Journal of managed care & specialty pharmacy最新文献

{"title":"The consequences of pharmaceutical tariffs in the United States.","authors":"Sean D Sullivan, Jens Grueger, Aidan P Sullivan, Scott D Ramsey","doi":"10.18553/jmcp.2025.25090","DOIUrl":"10.18553/jmcp.2025.25090","url":null,"abstract":"<p><p>The Trump Administration has threatened to impose tariffs on imported branded, generic, and biosimilar pharmaceutical products. Although specific details regarding the exact rates and implementation timeline remain unclear, the administration has indicated that these tariffs will be substantial. Tariffs can create supply chain disruptions, increase costs, limit patient access to essential medications, and negatively impact research and innovation. Rather than punitive tariffs, industrial policy options and collaborative international treaties may better serve US economic and public health interests and lead to a more secure and consistent domestic supply of critical medicines.</p>","PeriodicalId":16170,"journal":{"name":"Journal of managed care & specialty pharmacy","volume":" ","pages":"533-536"},"PeriodicalIF":2.3,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12123191/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144008541","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":"Examining the relationship between adherence and the number of cardiometabolic medications: Findings for patients with type 2 diabetes within a Tribal health care system.","authors":"Tarah Nelson, Chasity Pierre, Yingwei Yao, Richard Segal, Marilyn E Aguila, Anatolia B Legaspi, Ashley DeVaughan Circles, William T Donahoo, R Turner Goins, Diana J Wilkie, Lisa Scarton","doi":"10.18553/jmcp.2025.31.6.590","DOIUrl":"10.18553/jmcp.2025.31.6.590","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;The literature is inconclusive regarding the association between adherence and the number of concurrent prescribed medications. Among patients with type 2 diabetes (T2D), low medication adherence is linked with inadequate glycemic management and increased diabetes-related complications. Adherence to glucose-lowering, lipid-lowering, and antihypertensive medications may be impacted by the number of cardiometabolic medications taken by adults with T2D, including American Indian adults.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To examine the association between medication adherence and the number of cardiometabolic medications among American Indian adults with T2D using Tribal health services, a health care system where all medical care and medications are provided free of charge.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We used 2019 medication dispensing data and patient data from the electronic health records of the Choctaw Nation Health Services Authority. Our sample included 6,774 American Indian adults aged 20 years and older, previously diagnosed with T2D, who received at least 1 cardiometabolic medication from a Choctaw Nation Health Services Authority pharmacy. We measured medication adherence as the proportion of days covered (PDC; possible range 0-1). Analysis of variance and chi-square tests were used to examine the association between the number of medications and patient characteristics. Multiple linear regression was used to estimate the association of adherence with patient characteristics.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The sample mean age was 58.4 (SD = 13.2) years; 63.4% were aged 55 years or older; 47.8% were male; 49.6% were single; 36.9% had comorbidities. 30.9% were prescribed 2 or fewer medications, 43.1% were prescribed greater than 2 to 4 medications, and 26.0% were prescribed more than 4 medications. 71.7% had noninsulin glucose-lowering medications, 68% had lipid-lowering medication, and 90% had antihypertensive medications. Overall, 60.6% of the sample were adherent (PDC ≥ 0.80), including 49% of those with 2 or fewer medications, 62% of those with greater than 2 to 4 medications, and 72% with more than 4 medications. In a multiple regression model, adherence was positively associated with the number of medications (b = 0.026, &lt;i&gt;P&lt;/i&gt; &lt; 0.001), age 55 years or older (b = 0.062, &lt;i&gt;P&lt;/i&gt; &lt; 0.001), male sex (b = 0.009, &lt;i&gt;P&lt;/i&gt; = 0.046), and presence of comorbidities (b = 0.033, &lt;i&gt;P&lt;/i&gt; &lt; 0.001) but negatively associated with being single (b = -0.034, &lt;i&gt;P&lt;/i&gt; &lt; 0.001) and insulin usage (b = -0.019, &lt;i&gt;P&lt;/i&gt; &lt; 0.001).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;To our knowledge, this is the first study demonstrating the association between a higher number of cardiometabolic medications and better adherence in American Indian adults diagnosed with T2D whose medications were provided without cost to the patients. Medication cost is a well-known medication adherence barrier. Future studies should further examine fac","PeriodicalId":16170,"journal":{"name":"Journal of managed care & specialty pharmacy","volume":"31 6","pages":"590-597"},"PeriodicalIF":2.9,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12123192/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144182588","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":"Pediatric-onset rare disease therapy pipeline yields hope for some and gaps for many: 10-year projection of approvals, treated patients, and list price revenues.","authors":"Colin M Young, Sharon E Phares, Annie Kennedy, Jamie Sullivan, Baillie McGowan, Mark R Trusheim","doi":"10.18553/jmcp.2025.31.5.491","DOIUrl":"https://doi.org/10.18553/jmcp.2025.31.5.491","url":null,"abstract":"<p><strong>Background: </strong>More than 10,000 rare diseases affect more than 30 million Americans, nearly 70% of which manifest in childhood. The drug development pipeline boasts hundreds of candidates for pediatric-onset rare disease, but little is known about the impact of potential approvals.</p><p><strong>Objective: </strong>To quantify US projected product approvals, patients treated, and product revenues for pediatric-onset rare disease treatments through 2033.</p><p><strong>Methods: </strong>Four-stage model consisting of a Markov Chain Monte Carlo simulation of US Food and Drug Administration approvals, calculation of eligible patients per clinical trial criteria, and projection of adoption and list price revenues, all using publicly available data.</p><p><strong>Results: </strong>By 2033 the pipeline will yield approximately 45 new product approvals, a 14% growth in annual treated patients, and an incremental $10.7B in list price drug revenues ($28.2B: 2023; $38.9B: 2033) prior to any health care cost offsets, caregiving impacts, long-term social benefits, or other benefits from treating the additional patients.</p><p><strong>Conclusions: </strong>The projected approvals over the next decade will undoubtedly be transformational for the patient communities impacted, many of whom have no currently approved treatments. However, the number of newly identified rare diseases is likely to outpace the rate of new therapies to treat them. Resources are needed to accelerate progress as 95% of pediatric-onset rare diseases are projected to still have no approved treatments in the next decade, and even for the 5% that have some options, more is needed.</p>","PeriodicalId":16170,"journal":{"name":"Journal of managed care & specialty pharmacy","volume":"31 5","pages":"491-498"},"PeriodicalIF":2.3,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12039501/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144017162","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 influence of medication adherence on Medicare Star Ratings: A decade-long analysis of health plan performance.","authors":"Eric P Borrelli, Peter Saad, Nathan Barnes, Julia D Lucaci","doi":"10.18553/jmcp.2025.31.5.512","DOIUrl":"https://doi.org/10.18553/jmcp.2025.31.5.512","url":null,"abstract":"<p><strong>Background: </strong>The Medicare Star Ratings Program, managed by the Centers for Medicare & Medicaid Services, assesses Medicare health plan performance. This program consists of quality measures that evaluate plan performance for both Medicare Part C and Part D, including 3 key medication adherence measures.</p><p><strong>Objective: </strong>To assess the potential relationship between performance on medication adherence measures and overall star rating performance for Medicare Advantage (MA) health plans.</p><p><strong>Methods: </strong>An analysis was conducted using annual Medicare Star Rating health plan performance data from 2015 to 2024 to assess the impact of performance on medication adherence measures on health plan overall star rating. Numerical percentages were calculated to assess the rates of a health plan achieving at least a 4-star overall rating if they achieved 4 or more stars, as well as a 5-star rating on each medication adherence measure or composite measure.</p><p><strong>Results: </strong>From 2015 to 2024, 4,213 health plan contracts received a star rating, of which 2,076 achieved at least a 4-star overall rating (49.3%). For plans achieving at least 4 stars on the medication adherence measures, 70%-74% of them also achieved at least a 4-star overall summary rating, depending on the specific measure. Among plans achieving 5 stars on any adherence measure, 85%-90% of them achieved at least a 4-star overall rating.</p><p><strong>Conclusions: </strong>Assessing a decade of the Medicare Star Rating performance data showed that MA health plans that performed well on the medication adherence measures also had a high rate of achieving a 4-star overall rating. Future research should explore the interplay between medication adherence measures and other Medicare Star Rating criteria.</p>","PeriodicalId":16170,"journal":{"name":"Journal of managed care & specialty pharmacy","volume":"31 5","pages":"512-519"},"PeriodicalIF":2.3,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12039503/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143986145","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cost-effectiveness analysis of targeted-release formulation of budesonide (Tarpeyo) in conjunction with optimized renin-angiotensin system inhibitor (RASi) therapy relative to optimized RASi therapy alone for adults with primary immunoglobulin A nephropathy in the United States.","authors":"Mohsen Yaghoubi, Heng Jiang, Roman Casciano, Christopher Ngai, Mit Patel","doi":"10.18553/jmcp.2025.31.5.499","DOIUrl":"https://doi.org/10.18553/jmcp.2025.31.5.499","url":null,"abstract":"<p><strong>Background: </strong>Immunoglobulin A nephropathy (IgAN) is a rare autoimmune disease that often leads to end-stage renal disease. The goal of treatment is to reduce disease progression so that patients are less likely to develop kidney failure in their natural lifetime. Recent clinical trial results show that Tarpeyo, a targeted-release formulation of budesonide designed to deliver the drug directly to gut-associated lymphoid tissue, reduces estimated glomerular filtration rate loss, potentially modifying the disease and thus prolonging the time to kidney failure.</p><p><strong>Objective: </strong>To assess the cost-effectiveness of Tarpeyo in conjunction with optimized renin-angiotensin system inhibitor (RASi) therapy relative to optimized RASi therapy alone in US adult patients with primary IgAN.</p><p><strong>Methods: </strong>A cost-utility approach is taken based on the full dataset from the phase 3 NefIgArd clinical trial. A semi-Markov model was developed with a lifetime horizon, encompassing both the US commercial payer and societal perspectives. The model architecture incorporated 9 health states, reflecting varying degrees of disease severity and mortality. Transition probabilities between health states were determined by a robust regression analysis of individual patient-level data obtained from the NefIgArd clinical trial and supplemented with data from literature. In the base-case analysis, treatment effect was assumed to be continuously maintained over the model time horizon (lifetime) and treatment was reapplied every 2 years. Treatment cost, adverse event management, dialysis, transplantation, mortality costs, and indirect costs were considered.</p><p><strong>Results: </strong>Tarpeyo + optimized RASi was found to be dominant compared with optimized RASi alone from the perspective of a US third-party commercial payer, ie, cost saving ($105 729) with concurrent quality-adjusted life-year (QALY) gains of 1.12. The base-case results show that Tarpeyo is dominant when retreatment occurs every 2 years, with the treatment benefit assumed to be maintained over the same period throughout the model. Sensitivity analyses confirmed the robustness of the base-case results, showing that Tarpeyo plus optimized RASi is cost saving if benefits are sustained for at least 3 years. The treatment demonstrated high probabilities of cost-effectiveness at willingness-to-pay thresholds of less than $100K and less than $150K per QALY.</p><p><strong>Conclusions: </strong>Clinical trials suggest that adding Tarpeyo to optimized RASi can help preserve kidney function by reducing estimated glomerular filtration rate loss in patients with IgAN. This addition was estimated to produce a greater QALY gain and reduced overall net costs from the payer and societal perspective in the United States.</p>","PeriodicalId":16170,"journal":{"name":"Journal of managed care & specialty pharmacy","volume":"31 5","pages":"499-509"},"PeriodicalIF":2.3,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12041922/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143995933","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":"Tirzepatide vs semaglutide and liraglutide for weight loss in patients with overweight or obesity without diabetes: A short-term cost-effectiveness analysis in the United States.","authors":"Ligang Liu, Jiayu Cui, Marjorie V Neidecker, Milap C Nahata","doi":"10.18553/jmcp.2025.31.5.441","DOIUrl":"https://doi.org/10.18553/jmcp.2025.31.5.441","url":null,"abstract":"<p><strong>Background: </strong>Glucagon-like peptide-1 receptor agonists and their analogues have emerged as effective pharmacotherapies for obesity.</p><p><strong>Objective: </strong>To assess the short-term cost-effectiveness of subcutaneous tirzepatide, semaglutide, liraglutide, and oral semaglutide for managing obesity or overweight in patients without diabetes.</p><p><strong>Methods: </strong>A decision tree model was developed using a 68-week time window with consideration of serious adverse events and treatment discontinuation from a US payer's perspective. The study population were adults with obesity or overweight with at least 1 weight-related comorbidity but without diabetes. Clinical data were obtained from clinical trials. Model utilities, disutilities, and the costs of serious adverse events were sourced from published literature. Medication costs were assigned from Red Book. All costs were calculated in 2024 US dollars. The incremental cost-effectiveness ratio was calculated based on the cost per quality-adjusted life-year (QALY) gained. A willingness-to-pay threshold of $150,000 per QALY was used. One-way sensitivity analysis and probabilistic sensitivity analysis were performed to assess the effect of parameter uncertainty on the results.</p><p><strong>Results: </strong>In the base-case analysis, both subcutaneous tirzepatide and oral semaglutide were cost-effective vs subcutaneous liraglutide and subcutaneous semaglutide. Compared with oral semaglutide, subcutaneous tirzepatide was cost-effective, with an incremental cost-effectiveness ratio of $34,212 per QALY gained. Sensitivity analyses indicated the results were highly sensitive to medication costs and the effectiveness of medications. The probabilistic sensitivity analysis suggested that subcutaneous tirzepatide was most likely to remain cost-effective, with a 98% probability at a willingness to pay of $150,000 per QALY compared with other medications.</p><p><strong>Conclusions: </strong>Subcutaneous tirzepatide and oral semaglutide were cost-effective therapies compared with subcutaneous liraglutide and subcutaneous semaglutide for the short-term management of obesity in adults without diabetes. At or under a willingness-to-pay threshold of $150,000 per QALY, subcutaneous tirzepatide was most cost-effective, surpassing oral semaglutide. These findings provide valuable insights for health care decision-makers in selecting antiobesity medications.</p>","PeriodicalId":16170,"journal":{"name":"Journal of managed care & specialty pharmacy","volume":"31 5","pages":"441-450"},"PeriodicalIF":2.3,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12039506/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144028943","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":"Assessing variation in US payer coverage of anti-vascular endothelial growth factor therapies for the treatment of age-related macular degeneration, diabetic retinopathy, and diabetic macular edema.","authors":"James D Chambers, Molly T Beinfeld, Terry Richardson, Michael Pangrace","doi":"10.18553/jmcp.2025.24340","DOIUrl":"10.18553/jmcp.2025.24340","url":null,"abstract":"<p><strong>Background: </strong>Timely anti-vascular endothelial growth factor (anti-VEGF) therapy is recommended to preserve vision in age-related macular degeneration (AMD), diabetic retinopathy (DR), and diabetic macular edema (DME). Coverage of anti-VEGF agents for the treatment of retinal diseases varies, resulting in administrative burdens for providers and treatment delays for patients.</p><p><strong>Objective: </strong>To examine how US commercial and Medicare Advantage (MA) health plans cover anti-VEGF therapies for the treatment of retinal diseases using information from the Tufts Medical Center Specialty Drug Evidence and Coverage Database.</p><p><strong>Methods: </strong>This descriptive study evaluated coverage of US Food and Drug Administration (FDA)-approved anti-VEGF drugs for AMD, DR, and DME current as of April 2024 using the Specialty Drug Evidence and Coverage Database from 18 of the largest US commercial health plans and MA offerings from a subset of 6 of these plans.</p><p><strong>Results: </strong>Substantial variation exists in commercial coverage across FDA-approved anti-VEGF therapies for AMD, DR, and DME. Descriptive assessment showed that approximately 65% of commercial coverage decisions and approximately 52% of MA decisions included restrictions beyond the FDA label. Coverage decisions for originator products were more likely to include restrictions compared with those for biosimilar products. Step therapy protocols were found in up to 75% of plans but were variable by drug, with most requiring a first-line trial of bevacizumab. Evidence cited to support coverage restrictions was likewise variable.</p><p><strong>Conclusions: </strong>Descriptive data show that US commercial and MA coverage and step therapy protocols vary substantially across health plans, which may potentially contribute to administrative burdens and treatment delays.</p>","PeriodicalId":16170,"journal":{"name":"Journal of managed care & specialty pharmacy","volume":" ","pages":"451-460"},"PeriodicalIF":2.3,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12039497/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143772458","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 blood pressure, medication adherence, and cardiovascular-related health care use associated with the 2018 angiotensin receptor blocker recalls and drug shortages among patients with hypertension.","authors":"Katherine Callaway Kim, Eric T Roberts, Julie M Donohue, Chester B Good, Lindsay M Sabik, Joshua W Devine, Mina Tadrous, Katie J Suda","doi":"10.18553/jmcp.2025.31.5.461","DOIUrl":"10.18553/jmcp.2025.31.5.461","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;One of the largest-ever retail drug shortages began in 2018 when several angiotensin II receptor blockers (ARBs) for treating hypertension, heart failure, and chronic kidney disease-valsartan, losartan, and irbesartan-were recalled for carcinogenic impurities. The long-term consequences of the ARB shortages and whether certain groups experienced more adverse outcomes is unknown.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To evaluate changes in adherence and health outcomes after ARB recalls and to identify patients who experienced greater changes in access and adverse clinical outcomes.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Using an integrated claims and electronic health record dataset and a difference-in-differences design, we evaluated changes in the proportion of days covered (PDC) for ARBs and similar drugs (angiotensin-converting enzyme inhibitors [ACE-Is]), uncontrolled blood pressure, major cardiovascular event (MACE)-related acute care visits, and all-cause ambulatory care visits in the 12 months before vs 18 months after recalls for valsartan, losartan, and irbesartan users vs patients taking similar, nonrecalled drugs (ACE-Is, nonrecalled ARBs). Triple-difference models characterized heterogeneous associations by pre-recall patient demographic (race, ethnicity, age), clinical (baseline indication, mental health conditions), and adherence variables.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Adjusting for pre-recall patient characteristics, we observed no significant changes in PDC for ARBs and ACE-Is (combined), uncontrolled blood pressure, or ambulatory care visits among 86,507 recalled ARB users vs 123,583 comparison drug users in the 18 months after the recalls. Following the recalls, medication switches increased on average by an additional 2.08 percentage points (p.p.) per quarter (95% CI = 2.01-2.15) for recalled ARB vs comparison drug users, a 195.9% relative increase. We observed the most switches in the 90-day period immediately after valsartan's recall (difference-in-difference: 9.48 p.p.; 95% CI = 9.36-9.59; relative change = 892%). Cumulatively, 55.2% of valsartan, 7.6% of losartan, and 18.9% of irbesartan users switched medications after 18 months. We observed an increase in the proportion of recalled ARB vs comparison patients who experienced medication gaps exceeding 30 days (1.13 p.p. per quarter on average; 95% CI = 0.97-1.30), which was most apparent after approximately 15 months (5 quarters). Although MACE-related acute care visits did not change in the quarter (90 days) immediately after valsartan's recall, we observed an increase of 1.40 additional visits per 1,000 recalled ARB vs comparison drug patients in each subsequent quarter, a 9.3% relative increase. Results were similar across most subgroups.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;The 2018 ARB recalls were associated with immediate changes in antihypertension medication use. Many patients transitioned to alternative medications. Although overall impacts","PeriodicalId":16170,"journal":{"name":"Journal of managed care & specialty pharmacy","volume":"31 5","pages":"461-471"},"PeriodicalIF":2.3,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12039498/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144064077","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 costs and resource utilization among patients with myasthenia gravis in the United States.","authors":"Sun A Choi, Daniel R Touchette, Kibum Kim","doi":"10.18553/jmcp.2025.31.5.472","DOIUrl":"https://doi.org/10.18553/jmcp.2025.31.5.472","url":null,"abstract":"<p><strong>Background: </strong>Myasthenia gravis (MG) is a rare neuromuscular disorder with an estimated prevalence of 37 per 100,000 individuals in the United States. Despite patients with MG using a wide range of health care services, there is a lack of information regarding health care costs and health care resource utilization (HCRU).</p><p><strong>Objective: </strong>To gain insight into the health care cost and HCRU associated with an MG diagnosis from the US payer perspective.</p><p><strong>Methods: </strong>Patients with MG, defined by at least 2 claims for MG diagnoses, were identified from a commercial and Medicare claims database between 2016 and 2021. Controls who were never diagnosed with MG were matched at a 10:1 ratio with each patient with MG based on baseline demographic and clinical characteristics. The primary outcomes were 1-year total health care costs associated with MG diagnosis, and the secondary outcomes were 1-year HCRU associated with MG diagnosis. Difference-in-difference estimates from a multivariable linear regression model were used to report adjusted health care costs and HCRU.</p><p><strong>Results: </strong>The final analytic cohort included 3,700 patients with MG and 37,000 controls. On average, patients were aged 54 years, with 60% being female. The difference-in-difference estimates of the total health care cost for MG diagnosis in commercial and Medicare patients were $25,799 and $4,927, respectively (<i>P</i> < 0.01). MG diagnosis had significant impacts on HCRU across all health care settings.</p><p><strong>Conclusions: </strong>We quantified a significant increase in health care costs and HCRU in the first year following diagnosis of MG compared with the matched cohort. Future studies can further investigate long-term health care costs associated with patients with MG.</p>","PeriodicalId":16170,"journal":{"name":"Journal of managed care & specialty pharmacy","volume":"31 5","pages":"472-481"},"PeriodicalIF":2.3,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12039500/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143996606","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":"Trends in first-line glucose-lowering medication use among US adults with type 2 diabetes from 2019 to 2023.","authors":"Duy Do, Tiffany Lee, Samuel Peasah, Angela Inneh, Urvashi Patel, Chester Good","doi":"10.18553/jmcp.2025.31.5.520","DOIUrl":"https://doi.org/10.18553/jmcp.2025.31.5.520","url":null,"abstract":"<p><strong>Background: </strong>The introduction of newer classes of glucose-lowering therapies has dramatically altered the diabetes therapeutic landscape. However, little is known about trends in the use of first-line glucose-lowering therapies over time.</p><p><strong>Objective: </strong>To describe trends in the use of first-line glucose-lowering therapies from 2019 to 2023 among patients with type 2 diabetes (T2D) and changes over time in the demographic and clinical characteristics of patients initiating these therapies.</p><p><strong>Methods: </strong>This retrospective study identified patients aged 18 years and older from the Komodo Healthcare Map database who filled any glucose-lowering medication between January 2019 and May 2023. The prevalence of first-line glucose-lowering therapy use among patients with T2D was calculated in each month. Pearson χ² and Kruskal-Wallis rank sum tests were used to compare patients' demographic and clinical characteristics such as cardiovascular disease, heart failure, or chronic kidney disease by type of first-line glucose-lowering medication.</p><p><strong>Results: </strong>The study cohort of 964,914 patients was predominantly made up of female patients (68%) and had a mean age of 54 (SD = 13). The majority of patients initiated metformin before 2022 (74%-83%), followed by insulin (6%-11%), sulfonylureas (3%-7%), glucagon-like peptide 1 receptor agonists (GLP-1RAs) (2%-5%), sodium-glucose cotransporter 2 inhibitor (SGLT2is) (1%-4%), and dipeptidyl peptidase-4 inhibitors (1%-3%). From January 2022 to May 2023, first-line use of GLP-1RAs and SGLT2is increased from 6% and 4% to 18% and 7%, respectively. In contrast, first-line use of metformin, sulfonylureas, and dipeptidyl peptidase-4 inhibitors declined from 76%, 4%, and 2% to 64%, 2%, and 1% over the same period, respectively. Relative to 2019-2021, first-line GLP-1RA users in 2022-2023 were likely to be younger, female, and covered by Medicaid and to have fewer comorbidities as determined by the Charlson Comorbidity Index. In contrast, first-line SGLT2i users were more likely to be older and to have more comorbidities over the same period.</p><p><strong>Conclusions: </strong>This study shows a significant shift in the use of first-line glucose-lowering therapies from metformin to GLP-1RAs and SGLT2is. The proportion of first-line GLP-1RA and SGLT2i users with cardiovascular disease, heart failure, or chronic kidney disease has increased significantly over time, aligning with guidelines from the American Diabetes Association. Further studies are merited to evaluate the cost-benefit implications of this shift in first-line glucose-lowering use.</p>","PeriodicalId":16170,"journal":{"name":"Journal of managed care & specialty pharmacy","volume":"31 5","pages":"520-526"},"PeriodicalIF":2.3,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12039499/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144022794","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}