resource utilization (HCRU), and costs remain limited.</p><p><strong>Objective: </strong>To describe real-world patient characteristics, treatment patterns, HCRU, and costs among patients with HER2-negative advanced G/GEJC in the Medicare and MarketScan databases.</p><p><strong>Methods: </strong>Two retrospective observational cohort studies were conducted using the 100% Medicare Fee-for-Service database and the Merative MarketScan Commercial and Medicare Databases. Patients with advanced G/GEJC initiating first-line (1L) non-HER2-targeted systemic anticancer therapy from 2021 to 2024, continuously enrolled for at least 6 months before and at least 1 month after the 1L initiation (index date), were identified. Primary outcomes including treatment patterns, HCRU, and costs were assessed from the index to death, disenrollment, or study end, whichever occurred first. Real-world overall survival (rwOS) was assessed as a secondary outcome in the Medicare database.</p><p><strong>Results: </strong>We identified 2,029 and 419 patients in the Medicare and MarketScan databases, respectively. Across both databases, chemotherapy was the most common 1L regimen (approximately 50%), followed by nivolumab-containing regimens (34.7% in Medicare; 44.2% in MarketScan) and pembrolizumab-containing regimens (9.9% and 5.3%, respectively). In both databases, 38.2% of patients received second-line (2L) therapy and 11.7% received third-line (3L) therapy. Nivolumab-containing regimens were the most common 2L treatment (36.3% in Medicare; 41.3% in MarketScan), whereas ramucirumab-containing regimens were most common in 3L (36.7% and 34.0%, respectively). Outpatient visits accounted for the majority of HCRU across lines of therapy, with mean visits per patient per month (PPPM) of 3.7, 3.8, and 3.6 in Medicare and 7.7, 6.5, and 6.6 in MarketScan for 1L, 2L, and 3L, respectively. Mean total all-cause health care costs increased with line of therapy and were higher in MarketScan than Medicare: $17,191, $19,572, and $19,373 PPPM in Medicare and $47,092, $62,358, and $73,192 PPPM in MarketScan for 1L, 2L, and 3L, respectively. Outpatient costs accounted for more than half of total health care costs in both databases. Among Medicare patients, median 1L rwOS was 10.9 months.</p><p><strong>Conclusions: </strong>Analyses of recent data from the Medicare and MarketScan databases showed that most treated patients with HER2-negative advanced G/GEJC received standard chemotherapy in the 1L setting. Treatment of advanced G/GEJC remains associated with poor rwOS and high economic burden, suggesting significant remaining unmet need.</p>","PeriodicalId":16170,"journal":{"name":"Journal of managed care & specialty pharmacy","volume":"32 7","pages":"807-819"},"PeriodicalIF":3.3,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13294547/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148317557","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":"Findings from the 2025 AMCP Foundation Symposium: Health Optimization 2.0.","authors":"Bridget Flavin, Steve Kheloussi","doi":"10.18553/jmcp.2026.32.7-a.s1","DOIUrl":"10.18553/jmcp.2026.32.7-a.s1","url":null,"abstract":"<p><p>The 2025 AMCP Foundation Symposium: Health Optimization 2.0 convened a select group of just over 70 managed care stakeholders in Dallas, Texas, on December 2-3, 2025. Via presentations and panel sessions, participants examined how precision medicine, data analytics, evolving policy, and health system design can address inequities in care delivery. Focus areas included precision medicine in oncology, vaccine hesitancy, use of data and artificial intelligence, and multiple sclerosis. Following group sessions, participants were divided into work groups and asked to highlight 1 key problem-solution pair for each of 2 assigned focus areas. This article presents a summary of the discussion for key problem-solution pairs in each of the 4 focus areas. The problem-solution pairs identified for vaccine hesitancy all related to delivering positive, community-driven messaging to rebuild eroded public trust. The other focus areas had multiple problems and solutions, which implies that driving meaningful change in these areas may be more complex.</p>","PeriodicalId":16170,"journal":{"name":"Journal of managed care & specialty pharmacy","volume":"32 7-a Suppl","pages":"S1-S10"},"PeriodicalIF":3.3,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13307509/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148338916","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 switching and switch-back patterns among patients transitioning from adalimumab to biosimilars in the United States (February 2023 to August 2025).","authors":"Karen Gilbert Farrar, Nina B Masters, Duy Do, Nicholas Stucky, Brianna M Goodwin Cartwright","doi":"10.18553/jmcp.2026.32.7.856","DOIUrl":"10.18553/jmcp.2026.32.7.856","url":null,"abstract":"<p><strong>Background: </strong>Adalimumab is a widely used biologic for autoimmune diseases. Biosimilars to adalimumab became available in 2023 and were expected to improve affordability and access, yet real-world evidence on switching after biosimilar initiation remains limited.</p><p><strong>Objective: </strong>To assess adoption of adalimumab biosimilars and characterize the frequency and timing of switch-backs to originator adalimumab.</p><p><strong>Methods: </strong>This retrospective cohort study used Truveta Data, a deidentified electronic health record dataset. Adult patients were included if they had at least 1 outpatient or telehealth encounter between February 1, 2023, and August 31, 2025, and at least 2 originator adalimumab dispenses in the prior year. Switching was defined as the first biosimilar dispense following originator use, and switch-back was defined as a subsequent originator dispense after biosimilar initiation. Multivariable logistic regression identified characteristics associated with switch-back, and a Cox proportional hazards model evaluated factors associated with earlier switch-back (≤30 days).</p><p><strong>Results: </strong>Among 67,594 patients treated with originator adalimumab, 17.7% (n = 11,947) switched to a biosimilar during the study period. Switching peaked in April 2024, coinciding with formulary changes. Among 9,252 biosimilar initiators, with at least 1 clinical encounter at least 90 days after a biosimilar dispense, 16.0% (n = 1,478) switched back to the originator. Older adults (≥65 years and 50-64 years) had higher odds of switching back (odds ratio [OR] = 2.05 [95% CI = 1.64-2.56] and OR = 1.23 [95% CI = 1.03-1.46], respectively), as did women (OR = 1.19; 95% CI = 1.05-1.34) and patients with ankylosing spondylitis (OR = 1.32; 95% CI = 1.10-1.58). Rural residence was associated with higher odds of early switch-back (OR = 1.80; 95% CI = 1.20-2.70).</p><p><strong>Conclusions: </strong>Biosimilar uptake increased following formulary changes, yet more than 1 in 7 biosimilar initiators returned to originator adalimumab. Variation in early switch-back and patient characteristics highlights the importance of real-world evidence to understand biosimilar adoption beyond formulary-driven transitions.</p>","PeriodicalId":16170,"journal":{"name":"Journal of managed care & specialty pharmacy","volume":"32 7","pages":"856-863"},"PeriodicalIF":3.3,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13293494/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148317512","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The effectiveness and value of B-cell-directed therapies for the treatment of immunoglobulin A nephropathy.","authors":"Avery McKenna, Jason H Wasfy, R Brett McQueen, Sophia Cassim, Michael J DiStefano, Antal Zemplenyi, Woojung Lee, Marie Phillips, Deepika Paratane, David M Rind, Foluso Agboola","doi":"10.18553/jmcp.2026.32.7.878","DOIUrl":"10.18553/jmcp.2026.32.7.878","url":null,"abstract":"","PeriodicalId":16170,"journal":{"name":"Journal of managed care & specialty pharmacy","volume":"32 7","pages":"878-884"},"PeriodicalIF":3.3,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13293492/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148317484","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 use of semaglutide for obesity treatment: A cohort study in an integrated health care delivery system.","authors":"Angela Baalmann, Jakub Michel, Sean N Avedissian, Alex Pow, Karen Farris","doi":"10.18553/jmcp.2026.32.6.660","DOIUrl":"10.18553/jmcp.2026.32.6.660","url":null,"abstract":"<p><strong>Background: </strong>Novel antiobesity medications have demonstrated significant weight loss in clinical trials. Data on real-world use of semaglutide are lacking. Such data are vital to inform health benefit design of this and other costly incretin mimetics, as well as inform patients of expected outcomes outside of clinical trials.</p><p><strong>Objective: </strong>To evaluate real-world persistence and adherence to semaglutide for obesity treatment and impacts on weight loss.</p><p><strong>Methods: </strong>The primary outcome was persistence to therapy. Secondary outcomes were adherence to therapy and its approved dosing schedule. Weight loss observations for all outcomes were also analyzed. This retrospective, cohort, observational study evaluated prescription and clinical data from a single health system between 2021 and 2024. The index date was defined as the first semaglutide claim filled for weight loss, and all refill data were obtained up to 12 months following. Electronic medical record data were collected at 6 and 12 months. Persistence was defined as the absence of any therapy gap exceeding 60 days within 12 months. Adherence was defined as proportion of days covered greater than or equal to 80%. Weight loss was calculated as percent change from baseline, defined as the collected weight closest to the index date. Multivariable logistic regression was used to identify factors independently associated with persistence and adherence at 12 months.</p><p><strong>Results: </strong>A total of 393 patients were included. Throughout the 12-month follow-up period, 44% (172) of patients remained persistent and lost a mean of 13.8% of their baseline weight, compared with 6.4% for nonpersistent patients. At 12 months, 44% (175) patients were adherent and experienced 13% weight loss. For those closely following the approved titration schedule, a 12.5% average weight loss at month 12 was observed, almost double that of patients using other titration patterns (7.2% average weight loss at month 12). In multivariable logistic regression analyses, compared with male sex, female sex was associated with lower odds of persistence (odds ratio = 0.32; 95% CI = 0.14-0.75) and adherence (odds ratio = 0.33; 95% CI = 0.14-0.77), whereas race, ethnicity, and comorbidities were not statistically significantly associated with persistence or adherence.</p><p><strong>Conclusions: </strong>Less than 45% of patients were persistent or adherent to semaglutide for weight loss during the initial 12 months of use. The results of this study suggest that adding support measures and/or altering coverage criteria based on persistence or adherence patterns may be reasonable to consider. Efforts to promote persistence and adherence during the first year of treatment, as well as proper implementation of titration schedules, may lead to improved weight loss in patients using semaglutide.</p>","PeriodicalId":16170,"journal":{"name":"Journal of managed care & specialty pharmacy","volume":"32 6","pages":"660-669"},"PeriodicalIF":3.3,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13193313/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147987973","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 burden of heart failure in the United States: Medical costs and health-related quality of life.","authors":"Maria Alva, Sarahfaye Dolman, Slaven Sikirica, Paul Kolm, Katherine Andrade, Zugui Zhang, William S Weintraub","doi":"10.18553/jmcp.2026.32.6.670","DOIUrl":"10.18553/jmcp.2026.32.6.670","url":null,"abstract":"<p><strong>Background: </strong>Heart failure (HF) is a leading cause of morbidity, mortality, and health care utilization in the United States. Its burden is expected to increase with population aging and the growing prevalence of diabetes, yet comprehensive estimates of health care costs and health-related quality of life (HRQoL) stratified by age and diabetes status-2 key drivers of HF risk and resource use-remain limited.</p><p><strong>Objective: </strong>To quantify the economic burden and HRQoL impact of HF in the United States, stratified by age and diabetes status.</p><p><strong>Methods: </strong>Using a micro-level, bottom-up prevalence-based approach from a payer perspective, we analyzed health care costs from the Optum Research Database. HF prevalence and HRQoL via EuroQol 5-Dimensions and Healthy Days instruments were estimated using the National Health and Nutrition Examination Survey.</p><p><strong>Results: </strong>The average annual direct health care cost per patient with HF was approximately $31,464 at baseline, rising to $45,893 in the first year after diagnosis before stabilizing around $37,500 annually. Inpatient and emergency care accounted for the largest cost share. Extrapolating at the national level, expenditures exceeded $227 billion at baseline and peaked at $332 billion in the year following an HF hospitalization. Individuals without diabetes had the highest quality-adjusted life-years (QALYs) and lowest costs, whereas patients with type 1 diabetes had the lowest QALYs and highest costs. Patients with type 2 diabetes represented the largest subgroup with intermediate QALYs but substantial costs.</p><p><strong>Conclusions: </strong>HF imposes a significant, sustained economic and quality-of-life burden, highlighting the need for targeted management strategies, especially for older adults and those with diabetes.</p>","PeriodicalId":16170,"journal":{"name":"Journal of managed care & specialty pharmacy","volume":"32 6","pages":"670-678"},"PeriodicalIF":3.3,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13193315/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147987900","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}