Journal of managed care & specialty pharmacy最新文献

{"title":"Marginal health care expenditures for melanoma care in the United States.","authors":"Olajumoke A Olateju, Jieni Li, J Douglas Thornton, Rajender R Aparasu","doi":"10.18553/jmcp.2024.30.12.1364","DOIUrl":"10.18553/jmcp.2024.30.12.1364","url":null,"abstract":"<p><strong>Background: </strong>The incidence of melanoma has increased significantly in the past few decades, posing a significant public health challenge. However, there is an evidence gap regarding the marginal costs of treating melanoma.</p><p><strong>Objective: </strong>To examine the marginal health care expenditures for melanoma compared with other nonskin cancers among US adults.</p><p><strong>Methods: </strong>This study examined individuals aged 18 years or older with melanoma, nonmelanoma skin cancer (NMSC), and other cancers from the 2011-2020 Medical Expenditure Panel Survey datasets. Direct health care expenditures involving hospital inpatient, outpatient, prescription medications, dental, vision, home health care, and other medical services for melanoma were analyzed using generalized linear models, and comparisons were made with expenditures for other types of cancers while adjusting for other patient characteristics.</p><p><strong>Results: </strong>There were 0.70 million individuals (95% CI = 0.61-0.78) diagnosed with melanoma annually. Total health care expenditures among individuals with melanoma, NMSC, and other cancers were $19,427, $13,744, and $23,741, respectively. A generally increasing trend of expenditure was observed over the years. Notably, office-based care (30.46%), inpatient services (28.78%), and prescription (18.27%) costs primarily accounted for the health care burden of patients with melanoma. Adjusted marginal total health care expenditures for melanoma were found to be lower ($-3,369.01 [95% CI = -$5,934.15 to -$803.85]) than other cancers but higher ($2,844.75 [95% CI = $2,204.77-$3,484.72]) compared with NMSC. Prescription expenditures were similar across the 3 cancer study groups.</p><p><strong>Conclusions: </strong>This study found that adjusted marginal expenditures for melanoma were higher than those with NMSC but lower than other nonskin cancers, with office-based care and inpatient expenditures contributing to most of the expenditures. The findings suggest that concerted efforts are needed to control the primary cost drivers to reduce the associated burden of potentially preventable skin cancer like melanoma.</p>","PeriodicalId":16170,"journal":{"name":"Journal of managed care & specialty pharmacy","volume":"30 12","pages":"1364-1374"},"PeriodicalIF":2.3,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11607212/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142755146","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":"Fear of missing out: Drug availability in the United States vs Canada.","authors":"Mina Tadrous, Clara Chen, Katherine Callaway Kim, Martin Ho, Joel Lexchin, Inmaculada Hernandez, Katie J Suda","doi":"10.18553/jmcp.2024.30.12.1349","DOIUrl":"10.18553/jmcp.2024.30.12.1349","url":null,"abstract":"<p><strong>Background: </strong>Per capita spending on drugs in the United States is double that of Canada. One commonly debated point when comparing the 2 countries is whether this additional spending allows residents of the United States access to valuable therapies not available in Canada.</p><p><strong>Objective: </strong>To characterize the therapeutic value of prescription drugs used in the United States that are not marketed in Canada.</p><p><strong>Methods: </strong>This cross-sectional study used IQVIA Multinational Integrated Data Analysis System data to identify drugs purchased in the United States but not in Canada from 2017 to 2021. Drug listing and regulatory review statuses were obtained. We categorized the drugs into 8 mutually exclusive groups: listing status in Canada (\"cancelled post-market\" or \"dormant; approved but not marketed; cancelled pre-market\"), other alternatives available (\"formulation unavailable,\" \"existing drug class,\" or \"therapeutically similar\"), \"pre-approval,\" \"atypical access available,\" or \"unavailable without alternatives marketed\" in Canada. Therapeutic value assessments of drugs in the last category were obtained from 3 international organizations.</p><p><strong>Results: </strong>2,084 products were purchased in the United States but not in Canada from 2017 to 2021; 1,685 were excluded because they were not prescription drugs, were combinations in which each active pharmaceutical ingredient was already available in the United States as a separate drug, had been discontinued in the United States by August 30, 2023, or were marketed in Canada by August 30, 2023. After exclusions, there were 399 drugs; 120 (30%) were \"cancelled post-market,\" 38 (10%) were \"dormant; approved but not marketed; cancelled pre-market,\" 49 (12%) were \"formulation unavailable,\" 130 (33%) were \"existing drug class,\" 35 (9%) were \"therapeutically similar,\" 3 (1%) were \"preapproval,\" 15 (4%) were \"atypical access available,\" and 9 (2%) were \"unavailable\" in Canada. 6 of the 9 drugs had been evaluated by 1 or more independent organizations, and all 6 were rated as offering minor to no additional therapeutic value compared with existing drugs.</p><p><strong>Conclusions: </strong>There was similar access to important prescription drug therapies in the United States and Canada. Overall, the additional spending in the United States may not have necessarily translated into access to important therapeutic innovations.</p>","PeriodicalId":16170,"journal":{"name":"Journal of managed care & specialty pharmacy","volume":"30 12","pages":"1349-1354"},"PeriodicalIF":2.3,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11607214/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142755126","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of next-generation sequencing vs polymerase chain reaction testing on payer costs and clinical outcomes throughout the treatment journeys of patients with metastatic non-small cell lung cancer.","authors":"Christine M Bestvina, Dexter Waters, Laura Morrison, Bruno Emond, Marie-Hélène Lafeuille, Annalise Hilts, Deo Mujwara, Patrick Lefebvre, Andy He, Julie Vanderpoel","doi":"10.18553/jmcp.2024.24137","DOIUrl":"10.18553/jmcp.2024.24137","url":null,"abstract":"<p><strong>Background: </strong>For patients with metastatic non-small cell lung cancer (mNSCLC), next-generation sequencing (NGS) biomarker testing has been associated with a faster time to appropriate targeted therapy and more comprehensive testing relative to polymerase chain reaction (PCR) testing. However, the impact on payer costs and clinical outcomes during patients' treatment journeys has not been fully characterized.</p><p><strong>Objective: </strong>To assess the costs and clinical outcomes of NGS vs PCR biomarker testing among patients with newly diagnosed de novo mNSCLC from a US payers' perspective.</p><p><strong>Methods: </strong>A Markov model assessed costs and clinical outcomes of NGS vs PCR testing from the start of testing up to 3 years after. Patients entered the model after receiving biomarker test results and then initiated first-line (1L) targeted or nontargeted therapy (immunotherapy and/or chemotherapy) depending on actionable mutation detection. A few patients with an actionable mutation were not detected by PCR and inappropriately initiated 1L nontargeted therapy. At each 1-month cycle, patients could remain on treatment with 1L, progress to second line or later (2L+), or die. Literature-based inputs included the rates of progression-free survival (PFS) and overall survival (OS), targeted and nontargeted therapy costs, total costs of testing, and medical costs of 1L, 2L+, and death. Per patient average PFS and OS as well as cumulative costs were reported for NGS and PCR testing.</p><p><strong>Results: </strong>In a modeled population of 100 patients (75% commercial and 25% Medicare), 45.9% of NGS and 40.0% of PCR patients tested positive for an actionable mutation. Relative to PCR, NGS was associated with $7,386 in savings per patient (NGS = $326,154; PCR = $333,540) at 1 year, driven by lower costs of testing, including estimated costs of delayed care and nontargeted therapy initiation before receiving test results (NGS = $8,866; PCR = $16,373). Treatment costs were similar (NGS = $305,644; PCR = $305,283). In the PCR cohort, the per patient costs of inappropriate 1L nontargeted therapy owing to undetected mutations were $6,455, $6,566, and $6,569 over the first 1, 2, and 3 years, respectively. Relative to PCR testing, NGS was associated with $4,060 in savings at 2 years and $1,092 at 3 years. Patients who initiated 1L targeted therapy had an additional 5.4, 8.8, and 10.4 months of PFS and an additional 1.4, 3.6, and 5.3 months of OS over the first 1, 2, and 3 years, respectively, relative to those who inappropriately initiated 1L nontargeted therapy.</p><p><strong>Conclusions: </strong>In this Markov model, as early as year 1, and over 3 years following biomarker testing, patients with newly diagnosed de novo mNSCLC undergoing NGS testing are projected to have cost savings and longer PFS and OS relative to those tested with PCR.</p>","PeriodicalId":16170,"journal":{"name":"Journal of managed care & specialty pharmacy","volume":" ","pages":"1467-1478"},"PeriodicalIF":2.3,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11607215/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142289238","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":"Antidepressant therapeutic strategies and health care utilization in patients with depression.","authors":"Phuong Tran, Susan dosReis, Eberechukwu Onukwugha, Haeyoung Lee, Julia F Slejko","doi":"10.18553/jmcp.2024.30.12.1455","DOIUrl":"10.18553/jmcp.2024.30.12.1455","url":null,"abstract":"<p><strong>Background: </strong>Individuals with depression who do not respond to initial antidepressant may switch to a different antidepressant, add a second antidepressant, or add an atypical antipsychotic. Previous studies comparing these strategies' efficacy and safety reported conflicting results, and the impact of these strategies on subsequent health care utilization is unknown.</p><p><strong>Objective: </strong>To compare health care utilization between individuals with depression who switched antidepressants, added a second antidepressant (ie, combination), or added an atypical antipsychotic (ie, augmentation) following their initial antidepressant.</p><p><strong>Methods: </strong>This retrospective cohort study used a 25% random sample of the IQVIA PharMetrics Plus for Academics health plan claims database. The study cohort included individuals aged 10-64 years who newly initiated an antidepressant at any point from January 2016 to December 2020. New use was defined as no evidence of an antidepressant in the 180 days preceding the antidepressant dispensing. Individuals had to have a depression diagnosis and a treatment change in the 180 days following the initial antidepressant. The index date was the date of the first observed antidepressant change, which was defined as a switch, combination, or augmentation. Health care utilization, measured as the number of outpatient visits, any all-cause hospitalization, and any emergency department (ED) visit, was assessed in the 180 days after the index date. Negative binomial regression models evaluated the rate ratio of the number of outpatient visits. Logistic regression models estimated the odds ratio of a hospitalization, and modified Poisson regression estimated the relative risk of an ED visit. Models were adjusted for demographics, clinical characteristics, and previous health care utilization.</p><p><strong>Results: </strong>Among 3,847 individuals with depression who had the first treatment change following the initial antidepressant, we identified 2,418 (62.9%) who switched, 1,268 (33.0%) who combined, and 161 (4.2%) who augmented their antidepressant. The augmentation group had a significantly higher rate of outpatient visits than the combination group (adjusted rate ratio = 1.14, 95% CI = 1.04-1.25). There was no statistically significant difference in hospitalizations or ED visits between the switch and augmentation vs combination groups.</p><p><strong>Conclusions: </strong>Augmentation comprised 4% of our antidepressant cohort but had higher outpatient health care utilization than those who combined treatment.</p>","PeriodicalId":16170,"journal":{"name":"Journal of managed care & specialty pharmacy","volume":"30 12","pages":"1455-1466"},"PeriodicalIF":2.3,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11607206/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142755125","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":"Concentration of spending and share of specialty drug spending in Medicare Part D over a 10-year period.","authors":"Shu Niu, Laura E Happe, Sumaya Abuloha, Mikael Svensson","doi":"10.18553/jmcp.2024.30.12.1355","DOIUrl":"10.18553/jmcp.2024.30.12.1355","url":null,"abstract":"<p><strong>Background: </strong>In 2021, Medicare Part D gross prescription drug spending amounted to $216 billion, a number that has more than doubled over the last 10 years. Spending in Medicare Part D is concentrated on a small number of drugs, and spending on specialty drugs has increased in recent years. However, the extent to which concentration in Part D spending has changed over time and the drivers of this change have not been described.</p><p><strong>Objective: </strong>To quantify the time trends in Medicare Part D spending and utilization, the concentration of spending, and the share of spending accounted for by specialty drugs from 2012 to 2021.</p><p><strong>Methods: </strong>In this repeated cross-sectional study, we used data from the Centers for Medicare & Medicaid Services Part D Drug Spending Dashboard to investigate the time trends in total gross spending, prescriptions claims, and the average cost of a prescription claim for Part D drugs. We assessed the concentration based on the share of total gross spending and prescriptions by the drugs with the top 1%, 5%, and 10% of the highest spending and Lorenz curves and Gini coefficients. In addition, we stratified our analyses by specialty and nonspecialty drugs.</p><p><strong>Results: </strong>Over the last 10 years, total gross drug spending in Medicare Part D increased by 103.5%, with a compounded annual growth rate of 8.2%. This change was driven by both increases in prescription claims and price increases of existing drugs to a similar degree. The concentration of spending intensified, with the top 1% of drugs accounting for an escalating share of total spending (from 31.4% to 41.1%). Over the 10-year study period, these top-spending drugs accounted for 5.6% of prescriptions but 34.6% of spending. Lorenz curves and increased Gini coefficients similarly showed that a smaller number of drugs accounted for increased spending over the study period. Specialty drug spending increased by 566.5%, with a compounded annual growth rate of 23.5%. The share of total spending on specialty drugs increased from 21.7% in 2012 to 71.1% in 2021. In 2021, specialty drugs accounted for 6.2% of prescriptions but 71.1% of total spending.</p><p><strong>Conclusions: </strong>Medicare Part D gross drug spending became increasingly more concentrated from 2012 to 2021, which was especially pronounced for specialty drugs. Increases in prices for specialty and other brand-name drugs will likely continue to drive gross spending upward. Although the Inflation Reduction Act provisions will likely reduce net spending on selected drugs, other policy changes may be warranted.</p>","PeriodicalId":16170,"journal":{"name":"Journal of managed care & specialty pharmacy","volume":"30 12","pages":"1355-1363"},"PeriodicalIF":2.3,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11607209/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142755108","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":"Imetelstat for anemia in lower-risk myelodysplastic syndromes: A summary from the Institute for Clinical and Economic Review's California Technology Assessment Forum.","authors":"Shahariar Mohammed Fahim, Jeffrey A Tice, Linda Luu, Josh J Carlson, Marina Richardson, Belen Herce-Hagiwara, Ronald Dickerson, Daniel A Ollendorf","doi":"10.18553/jmcp.2024.30.12.1479","DOIUrl":"10.18553/jmcp.2024.30.12.1479","url":null,"abstract":"","PeriodicalId":16170,"journal":{"name":"Journal of managed care & specialty pharmacy","volume":"30 12","pages":"1479-1485"},"PeriodicalIF":2.3,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11607211/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142755069","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":"Correction.","authors":"","doi":"10.18553/jmcp.2024.30.12.1487","DOIUrl":"10.18553/jmcp.2024.30.12.1487","url":null,"abstract":"","PeriodicalId":16170,"journal":{"name":"Journal of managed care & specialty pharmacy","volume":"30 12","pages":"1487"},"PeriodicalIF":2.3,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11607203/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142755109","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluating estimated health care resource utilization and costs in patients with myelofibrosis based on transfusion status and anemia severity: A retrospective analysis of the Medicare Fee-For-Service claims data.","authors":"Aaron T Gerds, Joseph Tkacz, Laura Moore-Schiltz, Jill Schinkel, Kelesitse Phiri, Tom Liu, Boris Gorsh","doi":"10.18553/jmcp.2024.24050","DOIUrl":"10.18553/jmcp.2024.24050","url":null,"abstract":"<p><strong>Background: </strong>Myelofibrosis (MF) is a rare but aggressive myeloproliferative neoplasm that commonly affects older patients, with a mean age of onset of older than 60 years. At least a third of patients with primary MF are anemic at diagnosis, and nearly all patients become anemic over time; approximately half require red blood cell transfusions within a year of diagnosis. Anemia and transfusion dependence are leading negative prognostic factors for overall survival and are associated with diminished quality of life and increased health care-related economic burden in patients with MF.</p><p><strong>Objective: </strong>To describe baseline characteristics, health care resource utilization (HCRU), and costs as a function of transfusion status and anemia severity in patients diagnosed with MF among the US Medicare Fee-For-Service (FFS) population.</p><p><strong>Methods: </strong>This retrospective cohort study included patients diagnosed with MF appearing in the 100% Medicare FFS database enrolled between January 1, 2012, and December 31, 2020. Patients were segmented into hemoglobin level cohorts (no, mild, moderate, and severe anemia) and transfusion status cohorts (transfusion independent [TI], transfusion requiring [TR], or transfusion dependent [TD]). Across cohorts, demographics and disease characteristics were assessed at baseline; per patient per month all-cause HCRU and medical and pharmacy costs were reported during follow-up. All results were summarized descriptively.</p><p><strong>Results: </strong>The transfusion status cohort (N = 1,749) included TI (n = 980), TR (n = 559), and TD (n = 210) patients; the anemia severity cohort (N = 365) included patients with no (n = 100), mild (n = 128), moderate (n = 99), and severe (n = 38) anemia. On average, TR and TD patients or those with moderate or severe anemia had numerically higher Deyo-Charlson Comorbidity Index scores than those who were TI or had mild or no anemia. TR and TD cohorts reported numerically greater all-cause outpatient, inpatient, and emergency department utilization vs the TI cohort. All-cause costs were numerically higher in the TD and TR cohorts vs the TI cohort ($14,655 and $14,249 vs $8,191). Incremental increases in HCRU and costs were also observed with increasing anemia severity. All-cause medical and pharmacy costs for no, mild, moderate, and severe anemia cohorts were $4,689, $7,268, $10,439, and $13,590, respectively.</p><p><strong>Conclusions: </strong>This retrospective analysis of the US Medicare FFS database descriptively evaluated patients by transfusion status and anemia severity and showed that costs and HCRU were numerically lower for patients with transfusion independence compared with those with transfusion dependence. Similar trends were seen when comparing patients based on anemia status, with numerically lower HCRU and cost observed with decreasing anemia severity.</p>","PeriodicalId":16170,"journal":{"name":"Journal of managed care & specialty pharmacy","volume":" ","pages":"1395-1404"},"PeriodicalIF":2.3,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11607217/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142365523","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":"Area deprivation index impact on type 2 diabetes outcomes in a regional health plan.","authors":"Taylor N Laffey, David Marr, Ashley Modany, Molly McGraw, Tavvy Mounarath, Andrew Bryk, Nicholas Christian, Chester Good","doi":"10.18553/jmcp.2024.30.12.1375","DOIUrl":"10.18553/jmcp.2024.30.12.1375","url":null,"abstract":"<p><strong>Background: </strong>Rates of attainment of high-quality diabetes care have been shown to be lower for those living in more disadvantaged and rural areas. Diabetes management relies on access to care and is impacted by physical, social, and economic factors. Area deprivation index (ADI) is one way to quantify geographic disparities in aggregate. We aimed to investigate how ADI impacts outcomes in members with type 2 diabetes enrolled in a large, regional health plan.</p><p><strong>Objective: </strong>To evalute clinical and economic objectives. Clinical objectives included the percentage of members who achieved hemoglobin A1c (A1c) goal level of 7% or less, the percentage of members who received comorbidity-focused therapies, noninsulin diabetes medication adherence, and the frequency and type of health care services used. Economic outcomes included per member per month differences in total cost of care, pharmacy cost, medical cost, and diabetes-associated cost.</p><p><strong>Methods: </strong>This retrospective review of pharmacy and medical claims included 8,814 adult members with newly diagnosed type 2 diabetes enrolled in an integrated health plan during calendar year 2021. To be included, members were required to be at least 18 years of age, reside in Pennsylvania, and have continuous enrollment for 2 years prior to type 2 diabetes diagnosis. State-level ADI data were derived for each member and applied to the Census block group on file in the administrative claims data. The study population deciles were grouped into ADI quintiles for analysis. Multivariable regression models and descriptive statistics were used to evaluate the association between ADI and outcomes while controlling for confounding variables.</p><p><strong>Results: </strong>There were no statistically significant differences between any ADI quintile for achievement of A1c goal or receipt of comorbidity-focused therapy. Significant differences were identified between ADI quintiles 1 (least deprived) and 5 (most deprived) for obtainment of at least 1 A1c test during calendar year 2021 (72% vs 56%, <i>P</i> < 0.01) and adherence to noninsulin diabetes medications (70% vs 62%, <i>P</i> < 0.01). Significant differences were also identified for all-cause inpatient, outpatient, and unplanned health care service utilization. The difference in per member per month all-cause total cost of care was on average $363.50 less for those living in ADI quintile 1 vs those in quintile 5 (<i>P</i> < 0.01).</p><p><strong>Conclusions: </strong>Significant differences were identified between ADI quintiles 1 and 5 for noninsulin diabetes medication adherence, frequency of A1c test claims, all-cause health care service utilization, and total cost of care. There were no statistically significant differences between ADI quintiles for achievement of A1c goal or receipt of comorbidity-focused therapies.</p>","PeriodicalId":16170,"journal":{"name":"Journal of managed care & specialty pharmacy","volume":"30 12","pages":"1375-1384"},"PeriodicalIF":2.3,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11607216/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142755048","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":"Patient perceptions of their experience with comprehensive medication reviews: A framework for continued quality improvement.","authors":"Melissa Castora-Binkley, Shalini Selvarajah, Mariana Felix, Patrick J Campbell, Heather Black, Terri Warholak, David R Axon","doi":"10.18553/jmcp.2024.30.12.1385","DOIUrl":"10.18553/jmcp.2024.30.12.1385","url":null,"abstract":"<p><strong>Background: </strong>A comprehensive medication review (CMR) is an annual service offered to eligible Medicare Part D beneficiaries as a component of the Medication Therapy Management program. However, little is known about the most meaningful aspect of CMRs from the patient's perspective. This information is necessary to help improve the service.</p><p><strong>Objective: </strong>To conduct concept elicitation interviews with patients who recently received a CMR to guide quality improvement efforts.</p><p><strong>Methods: </strong>Those who recently received a telephonic CMR were invited to participate in semistructured interviews to provide their insights on the CMR service. An interview guide was used and contained the following 6 key questions (with additional probing questions) exploring: (1) overall experience, (2) medication knowledge, (3) concerns, (4) management, (5) satisfaction, and (6) experience. Interviews were transcribed and analyzed thematically.</p><p><strong>Results: </strong>Interviews were conducted with 42 patients and resulted in the identification of themes related to the CMR service that were most meaningful to patients. The resulting framework contained 3 themes related to the content of the CMR (eg, medication review), the characteristics of the pharmacy professional (eg, professionalism), and the interaction during the CMR (eg, the telephonic experience). Intrinsic patient factors (eg, prior experiences) were also identified as important to contextualize patients' experiences.</p><p><strong>Conclusions: </strong>The framework provides concrete examples of the need for continued quality improvement of the CMR service and can be illustrated using the structure-process-outcome model. Patient perspectives should be accounted for in future quality improvement activities.</p>","PeriodicalId":16170,"journal":{"name":"Journal of managed care & specialty pharmacy","volume":"30 12","pages":"1385-1394"},"PeriodicalIF":2.3,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11607213/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142755178","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}