American Journal of Managed Care最新文献

{"title":"Management updates in heart failure with mildly reduced or preserved ejection fraction.","authors":"Jamie Grossman, Bashir Kalayeh, Brian Hocum","doi":"10.37765/ajmc.2026.89948","DOIUrl":"https://doi.org/10.37765/ajmc.2026.89948","url":null,"abstract":"<p><p>Heart failure (HF) is a clinical syndrome characterized by structural or functional impairments in ventricular filling or the ejection of blood from the heart. In the United States, HF represents a growing public health concern, affecting an estimated 6.7 million adults 20 years or older, with prevalence expected to continue rising. Despite advances in guideline-directed medical therapy (GDMT), rates of hospitalization and mortality remain high. Therapeutic options are particularly limited for the most prevalent HF phenotypes-HF with preserved ejection fraction (HFpEF) and HF with mildly reduced ejection fraction (HFmrEF)-resulting in substantial unmet clinical need. This supplement reviews the pathophysiology, epidemiology, and staging of HF with an emphasis on HFmrEF and HFpEF, and summarizes current GDMT recommendations, including the evolving roles of SGLT2 inhibitors and mineralocorticoid receptor antagonists (MRAs). A main focus is on the safety and efficacy of finerenone, a nonsteroidal MRA, as an adjunct to standard therapy in patients with HFmrEF or HFpEF. Persistent barriers to optimal care-including challenges related to diagnostic nomenclature, coding, and access-contribute to a disproportionate economic burden associated with these HF phenotypes. Together, these considerations highlight the need for managed care strategies that facilitate appropriate initiation of therapy and access to emerging treatments to improve outcomes while addressing health care resource utilization.</p>","PeriodicalId":50808,"journal":{"name":"American Journal of Managed Care","volume":"32 6 Suppl","pages":"S87-S94"},"PeriodicalIF":2.1,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147845763","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A systematic literature search and narrative synthesis of economic drivers in hospitalizations for heart failure with preserved or mildly reduced ejection fraction in the United States.","authors":"Fiona Stewart, Malia Gill, Kristin Kistler, Brian Hocum, Arvind Katta, Andrew B Oliveira","doi":"10.37765/ajmc.2026.89949","DOIUrl":"https://doi.org/10.37765/ajmc.2026.89949","url":null,"abstract":"<p><strong>Background: </strong>Heart failure (HF) with mildly reduced ejection fraction (HFmrEF) or preserved EF (HFpEF) constitutes 74% of all HF cases in the US and is associated with significant clinical and economic burdens. Hospitalizations for HFmrEF/HFpEF are a leading contributor to the rising economic burden of HF. This literature review aims to identify key drivers of hospitalization costs for patients with HFmrEF/HFpEF in the US and to inform targeted interventions to reduce health care expenditures.</p><p><strong>Methods: </strong>A comprehensive search of MEDLINE and Embase was conducted to identify observational studies published between January 2022 and May 2025 that reported on hospitalization-related costs for US adults with HFmrEF/HFpEF (defined as left ventricular ejection fraction ≥ 40%). Eligible studies were those reporting direct costs of hospitalization, readmission rates, time to readmission, length of stay, and number of hospitalizations per person. Data were synthesized narratively, and costs were adjusted to 2025 US$.</p><p><strong>Results: </strong>Of 2624 records identified by the literature searches, 37 studies met inclusion criteria. Total annual costs for HFmrEF/HFpEF were $36,921 to $49,081 per person per year (PPPY), with inpatient hospitalizations accounting for nearly half ($18,844-$20,095 PPPY). Readmissions were a major cost driver, with median all-cause readmission costs ($21,371-$28,615) consistently higher than index admission costs ($13,763-$14,944). Approximately 20% of patients were readmitted within 30 days, with HF-specific readmissions accounting for one-third of 30-day readmissions. Comorbidities such as type 2 diabetes (T2D) and chronic kidney disease (CKD) significantly increased costs, with patients having multiple morbidities incurring nearly double the costs of individuals without comorbidities. Prolonged hospital stay was also linked to higher costs.</p><p><strong>Conclusions: </strong>HFmrEF/HFpEF hospitalizations represent a significant economic burden that is driven by high inpatient costs, frequent readmissions, and coexisting conditions (eg, T2D, CKD). These findings highlight the need for improved adherence to guideline-directed medical therapy and better management of comorbidities. Policymakers and health care providers should prioritize strategies to reduce HF-related hospitalizations and readmissions to mitigate the growing economic impact of HF.</p>","PeriodicalId":50808,"journal":{"name":"American Journal of Managed Care","volume":"32 6 Suppl","pages":"S95-S111"},"PeriodicalIF":2.1,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147845790","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prevalence, resource utilization, and economic impact of kidney function and proteinuria in patients with focal segmental glomerulosclerosis.","authors":"Mark E Bensink, Kamlesh M Thakker, Edgar V Lerma, Richard M Lieblich, C Martin Bunke, Kaijun Wang, Wu Gong, Andrew Rava, Michael V Murphy, David Oliveri, Diana T Amari, David Cork, Juan Carlos Q Velez","doi":"10.37765/ajmc.2026.89831","DOIUrl":"10.37765/ajmc.2026.89831","url":null,"abstract":"<p><strong>Background: </strong>Among patients with focal segmental glomerulosclerosis (FSGS), proteinuria and kidney function decline may be associated with increased economic burden. This study aimed to provide current information on the epidemiology and economic burden of FSGS in the United States.</p><p><strong>Methods: </strong>In this descriptive, noninterventional, retrospective cohort study, 9899 patients were identified between January 2016 and December 2020 in Optum de-identified Market Clarity Data based on International Classification of Diseases code or Optum proprietary natural language processing data. Descriptive statistics were reported for categorical and continuous variables. Prevalence estimates were standardized to the age, gender, and race/ethnicity distribution of the general US population using direct methods and data from the 2021 United States Census Bureau. Per-patient-per-month health care resource utilization and associated costs (2024 US $) were reported by proteinuria (≤ 1.5 g/g vs > 1.5 g/g or < 3.5 g/g vs ≥ 3.5 g/g) and chronic kidney disease stage (stage 1-5/kidney failure). The Fisher exact test was used for categorical health care resource utilization outcomes, and linear regression (mean) and the Jonckheere-Terpstra test (medians) were used for continuous health care resource utilization and cost outcomes.</p><p><strong>Results: </strong>Estimated annual US prevalence (average for 2016-2020) of FSGS was 212.6 per 1 million. There was a consistent trend toward higher health care resource utilization and total costs with both chronic kidney disease progression (stage 1-5/kidney failure) and higher levels of proteinuria (≤ 1.5 g/g vs > 1.5 g/g or < 3 .5 g/g vs ≥ 3.5 g/g).</p><p><strong>Conclusions: </strong>The observed prevalence of FSGS increased in the US and was highest among Black individuals. More advanced chronic kidney disease and higher levels of proteinuria were both associated with greater health care resource utilization and costs. Treatments that reduce proteinuria and slow kidney function decline have the potential to delay disease progression and to reduce the economic burden associated with FSGS.</p>","PeriodicalId":50808,"journal":{"name":"American Journal of Managed Care","volume":" ","pages":"S116-S125"},"PeriodicalIF":2.1,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145507892","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Review of the clinical, humanistic, and economic burden of focal segmental glomerulosclerosis.","authors":"Mark E Bensink, Chris Gisler, Colin Navickas","doi":"10.37765/ajmc.2026.89947","DOIUrl":"https://doi.org/10.37765/ajmc.2026.89947","url":null,"abstract":"<p><p>Focal segmental glomerulosclerosis (FSGS) is a progressive glomerular disease characterized by podocyte injury, proteinuria, and risk of kidney failure. Until recently, no medicines had been approved by the FDA or European Medicines Agency, with management focused on supportive care and proteinuria reduction. This supplement explores the burden of FSGS from a clinical, humanistic, and economic perspective, informed by the results of 3 systematic literature reviews. FSGS is associated with poorer quality of life and high health care costs, and these outcomes are correlated with disease severity. Kidney Disease: Improving Global Outcomes guidelines recommend monitoring estimated glomerular filtration rate (eGFR) for kidney function; however, it is acknowledged that given the variable decline in FSGS, eGFR is not an ideal trial end point. Consequently, proteinuria reduction has become the preferred surrogate efficacy end point, as supported by the International Society of Glomerular Disease's global Proteinuria and Other Biomarkers as Endpoints for Clinical Trials in Kidney Disease initiative and subsequent FDA endorsement. Available treatments, such as glucocorticoids or calcineurin inhibitors, are limited in efficacy and safety. Among emerging medicines, sparsentan, a dual endothelin and angiotensin receptor antagonist (DEARA), has demonstrated consistent and significant reductions in proteinuria among patients with primary and genetic FSGS resulting in its approval by the FDA to reduce proteinuria in adult and pediatric patients aged 8 years and older with FSGS without nephrotic syndrome. In the phase 2 DUET clinical trial (NCT01613118), those treated with sparsentan showed a urine protein-creatinine ratio reduction of -35.6% (95% CI, -46.3% to -24.6%) vs baseline at 240 weeks. Sparsentan also showed greater reductions in proteinuria vs irbesartan, a standard renin-angiotensin system agent, along with a comparable safety profile in the phase 3 DUPLEX trial (NCT03493685). In model-based projections among real-world registry cohorts, sustained reductions in proteinuria are associated with lower long-term risk of kidney failure. These findings align with the PARASOL-FSGS initiative, supporting the role of proteinuria reduction as a key end point, facilitating pragmatic trial designs to address the persistent treatment gap in FSGS.</p>","PeriodicalId":50808,"journal":{"name":"American Journal of Managed Care","volume":"32 7 Suppl","pages":"S126-S137"},"PeriodicalIF":2.1,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147845829","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Refining a diagnostic code list to investigate low-acuity utilization by veterans.","authors":"Anu Ramachandran, Justine Seidenfeld, Derek Boothroyd, Steven M Asch, Anita A Vashi","doi":"10.37765/ajmc.2026.89924","DOIUrl":"https://doi.org/10.37765/ajmc.2026.89924","url":null,"abstract":"<p><strong>Objectives: </strong>Recent Veterans Affairs (VA) legislation expanding access to community (non-VA) emergency care use has important implications for budget and policy. Understanding drivers of community emergency department (ED) and urgent care (UC) utilization for low-acuity conditions is crucial for budgeting and improving care continuity, but current tools for identifying low-acuity ED visits have significant limitations. This study aimed to update and make publicly available a dichotomous diagnosis code list to identify low-acuity ED visits. We describe low-acuity community ED/UC visits and their users and assess patient-level characteristics associated with the use of community facilities.</p><p><strong>Study design: </strong>Retrospective cross-sectional study.</p><p><strong>Methods: </strong>We evaluated all International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) diagnoses with at least 100 ED visits across fiscal years 2018-2023. Severity probabilities were calculated and reviewed by 3 study personnel. Summary statistics were used to describe low-acuity community ED/UC visits. A logistic regression model was fitted to determine patient-level factors associated with using community settings for low-acuity care.</p><p><strong>Results: </strong>For code list refinement, 4694 ICD-10 codes were reviewed, with 2439 (52.0%) rated as low acuity. Visits to community EDs and UCs for low-acuity conditions rose over the study period. Low-acuity diagnoses constituted 35.1% of community ED visits and 83.8% of community UC visits. Being younger, being female, and living farther from a VA ED were associated with greater odds of using community settings for low-acuity care.</p><p><strong>Conclusions: </strong>Community ED and UC utilization for low-acuity conditions remains below rates in VA settings but is rising, resulting in increased non-VA spending. Targeted interventions may be useful in redirecting low-acuity community ED use to lower-cost settings.</p>","PeriodicalId":50808,"journal":{"name":"American Journal of Managed Care","volume":"32 4","pages":"e118-e125"},"PeriodicalIF":2.1,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147788201","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Growth of dual-eligible special needs plans following permanent authorization.","authors":"Roshani Dahal, Sayeh Nikpay, Peter J Huckfeldt, Helen M Parsons","doi":"10.37765/ajmc.2026.89926","DOIUrl":"https://doi.org/10.37765/ajmc.2026.89926","url":null,"abstract":"<p><strong>Objective: </strong>To examine trends in Dual-Eligible Special Needs Plan (D-SNP) offerings and enrollment before and after permanent authorization in 2018.</p><p><strong>Study design: </strong>Retrospective descriptive analysis.</p><p><strong>Methods: </strong>We analyzed publicly available monthly SNP Comprehensive Reports, comparing preauthorization (2010-2018) and postauthorization (2019-2025) periods. We calculated annual totals of D-SNPs and enrollees along with mean annual growth rates for both periods.</p><p><strong>Results: </strong>The mean annual growth rate of unique D-SNP offerings increased from 10.0% preauthorization to 16.2% post authorization. Enrollment of dually eligible beneficiaries increased from a mean annual growth rate of 0.3% preauthorization to 12.8% post authorization. D-SNP enrollment has steadily increased, more than doubling over the past 5 years. By January 2025, there were 986 D-SNPs with 6,030,665 dual enrollees, representing approximately 44% of total dual enrollees.</p><p><strong>Conclusions: </strong>The significant acceleration in both D-SNP offerings and enrollment reflects notable changes in the D-SNP market following permanent authorization. As states transitioned plans into D-SNPs through 2025, these specialized Medicare Advantage plans are positioned to play an increasingly vital role in addressing the complex needs of Medicare-Medicaid dual enrollees.</p>","PeriodicalId":50808,"journal":{"name":"American Journal of Managed Care","volume":"32 4","pages":"e133-e137"},"PeriodicalIF":2.1,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147788195","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Medication use for patients with obesity: trends and characteristics for US employees.","authors":"Chester B Good, Ian A Beren, Eric M Rosenberg, Samuel K Peasah, Richard A Brook","doi":"10.37765/ajmc.2026.89920","DOIUrl":"https://doi.org/10.37765/ajmc.2026.89920","url":null,"abstract":"<p><strong>Objectives: </strong>Obesity has a US prevalence of more than 40% and is associated with many comorbid conditions, posing a significant burden on employers. Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are recently available and effective weight loss agents. We examined characteristics and outcomes of employees with obesity and those using vs not using GLP-1 RAs.</p><p><strong>Study design: </strong>Retrospective analysis of employee patients in Workpartners Research Reference Database from 2016 to 2023.</p><p><strong>Methods: </strong>Employees with obesity claims were identified and assigned to annual cohorts based on first year of obesity diagnosis (index). Study employees had at least 1 year of continuous data following their index diagnosis. Annual employee characteristics, comorbidities, absences, disability claims, and direct cost trends were explored for the year following diagnosis. Employees with obesity using and not using GLP-1 RAs were compared on the same metrics. Costs were inflation adjusted to December 2023 US$.</p><p><strong>Results: </strong>We identified 127,408 employees with obesity. Obesity prevalence increased during the study. Employees with obesity and type 2 diabetes decreased slightly, and other comorbidities were relatively stable during the time frame. Overall, 5.8% of employees with obesity (n = 7359) used a GLP-1 RA. GLP-1 RA use increased annually (3.6% in 2016 to 18.3% in 2023) and accounted for approximately 30% of the cohort's 2023 pharmacy costs. During the 12-month study period, compared with non-GLP-1 RA users, those using GLP-1 RAs had higher Charlson Comorbidity Index scores (difference = 0.71), higher proportions with all study comorbidities, $11,360 higher direct all-category costs (total medical costs were $12,092 [19.4%] higher), and 0.86 more absence days.</p><p><strong>Conclusions: </strong>Prevalence of obesity is increasing, and use of GLP-1 RAs as the preferred antiobesity medication has increased as well. The long-term impact of this increased use warrants monitoring and management.</p>","PeriodicalId":50808,"journal":{"name":"American Journal of Managed Care","volume":"32 4","pages":"238-244"},"PeriodicalIF":2.1,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147788208","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Billing for tobacco cessation: enhancing data quality and revenue capture.","authors":"Derek J Baughman, Marcus Rauhut, Ishan Mahajan, Allison McCoy, Edward Anselm","doi":"10.37765/ajmc.2026.89917","DOIUrl":"10.37765/ajmc.2026.89917","url":null,"abstract":"<p><strong>Objectives: </strong>This study aimed to quantify the economic impact of missed billing opportunities for tobacco cessation counseling at an academic medical center to identify what may be a systematic defect in the administration of tobacco cessation services and to highlight opportunities to improve patient outcomes and revenue. Patient surveys show that evidence-based tobacco cessation interventions are provided at low rates despite guidelines supporting the use of these services at every eligible encounter.</p><p><strong>Study design: </strong>Retrospective cohort study.</p><p><strong>Methods: </strong>The study analyzed deidentified patient health data from electronic health records at an academic medical center, focusing on primary care encounters from January 1, 2020, to December 31, 2023, involving patients 18 years and older with a history of current tobacco use. Billing data for tobacco cessation counseling ( Current Procedural Terminology codes 99406 or 99407) were examined to estimate revenue loss from unbilled eligible encounters.</p><p><strong>Results: </strong>Of 1,068,875 primary care visits, 16.8% (179,304) involved tobacco users. However, only 1.0% of these encounters were billed for cessation services, representing an estimated potential revenue loss of $3.2 million over 4 years.</p><p><strong>Conclusions: </strong>These findings identify a significant discrepancy between the billing of tobacco cessation services and the opportunities to do so. Better provision and billing of tobacco cessation counseling can improve patient health outcomes, advance value-based care goals, and enhance financial sustainability.</p>","PeriodicalId":50808,"journal":{"name":"American Journal of Managed Care","volume":"32 4","pages":"212-217"},"PeriodicalIF":2.1,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147788187","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Benefit design and consumer information: results from a randomized trial.","authors":"Tim McDonald, Katie White, Tsan-Yao Huang, Tyler Boese, Bryan E Dowd","doi":"10.37765/ajmc.2026.89918","DOIUrl":"https://doi.org/10.37765/ajmc.2026.89918","url":null,"abstract":"<p><strong>Objectives: </strong>To test whether consumer inertia in choosing primary care clinics (PCCs) in a tiered total cost of care system can be reduced by supplying tailored information on clinic cost directly to consumers during open enrollment.</p><p><strong>Study design: </strong>Randomized controlled trial among individuals with employment-based health insurance. Members were randomly assigned by their zip code of residence, with 100 zip codes assigned to the treatment group and 100 to the control group.</p><p><strong>Methods: </strong>During the open enrollment period for calendar year 2020, members in the treatment group received emails providing enhanced tier information on the most popular PCCs in their zip code. We ran regression analyses to evaluate the marginal effect of the targeted intervention on consumer choice.</p><p><strong>Results: </strong>The intervention had only a small marginal effect on choice of PCC. Before the intervention, nearly 85% of consumers were selecting PCCs in the 2 tiers with the lowest cost sharing, suggesting that tiering alone may already have addressed the problems of poor information and distorted prices inherent in many health insurance designs.</p><p><strong>Conclusions: </strong>Providing members with enhanced tier information on local PCCs had a limited marginal effect on consumer choice, suggesting that informational interventions alone are insufficient to overcome existing inertia or, potentially, that consumers were already adequately informed through the tiered total cost of care benefit design.</p>","PeriodicalId":50808,"journal":{"name":"American Journal of Managed Care","volume":"32 4","pages":"219-225"},"PeriodicalIF":2.1,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147788213","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Initiation of the interchangeable biosimilar insulin glargine-yfgn among older adults.","authors":"Shivani R Khan, Debra A Heller, Leroy L Latty, Michelle LaSure, Theresa V Brown","doi":"10.37765/ajmc.2026.89925","DOIUrl":"https://doi.org/10.37765/ajmc.2026.89925","url":null,"abstract":"<p><strong>Objective: </strong>The approval of the biosimilar insulin glargine-yfgn presents a cost-effective alternative for diabetes management. This study assessed insulin glargine-yfgn initiation among older adults using insulin glargine in Pennsylvania.</p><p><strong>Study design: </strong>This retrospective cohort study included insulin glargine users 65 years and older who were enrolled in Pennsylvania's Pharmaceutical Assistance Contract for the Elderly program from July 1, 2021, to June 30, 2023.</p><p><strong>Methods: </strong>The primary exposure variable, prior insulin glargine use between July 1 and December 31, 2021, was classified into 5 categories: no use, Lantus alone, Basaglar alone, Toujeo alone, and multiple insulin glargine types. The main outcome, insulin glargine-yfgn initiation, was classified based on having at least 1 insulin glargine-yfgn (branded Semglee or unbranded version) prescription between January 1, 2022, and June 30, 2023. Chi-square tests and multivariate logistic regression were used to examine factors associated with insulin glargine-yfgn initiation.</p><p><strong>Results: </strong>Among 6866 patients, 3.7% initiated insulin glargine-yfgn. Insulin glargine-yfgn initiators were less likely than noninitiators to have previously used Lantus, Basaglar, or Toujeo. They were more likely to reside in rural counties (adjusted OR [AOR], 1.39; P = .0135), be in long-term care facilities (AOR, 2.10; P = .0069), and have multiple prescribers (≥ 3 prescribers: AOR, 3.23; P < .0001) compared with noninitiators. Only 1.6% of insulin glargine prescriptions were for insulin glargine-yfgn, with relatively more prescriptions filled at nursing home pharmacies and written by physicians.</p><p><strong>Conclusions: </strong>Insulin glargine-yfgn use among older adults is low despite its cost-effectiveness. Overcoming barriers related to prescribing patterns, formulary placement and reimbursement challenges, and pharmacy channels could improve insulin glargine-yfgn adoption, reducing diabetes care costs.</p>","PeriodicalId":50808,"journal":{"name":"American Journal of Managed Care","volume":"32 4","pages":"e126-e132"},"PeriodicalIF":2.1,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147788219","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}