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Machine learning evaluation of racial and ethnic inclusion under alternative cost-based approaches to Medicare Medication Therapy Management eligibility. 机器学习评估在替代成本为基础的方法下的种族和民族纳入医疗保险药物治疗管理资格。
IF 3.3 4区 医学
Journal of managed care & specialty pharmacy Pub Date : 2026-06-01 DOI: 10.18553/jmcp.2026.32.6.736
Chi Chun Steve Tsang, Yan Cui, William C Cushman, Junling Wang
{"title":"Machine learning evaluation of racial and ethnic inclusion under alternative cost-based approaches to Medicare Medication Therapy Management eligibility.","authors":"Chi Chun Steve Tsang, Yan Cui, William C Cushman, Junling Wang","doi":"10.18553/jmcp.2026.32.6.736","DOIUrl":"10.18553/jmcp.2026.32.6.736","url":null,"abstract":"<p><strong>Background: </strong>The eligibility framework for the Medicare Medication Therapy Management (MTM) program has been associated with a lower likelihood of meeting enrollment criteria among racial and ethnic minority beneficiaries compared with their non-Hispanic White (White) counterparts. To optimize the MTM program design, the Centers for Medicare and Medicaid Services launched the Enhanced MTM demonstration, granting Part D plans greater flexibility to test alternative eligibility strategies. Many plans have adopted predictive modeling and cost-based criteria; however, their equity implications remain unclear.</p><p><strong>Objective: </strong>To assess and compare how alternative cost-based eligibility schemes, implemented using machine learning models, influence predicted racial and ethnic inclusion in potential MTM eligibility.</p><p><strong>Methods: </strong>A retrospective, cross-sectional analysis was conducted using a 10% national sample of Medicare fee-for-service beneficiaries in 2019. Two binary outcomes were defined using the top quartile of total health care costs and combined hospitalization and emergency department (ED) costs as eligibility thresholds. Five machine learning algorithms, including regularized logistic regression, random forest, gradient-boosted trees, support vector machines, and multilayer perceptron, were developed for each cost-based scheme. Their predicted probabilities were combined using a soft-voting ensemble to generate consensus estimates of potential eligibility. A multinomial logistic regression model was then used to assess associations between race and ethnicity and predicted inclusion across the 2 cost-based schemes, adjusting for predisposing, enabling, and need factors based on the Gelberg-Andersen model.</p><p><strong>Results: </strong>The analytic sample included 1,848,654 Medicare beneficiaries, with 75% designated as the training population and the remaining 25% as the test population. Racial and ethnic differences in predicted eligibility varied by cost-based scheme. Compared with White beneficiaries, Black (relative risk ratio [RRR] = 4.31; 95% CI = 3.92-4.75) and Hispanic (RRR = 2.28; 95% CI = 2.04-2.56) beneficiaries had a higher likelihood of inclusion under the hospitalization and ED-based scheme only, relative to inclusion under the total health care cost-based scheme only, whereas Asian (RRR = 0.24; 95% CI = 0.19-0.29) and Other (RRR = 0.43; 95% CI = 0.36-0.52) racial groups had lower likelihoods.</p><p><strong>Conclusions: </strong>Alternative cost-based definitions of MTM eligibility identify different beneficiary populations across racial and ethnic groups. Incorporating hospitalization and ED costs may improve representation of Black and Hispanic beneficiaries in potential MTM eligibility. These findings highlight the need for transparency and continued evaluation of algorithmic eligibility frameworks to ensure equitable access to medication management services.</p>","PeriodicalId":16170,"journal":{"name":"Journal of managed care & specialty pharmacy","volume":"32 6","pages":"736-747"},"PeriodicalIF":3.3,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13193318/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147987975","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}
引用次数: 0
Correction Statement. 更正声明。
IF 2.9 4区 医学
Journal of managed care & specialty pharmacy Pub Date : 2026-05-01 DOI: 10.18553/jmcp.2026.32.5.637
{"title":"Correction Statement.","authors":"","doi":"10.18553/jmcp.2026.32.5.637","DOIUrl":"https://doi.org/10.18553/jmcp.2026.32.5.637","url":null,"abstract":"","PeriodicalId":16170,"journal":{"name":"Journal of managed care & specialty pharmacy","volume":"32 5","pages":"637"},"PeriodicalIF":2.9,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13119486/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147774131","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}
引用次数: 0
Antiretroviral therapy switch among Medicare beneficiaries with HIV. 艾滋病毒医疗保险受益人的抗逆转录病毒治疗转换。
IF 3.3 4区 医学
Journal of managed care & specialty pharmacy Pub Date : 2026-05-01 Epub Date: 2026-02-26 DOI: 10.18553/jmcp.2026.25275
Mary J Christoph, Uche Mordi, Suying Li, Haifeng Guo, TingTing Gong, Travis Lim, Seojin Park, Woodie Zachry, Phyllis C Tien
{"title":"Antiretroviral therapy switch among Medicare beneficiaries with HIV.","authors":"Mary J Christoph, Uche Mordi, Suying Li, Haifeng Guo, TingTing Gong, Travis Lim, Seojin Park, Woodie Zachry, Phyllis C Tien","doi":"10.18553/jmcp.2026.25275","DOIUrl":"10.18553/jmcp.2026.25275","url":null,"abstract":"<p><strong>Background: </strong>Persistence to antiretroviral therapy (ART) is essential for optimal HIV treatment outcomes. People with HIV (PWH) enrolled in Medicare often have a higher prevalence of comorbidities, which can negatively impact persistence, leading to suboptimal HIV outcomes.</p><p><strong>Objective: </strong>To compare ART switch patterns among PWH insured by Medicare.</p><p><strong>Methods: </strong>Using Medicare Fee-for-Service and Medicare Advantage claims data from January 2017 to December 2022, a retrospective cohort study of treatment-experienced PWH aged 18 years and older and on ART was conducted. ART regimens included bictegravir/emtricitabine/tenofovir alafenamide (B/F/TAF), dolutegravir/lamivudine (DTG/3TC), dolutegravir/abacavir/lamivudine (DTG/ABC/3TC), or multitablet regimens (MTRs; dolutegravir + emtricitabine/tenofovir alafenamide [DTG + F/TAF] or dolutegravir + emtricitabine/tenofovir disoproxil fumarate [DTG + F/TDF]). An analysis of PWH who had mental health and/or substance use disorders was also conducted. Treatment switch by ART regimen was evaluated using Kaplan-Meier curves, log-rank tests, and Cox proportional hazards models after using inverse probability treatment weighting to balance across groups.</p><p><strong>Results: </strong>A total of 30,205 treatment-experienced PWH were included. PWH who initiated DTG/3TC, DTG/ABC/3TC, and MTRs on the index date had 1.28 (95% CI = 1.13-1.45), 2.67 (95% CI = 2.47-2.89), and 5.37 (95% CI = 4.60-6.26) times higher hazard ratio of switching ART, respectively, compared with PWH indexed on B/F/TAF (all <i>P</i> < 0.0001). Similar results were observed among PWH with mental health and/or substance use disorders.</p><p><strong>Conclusions: </strong>Medicare-insured PWH indexed on B/F/TAF had lower risk of treatment switch compared with other ART regimens, both overall and in the subgroup with mental health and/or substance use disorders. These findings may inform targeted strategies for optimal treatment selection for PWH.</p>","PeriodicalId":16170,"journal":{"name":"Journal of managed care & specialty pharmacy","volume":" ","pages":"574-583"},"PeriodicalIF":3.3,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13119497/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147290214","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}
引用次数: 0
AMCP Market Insights: Getting to the heart of hard-to-control hypertension in managed care. AMCP市场洞察:在管理式医疗中触及难以控制的高血压的核心。
IF 3.3 4区 医学
Journal of managed care & specialty pharmacy Pub Date : 2026-05-01 DOI: 10.18553/jmcp.2026.32.5-a.s1
Bridget Flavin, Denise Wolff, Gaurang Gandhi, Hiva Pourarsalan, Florian Rader, Terry Richardson, Michael Shannon, Stephanie Spence, Susan Wescott
{"title":"AMCP Market Insights: Getting to the heart of hard-to-control hypertension in managed care.","authors":"Bridget Flavin, Denise Wolff, Gaurang Gandhi, Hiva Pourarsalan, Florian Rader, Terry Richardson, Michael Shannon, Stephanie Spence, Susan Wescott","doi":"10.18553/jmcp.2026.32.5-a.s1","DOIUrl":"10.18553/jmcp.2026.32.5-a.s1","url":null,"abstract":"<p><p>Hard-to-control hypertension, comprising uncontrolled and resistant hypertension, is highly prevalent, meaning many patients with hypertension remain at risk of adverse outcomes despite treatment. To discuss the role of managed care in addressing hard-to-control hypertension, AMCP Market Insights virtually convened an expert panel of managed care stakeholders in November 2025. This article provides a qualitative summary of the panel discussion. Key insights were that despite multiple effective, low-cost pharmacotherapy options, a significant proportion of patients have blood pressure above recommended goals because of confounding factors at both the micro and macro levels; and managed care-specific challenges in hard-to-control hypertension include competing organizational priorities, data gaps, and lack of integration of existing resources. Opportunities to advance care in hard-to-control hypertension include focusing on prevention and providing additional patient and clinician support such as with education and enhancing use of digital technologies. Other insights were that top payer priorities in hypertension include reducing cardiovascular events and other complications and meeting quality goals, and that current clinical guidelines and provider input are important elements of payer decision-making. These findings can support informed clinical and coverage decisions, can offer practical actions for payers, and may inform future work.</p>","PeriodicalId":16170,"journal":{"name":"Journal of managed care & specialty pharmacy","volume":"32 5-a Suppl","pages":"S1-S10"},"PeriodicalIF":3.3,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13121772/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147773661","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}
引用次数: 0
AMCP Market Insights: Beyond skin deep on the role of managed care in moderate to severe atopic dermatitis. AMCP市场洞察:超越皮肤深层管理护理在中重度特应性皮炎中的作用。
IF 3.3 4区 医学
Journal of managed care & specialty pharmacy Pub Date : 2026-05-01 DOI: 10.18553/jmcp.2026.32.5-b.s1
Bridget Flavin, Denise Wolff, Mike Abdo, Aderonke Adeboye, Mona Chitre, Zachary Contreras, Gaurang Gandhi, Mark Lebwohl, Terry Richardson, Wendy Smith Begolka
{"title":"AMCP Market Insights: Beyond skin deep on the role of managed care in moderate to severe atopic dermatitis.","authors":"Bridget Flavin, Denise Wolff, Mike Abdo, Aderonke Adeboye, Mona Chitre, Zachary Contreras, Gaurang Gandhi, Mark Lebwohl, Terry Richardson, Wendy Smith Begolka","doi":"10.18553/jmcp.2026.32.5-b.s1","DOIUrl":"10.18553/jmcp.2026.32.5-b.s1","url":null,"abstract":"<p><p>Atopic dermatitis (AD), is a chronic, relapsing inflammatory skin disorder that can pose a significant burden to patients and their caregivers and decrease their quality of life. Although substantial advances have been made in the safety and effectiveness of treatments for moderate to severe AD, opportunity for improvement remains. To better understand the patient journey and to consider the management of both current and emerging treatments, AMCP Market Insights virtually convened an expert panel of managed care stakeholders in November 2025. This article provides a qualitative summary of the panel discussion. Key insights include that delayed diagnosis and limited access to dermatology specialists are top gaps in the provision of equitable care in moderate to severe AD and that despite treatment advances, more effective and affordable options are needed. Additionally, treatment adherence and positive outcomes in moderate to severe AD are multifactorial and may be affected by elements such as timely access, care coordination, disease severity and variability, and medication coverage and costs. Emerging agents show promise for a more durable response with less frequent dosing than current therapies, but payers are waiting for additional data to demonstrate long-term safety and efficacy and real-world outcomes. These findings can support informed clinical and coverage decisions, can offer practical actions for payers, and may inform future work.</p>","PeriodicalId":16170,"journal":{"name":"Journal of managed care & specialty pharmacy","volume":"32 5-b Suppl","pages":"S1-S9"},"PeriodicalIF":3.3,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13119489/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147773691","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}
引用次数: 0
Medicaid access to Most Favored Nation through the Pfizer agreement: The unanswered issues. 通过辉瑞协议获得最惠国医疗补助:悬而未决的问题。
IF 3.3 4区 医学
Journal of managed care & specialty pharmacy Pub Date : 2026-05-01 DOI: 10.18553/jmcp.2026.32.5.525
Jeromie Ballreich, Joseph Levy, Tucker Desmond, Nathan Jibat, Gerard Anderson
{"title":"Medicaid access to Most Favored Nation through the Pfizer agreement: The unanswered issues.","authors":"Jeromie Ballreich, Joseph Levy, Tucker Desmond, Nathan Jibat, Gerard Anderson","doi":"10.18553/jmcp.2026.32.5.525","DOIUrl":"10.18553/jmcp.2026.32.5.525","url":null,"abstract":"<p><p>In the following commentary, we discuss the motivation for the Trump-Pfizer Most Favored Nation (MFN) pricing deal, a preliminary analysis on potential savings, and discussion on the details that will determine the success of the Trump-Pfizer deal. This deal represents the Trump administration's pursued health policy to get Americans a \"better deal\" for drug pricing by providing Medicaid programs access to MFN pricing for Pfizer-branded drugs. Using different data sources, we provide a preliminary analysis on the deal's impact on 6 Pfizer drugs. Our results suggest Medicaid programs may save a maximum of $280 million from access to MFN pricing, reflecting 11.5% in additional rebates off gross spending. Medicaid programs will have greater potential net savings when using MFN benchmarking for newer drugs with lower baseline rebates compared with older, highly rebated drugs. It is uncertain if the MFN prices will apply to all new and existing Pfizer drugs or just a selection. We also highlight several implementation challenges ranging from different marketed names of drugs to selection of countries for MFN pricing that will influence the deal's impact.</p>","PeriodicalId":16170,"journal":{"name":"Journal of managed care & specialty pharmacy","volume":"32 5","pages":"525-529"},"PeriodicalIF":3.3,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13119475/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147774082","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}
引用次数: 0
State-level variation in the use of glucagon-like peptide-1 receptor agonists for weight loss and diabetes: a real-world analysis. 在使用胰高血糖素样肽-1受体激动剂减肥和糖尿病的国家水平的变化:现实世界的分析。
IF 3.3 4区 医学
Journal of managed care & specialty pharmacy Pub Date : 2026-05-01 DOI: 10.18553/jmcp.2026.32.5.625
Steven Do, Kathryn Christensen, Angela Inneh, Samuel Peasah, Chester Good
{"title":"State-level variation in the use of glucagon-like peptide-1 receptor agonists for weight loss and diabetes: a real-world analysis.","authors":"Steven Do, Kathryn Christensen, Angela Inneh, Samuel Peasah, Chester Good","doi":"10.18553/jmcp.2026.32.5.625","DOIUrl":"10.18553/jmcp.2026.32.5.625","url":null,"abstract":"<p><strong>Background: </strong>Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) have demonstrated clinical benefits beyond glycemic control, including weight loss and cardiovascular protection. Given the growing interest in the clinical value of GLP-1 RAs, greater understanding of geographic variation in utilization by disease prevalence and the influence of state-level coverage policies is desirable.</p><p><strong>Objective: </strong>To assess (1) state-level utilization of GLP-1 RAs by indication for diabetes and obesity, (2) correlation of those rates to the state-level prevalence of diabetes and obesity, and (3) state-specific Medicaid formulary coverage of GLP-1 RAs for weight loss and diabetes.</p><p><strong>Methods: </strong>We conducted a cross-sectional analysis of pharmacy claims from the Komodo Healthcare Map between January 1 and December 31, 2023. GLP-1 RA utilization was defined as the prevalence of members with GLP-1 RA claims for US Food and Drug Administration-approved indications for diabetes or obesity. State-level diabetes and obesity prevalence were obtained from the 2022-2023 Behavioral Risk Factor Surveillance System. Medicaid coverage for GLP-1 RAs was categorized as \"not covered,\" \"restricted,\" or \"unrestricted.\" Pearson correlation coefficients were calculated to assess relationships between state-level disease prevalence and GLP-1 RA utilization.</p><p><strong>Results: </strong>State-level utilization of GLP-1 RAs for diabetes was strongly correlated with diabetes prevalence in the commercially insured population, but correlation was moderate with those with Medicare and weak with the Medicaid population. For obesity, utilization showed only weak or negligible correlations with obesity prevalence. Medicaid coverage policies influenced access where utilization in states with \"restricted\" or \"unrestricted\" coverage was nominally higher than in states with \"not covered\" policies.</p><p><strong>Conclusions: </strong>GLP-1 RA utilization in the United States varies substantially by payer type, indication, and state-level coverage policies.</p>","PeriodicalId":16170,"journal":{"name":"Journal of managed care & specialty pharmacy","volume":"32 5","pages":"625-630"},"PeriodicalIF":3.3,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13119483/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147773716","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}
引用次数: 0
Assessment of IPAY 2027 Medicare drug price negotiation maximum fair prices with prices in most-favored nation reference countries. IPAY 2027医疗保险药品价格谈判与最惠国参考国价格的最大公平价格评估。
IF 3.3 4区 医学
Journal of managed care & specialty pharmacy Pub Date : 2026-05-01 DOI: 10.18553/jmcp.2026.32.5.530
Nico Gabriel, Kristi Martin, Emma M Cousin, Kevin H Li, Jens Grueger, Sean D Sullivan
{"title":"Assessment of IPAY 2027 Medicare drug price negotiation maximum fair prices with prices in most-favored nation reference countries.","authors":"Nico Gabriel, Kristi Martin, Emma M Cousin, Kevin H Li, Jens Grueger, Sean D Sullivan","doi":"10.18553/jmcp.2026.32.5.530","DOIUrl":"10.18553/jmcp.2026.32.5.530","url":null,"abstract":"<p><strong>Background: </strong>Prescription drug list prices in the United States far exceed those in peer nations, averaging 278% of non-US prices and 422% for branded products. The Inflation Reduction Act authorized Medicare to negotiate net prices for high-expenditure drugs, resulting in maximum fair prices (MFPs) for 15 Part D products effective in 2027. Subsequently, Centers for Medicare and Medicaid Services (CMS) introduced the GLOBE and GUARD models, which propose a most-favored nation (MFN) pricing framework for both Part B and Part D, respectively, that is tied to international prices in 19 countries. CMS also introduced the GENEROUS model for Medicaid, which uses an 8-country subset of the GLOBE/GUARD reference nations.</p><p><strong>Objective: </strong>To evaluate the performance of the Medicare Drug Price Negotiation Program by comparing negotiated net prices with domestic and international list price benchmarks.</p><p><strong>Methods: </strong>We identified negotiated drugs using CMS publications and estimated initial US net prices and CMS price benchmarks for negotiation including statutory discounts. International list prices from the 19 countries that will be used as reference for the GUARD and GLOBE models were extracted from Eversana's NAVLIN database and converted to US dollars using 2025 exchange rates. Prices were adjusted using purchasing power parity. All prices were standardized to a 30-day equivalent supply following CMS methods. For drugs with multiple brands or strengths, weighted average per-unit prices were estimated using Medicare Part D utilization data.</p><p><strong>Results: </strong>Postnegotiation MFPs were 15% to 60% (median: 38%) lower than estimated US net prices with greater reductions for drugs whose ceiling price was determined by the net price. However, MFPs remained 17% to 755% (median: 108%) higher than the average purchasing power parity-adjusted published list price in MFN reference countries. The mean US-to-international price ratio declined from 5.8 before negotiation to 3.3 afterward. Twelve of 14 drugs had MFPs below their estimated ceilings, whereas the 15th drug had an inestimable ceiling. There is not enough information about the proposed GLOBE and GUARD models to project MFN prices for Part B or D at this time. Discounts varied by therapeutic class and were larger for drugs with prior negotiated comparators.</p><p><strong>Conclusions: </strong>The 2025 Medicare drug negotiations will generate meaningful reductions in domestic drug prices when they take effect in 2027 but left substantial disparities relative to peer nations. Upcoming MFN-based pricing models may exert further downward pressure, although their implementation and international effects warrant careful monitoring.</p>","PeriodicalId":16170,"journal":{"name":"Journal of managed care & specialty pharmacy","volume":"32 5","pages":"530-539"},"PeriodicalIF":3.3,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13119479/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147774023","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}
引用次数: 0
Development of a decision aid to help dually enrolled veterans make informed choices on medication sourcing. 开发决策援助,帮助双重登记的退伍军人在药物采购方面做出明智的选择。
IF 3.3 4区 医学
Journal of managed care & specialty pharmacy Pub Date : 2026-05-01 DOI: 10.18553/jmcp.2026.32.5.551
Anna Hung, Jadyn Cleary, Ellen B Lawrence, Kaitlyn Goodwin, Theodore S Berkowitz, Valerie A Smith, Carolyn T Thorpe, Shelby D Reed, Matthew L Maciejewski, Matthew J Crowley, William E Bryan, Richard Erickson, Kelli Tharpe, Lesley McCathern, Leigh McNaughton, Gina Upchurch, Francesca Cunningham, Jeffrey T Kullgren, Angela Fagerlin
{"title":"Development of a decision aid to help dually enrolled veterans make informed choices on medication sourcing.","authors":"Anna Hung, Jadyn Cleary, Ellen B Lawrence, Kaitlyn Goodwin, Theodore S Berkowitz, Valerie A Smith, Carolyn T Thorpe, Shelby D Reed, Matthew L Maciejewski, Matthew J Crowley, William E Bryan, Richard Erickson, Kelli Tharpe, Lesley McCathern, Leigh McNaughton, Gina Upchurch, Francesca Cunningham, Jeffrey T Kullgren, Angela Fagerlin","doi":"10.18553/jmcp.2026.32.5.551","DOIUrl":"10.18553/jmcp.2026.32.5.551","url":null,"abstract":"<p><strong>Background: </strong>Veterans enrolled in both Veterans Affairs (VA) health care and Medicare Part D can choose to obtain medications through the VA, Medicare Part D, or both, with each option differing in cost, coverage, and coordination of care. Poorly informed choices can lead to veteran frustration when their expectations are not met, delays in medication access, and increased risks. This study aimed to develop a decision aid (DA) to help veterans with diabetes make informed choices about medication sourcing (ie, whether to fill medications through VA health care only, Part D only, or both).</p><p><strong>Methods: </strong>DA development was guided by the International Patient DA Standards and the Ottawa Decision Support Framework. Interviews with veterans and care partners informed the prototype design. Alpha testing with 18 end users (mostly veterans) and 12 stakeholders (pharmacists, doctors, payers, Medicare counselors, and others) assessed comprehensibility, usability, and acceptability. During beta testing, the feasibility of the revised DA was assessed during interviews with 20 end users and 8 stakeholders. For end-user interviews, a survey assessing decisional conflict, satisfaction, and knowledge was provided before and after respondents filled out the DA.</p><p><strong>Results: </strong>Alpha testing feedback led to simplifying the cost and formulary comparison chart and expanding the medication list template to include more medications, fill location, and prescriber contact information. Based on beta testing responses (n = 16), the mean system usability scale score for the DA was 77.5 (SD = 14.4), suggesting usability. Beta testers also reported the DA to be acceptable in length (94%), balance (88%), and amount of information (81%). Based on pre- vs post-DA survey responses, decisional conflict was reduced, as indicated by an increase in the mean Sure of myself; Understand information; Risk-benefit ratio; Encouragement (SURE) score (pre-DA: 3.1, SD = 1.4 to all 16 respondents reporting a maximum SURE score of 4.0). Knowledge about VA and Medicare coverage of diabetes medications also improved: the proportion who answered all 5 comprehension questions correctly increased from 57% to 81%. Last, the proportion of respondents who reported being \"very satisfied\" with how they were currently filling their diabetes medicines (VA only, Part D only, or both) improved from 64% pre-DA to 81% post-DA.</p><p><strong>Conclusions: </strong>The DA developed iteratively was usable and acceptable and showed potential in reducing decisional conflict, increasing knowledge, and increasing satisfaction, so it may help Part D-enrolled veterans with decisions about medication sourcing.</p>","PeriodicalId":16170,"journal":{"name":"Journal of managed care & specialty pharmacy","volume":"32 5","pages":"551-562"},"PeriodicalIF":3.3,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13119477/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147774141","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}
引用次数: 0
Semaglutide and tirzepatide for obesity: A summary from the Institute for Clinical and Economic Review's New England Comparative Effectiveness Public Advisory Council. 西马鲁肽和替西帕肽治疗肥胖:来自临床和经济评论研究所新英格兰比较有效性公共咨询委员会的总结。
IF 3.3 4区 医学
Journal of managed care & specialty pharmacy Pub Date : 2026-05-01 DOI: 10.18553/jmcp.2026.32.5.631
Foluso Agboola, Shahariar Mohammed Fahim, Grace A Lin, Woojung Lee, Marina Richardson, David Rind
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