American Journal of Managed Care最新文献

{"title":"Justified Billing Practices Can Improve Revenue for Weight-Focused Visits.","authors":"Leigh Perreault, Carlos Rodriguez, Jodi Summers Holtrop, R Mark Gritz","doi":"10.37765/ajmc.2026.89927","DOIUrl":"10.37765/ajmc.2026.89927","url":null,"abstract":"<p><strong>Objective: </strong>To determine whether implementation of a care process for weight management, which included guidance on billing for weight-focused care, changed primary care practice procedure coding and revenue for these visits.</p><p><strong>Study design: </strong>PATHWEIGH, a cluster randomized, stepped-wedge pragmatic trial, was conducted across 56 primary care clinics in a single health system.</p><p><strong>Methods: </strong>We identified patients receiving weight-focused care by provider use of weight-related diagnostic codes for billing recorded in the electronic health record (EHR). EHR-derived procedure codes for billing were used to examine coding practices for these visits during usual care and intervention phases. Practice revenue for these encounters was calculated based on published mean allowed amounts from paid claims submitted by commercial insurance, Medicare, and Medicaid payers to the Colorado All Payer Claims Database.</p><p><strong>Results: </strong>Use of 55 unique code combinations was significantly different ( P  < .001) between the usual care and intervention phases. The proportion of weight-focused visits with multiple procedure codes recorded for billing was 14% in the usual care phase vs 19% in the intervention phase, with a shift toward the use of higher-level evaluation and management codes (99214/99215 vs 99213) during the intervention phase. Changes in code combinations resulted in higher mean reimbursements for both initial and subsequent weight-focused visits during the intervention phase compared with usual care. These coding changes increased revenue for the 124,621 weight-focused visits in the intervention phase by $1,071,293.</p><p><strong>Conclusions: </strong>Having a care process for weight management in primary care that includes guidance for billing can increase primary care practice revenue for weight-focused care.</p>","PeriodicalId":50808,"journal":{"name":"American Journal of Managed Care","volume":"32 8","pages":"429-431"},"PeriodicalIF":2.1,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148841969","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":"Trends and Disparities in High-Risk Nonsteroidal Anti-Inflammatory Drug Utilization.","authors":"Michelle S Rockwell, Christopher Grubb, Jamie K Turner, Matthew Vinson, Isaiah Yim, Alexandra L Hanlon, John W Epling","doi":"10.37765/ajmc.2026.90002","DOIUrl":"https://doi.org/10.37765/ajmc.2026.90002","url":null,"abstract":"<p><strong>Objectives: </strong>Regular use of nonsteroidal anti-inflammatory drugs (NSAIDs) poses a risk to patients with chronic kidney disease (CKD), heart failure (HF), and hypertension (HTN). We evaluated changes in NSAID utilization among a large cohort of Virginia patients with CKD, HF, and/or HTN during the COVID-19 pandemic and assessed variation by patient demographic characteristics.</p><p><strong>Study design: </strong>Quasi-experimental difference-in-differences approach.</p><p><strong>Methods: </strong>Using claims from the Virginia All-Payer Claims Database, we identified NSAID prescriptions dispensed to patients with CKD, HF, and/or HTN during the years 2019-2021. We applied Poisson regression to assess the impact of the COVID-19 pandemic (March 1, 2020- December 31, 2021) on NSAID utilization rates, stratifying incidence rate ratios (IRRs) by rurality, sex, and age.</p><p><strong>Results: </strong>Extrapolated to the statewide population, approximately 3.8 million NSAID prescriptions were dispensed to Virginians with CKD, HF, and/or HTN between 2019 and 2021. Utilization rates declined by 23% during the first 2 years of the pandemic, were greater in rural vs urban areas (IRR, 1.594; 95% CI, 1.408-1.803) and among those aged 40 to 64 years, 65 to 79 years, and 80 years and older vs those aged 18 to 39 years (40-64 years: IRR, 6.366; 95% CI, 5.979-6.778; 65-79 years: IRR, 6.980; 95% CI, 6.568-7.417; ≥ 80 years: IRR, 5.223; 95% CI, 4.772-5.715); and were lower among men than women (IRR, 0.779; 95% CI, 0.758-0.800). The pandemic impacted rural and urban areas and women and men similarly but was associated with lower NSAID utilization among the 3 older age groups vs those aged 18 to 39 years (40-64 years: IRR, 0.869; 95% CI, 0.812-0.931; 65-79 years: IRR, 0.788; 95% CI, 0.733-0.847; ≥ 80 years: IRR, 0.769; 95% CI, 0.709-0.833).</p><p><strong>Conclusions: </strong>Despite a modest decline during the first 2 years of the pandemic, NSAID use remains prevalent among patients with CKD, HF, and/or HTN, especially in rural areas and among women. Results highlight the need for tailored deprescribing efforts.</p>","PeriodicalId":50808,"journal":{"name":"American Journal of Managed Care","volume":"32 8","pages":"464-468"},"PeriodicalIF":2.1,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148841993","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":"Predicting GLP-1 Discontinuation From Pharmacy Claims.","authors":"Aayush Sisodia","doi":"10.37765.ajmc.2026.89993","DOIUrl":"10.37765.ajmc.2026.89993","url":null,"abstract":"<p><p>Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) have rapidly become high-visibility therapies for type 2 diabetes and obesity, with growing evidence of cardiovascular benefit. Yet multiple real-world studies show that adherence and persistence are modest: In obesity cohorts without diabetes, approximately one-third of members remain on therapy at 1 year, and among those with type 2 diabetes, nearly half discontinue by 12 months and approximately 70% by 24 months. This gap between trial efficacy and real-world use raises critical questions for payers, pharmacy benefit managers, and employers funding GLP-1 RA coverage. This commentary proposes a pragmatic, claims-based framework for improving GLP-1 RA persistence. Routine pharmacy claims can be used to define new-start cohorts, calculate standard measures such as the proportion of days covered, and identify early warning signs, including delayed refills, prolonged use of starter doses, high out-of-pocket costs, and patterns of gastrointestinal adverse effects. These signals can drive simple rule-based alerts and, where appropriate, low-complexity predictive models to prioritize outreach. Clinical pharmacists, nurse case managers, and digital tools can then translate these risk flags into concrete support for members-such as cost navigation, adverse effect management, expectation setting, and coordination with prescribers-while maintaining a \"do no harm\" stance. Finally, the commentary highlights the importance of monitoring GLP-1 RA persistence through an equity lens, ensuring that supportive interventions reduce, rather than widen, disparities in access and outcomes.</p>","PeriodicalId":50808,"journal":{"name":"American Journal of Managed Care","volume":"32 8","pages":"426-428"},"PeriodicalIF":2.1,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148842038","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":"Impact of an Intensive Outpatient Clinic Model on Health Care Utilization and Cost.","authors":"Jaewhan Kim, Kenechukwu C Ben-Umeh, Steven Hayworth, Jacob Kean, Brittany L Sisco-Taylor, Angela Fagerlin, Elissa M Ozanne, Peter Weir","doi":"10.37765/ajmc.2026.89915","DOIUrl":"10.37765/ajmc.2026.89915","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the impact of an intensive outpatient clinic (IOC) model on health care utilization and costs among medically and behaviorally complex adults enrolled in a Medicaid managed care organization.</p><p><strong>Study design: </strong>A retrospective cohort study using interrupted time series (ITS) and Bayesian structural time series (BSTS) analysis was conducted to examine changes in health care use and costs before and after IOC enrollment.</p><p><strong>Methods: </strong>Observational claims data from 2015 to 2023 were analyzed for 150 adults who enrolled in an IOC between 2017 and 2023. Outcomes included total, medical, and pharmacy costs; hospital admissions; and emergency department (ED) visits, tracked 24 months before and after enrollment.</p><p><strong>Results: </strong>Mean annual health care spending decreased by 43% 2 years after IOC enrollment. ITS analysis showed significant monthly reductions in total spending (-$142; 95% CI, -$242 to -$42; P  < .01) and medical costs (-$129; 95% CI, -$229 to -$29; P  = .01). Hospital admissions and ED visits declined by 36 (95% CI, -58 to -13; P  < .01) and 25 (95% CI, -35 to -16; P  < .01) per 1000 patients per month, respectively. BSTS estimates showed a 6% decrease in total spending, a 10% decrease in medical costs, and a 28% decrease in ED visits.</p><p><strong>Conclusions: </strong>The IOC was associated with significant reductions in health care costs and utilization among medically and behaviorally complex adults. Scalable interventions such as an IOC may help improve care coordination and reduce costs for high-risk Medicaid populations.</p>","PeriodicalId":50808,"journal":{"name":"American Journal of Managed Care","volume":"32 7","pages":"406-412"},"PeriodicalIF":2.1,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148814760","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":"The New Oncology Blueprint: Integrating Clinical Intelligence for Sustainable Value.","authors":"Vivian T E Tar","doi":"10.37765/ajmc.2026.89985","DOIUrl":"10.37765/ajmc.2026.89985","url":null,"abstract":"<p><p>Oncology is one of the most exciting yet most challenging areas of health care. Scientific advances in immunotherapies, targeted agents, and cell and gene therapies are transforming survival, but costs are rising just as quickly. Global oncology spending is projected to exceed $400 billion by 2028, with more than half concentrated in just 5 tumor types. These dynamics present a critical challenge for payers-pharmacy benefit managers and health plans-to sustain access to innovation while protecting the long-term viability of the health care system. Traditional tools such as step therapy, prior authorization, and formulary tiers, although important in many areas of care, struggle to keep pace with oncology, where treatment is adaptive, evidence evolves rapidly, and care decisions are highly personalized. Fragmented benefits and siloed data further obscure the total cost of care and hinder coordination across the patient journey. This article outlines a sustainable path forward: a systems-level blueprint that places patient and system outcomes at the center, supported by clinically intelligent utilization management tools, aligned incentives across benefits, whole-patient support, and collaborative partnerships. Together, these levers create a unified framework that enhances patient experience while enabling payers and providers to focus on value, not volume.</p>","PeriodicalId":50808,"journal":{"name":"American Journal of Managed Care","volume":"32 7","pages":"e217-e221"},"PeriodicalIF":2.1,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148814915","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":"Roles and Priorities Guiding Medicare Advantage Postacute Home Health Referrals.","authors":"Emily A Gadbois, Jennifer Bunker, Marguerite Daus, Jamie M Smith, Emily Buss, Christine D Jones, Kali S Thomas","doi":"10.37765/ajmc.2026.89990","DOIUrl":"10.37765/ajmc.2026.89990","url":null,"abstract":"<p><strong>Objectives: </strong>Home health care (HHC) helps patients-including those recently discharged from the hospital-regain function and maintain independence. The provision of postacute HHC is influenced by multiple players: Medicare Advantage (MA) plans, postacute care management companies (CMCs), hospitals, home health agencies (HHAs), and patients and families. This study sought to characterize the roles and priorities of these players in organizing and delivering postacute HHC.</p><p><strong>Study design: </strong>In-depth, semistructured interviews with 44 leaders of MA plans, CMCs, and HHAs across the US.</p><p><strong>Methods: </strong>Interviews were recorded, transcribed, and analyzed using content analysis.</p><p><strong>Results: </strong>MA plans and CMCs agreed that home is the ideal setting for postacute care; however, MA plans and CMCs varied in their involvement in referrals, and HHAs viewed their involvement as burdensome (theme 1). According to MA plan, CMC, and HHA leaders, a hospital's role is to select the appropriate postacute care setting, but participants reported that selections can be influenced by relationships with MA plans and HHAs (theme 2). HHAs were reported to balance clinical complexity, staffing, patient location, and payer when accepting referrals, but they had relatively limited control in the referral process (theme 3). Participants expressed that patients prioritized prior experiences, recommendations, quality of care, access, and timeliness when making decisions; however, patients had a minimal role and limited information to guide decision-making (theme 4).</p><p><strong>Conclusions: </strong>Findings can help policy makers, payers, HHAs, hospitals, and patients understand the varied roles and shared incentives in coordinating postacute HHC for vulnerable older adults.</p>","PeriodicalId":50808,"journal":{"name":"American Journal of Managed Care","volume":"32 7","pages":"e249-e262"},"PeriodicalIF":2.1,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148814804","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":"State Medicaid Budgetary Implications of New Cancers.","authors":"Amanda C Chen, Anuraag R Kansal, David C Grabowski","doi":"10.37765/ajmc.2026.89988","DOIUrl":"10.37765/ajmc.2026.89988","url":null,"abstract":"<p><strong>Objectives: </strong>The burden of a new cancer diagnosis on state Medicaid programs is not well understood. Our study aimed to (1) quantify Medicaid program spending, use of health care services, and enrollment patterns among Medicaid beneficiaries newly diagnosed with cancer; and (2) assess how spending and health care use differ between a new metastatic and a new nonmetastatic cancer diagnosis.</p><p><strong>Study design: </strong>Cross-sectional study.</p><p><strong>Methods: </strong>This study used Transformed Medicaid Statistical Information System Analytic Files (2016-2019) to identify Medicaid beneficiaries 50 years and older who were newly diagnosed with cancer in 2017 and 2018. We provide descriptive evidence about their use of health care resources and used linked Medicare-Medicaid claims to follow enrollment patterns among dual-eligible beneficiaries. We also used generalized estimating equations to compare Medicaid program spending among those diagnosed with a new metastatic vs nonmetastatic cancer. Study measures were differences in total Medicaid spending, hospitalizations and emergency department visits per year, and Medicaid enrollment status at the end of the study (ie, continuously enrolled, disenrolled, or died) by metastatic status.</p><p><strong>Results: </strong>We identified 291,014 new cancer diagnoses among Medicaid beneficiaries 50 years and older (18.8% metastatic vs 81.2% nonmetastatic). A metastatic cancer diagnosis was associated with higher hospitalizations, emergency department use, and spending compared with a nonmetastatic cancer diagnosis.</p><p><strong>Conclusions: </strong>Our results quantify the cost and health care resource utilization burden borne by state Medicaid programs following a new cancer diagnosis. These findings can inform policy makers about the budgetary considerations associated with investing in reducing late-stage cancer diagnoses, such as through early detection and increased access to care.</p>","PeriodicalId":50808,"journal":{"name":"American Journal of Managed Care","volume":"32 7","pages":"e234-e241"},"PeriodicalIF":2.1,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148814886","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":"Cost-effectiveness of integrated behavioral health for depression, anxiety, and chronic pain.","authors":"Dennis Xuan, Jeffrey Burton, Lizheng Shi, Eboni G Price-Haywood","doi":"10.37765/ajmc.2026.89913","DOIUrl":"10.37765/ajmc.2026.89913","url":null,"abstract":"<p><strong>Objective: </strong>To conduct a cost-effectiveness analysis comparing behavioral health integration (BHI) in primary care vs clinical decision support (usual care) for adult patients with depression and/or anxiety taking chronic opioid therapy for noncancer pain.</p><p><strong>Study design: </strong>Piggyback economic analysis of data collected for 632 adult patients during a pragmatic, stepped-wedge, type 2 effectiveness-implementation hybrid trial conducted in a health system in Louisiana between April 2019 and June 2022.</p><p><strong>Methods: </strong>The study used decision tree analysis. The base case modeled study patients and assessed costs associated with interventions, acute care, ambulatory utilization, and prescriptions. Efficacy measures were modeled using quality-adjusted life-years (QALYs) and morphine equivalent daily dose (MEDD). Sensitivity analyses included 1-way sensitivity analysis and probabilistic sensitivity analysis (PSA). A US-based willingness to pay threshold range of $100,000 to $150,000 per QALY was used.</p><p><strong>Results: </strong>In the base case, the BHI group incurred a cost of $10,489.19 per patient for 1 year compared with $5673.96 for usual care. BHI was associated with 0.0439 QALYs gained, which yielded an incremental cost-effectiveness ratio (ICER) of $108,784 per QALY. The BHI group had a MEDD reduction of 7.3 mg/d compared with an increase of 2.0 mg/d among usual care. This translates into an ICER of $513.51 per 1-mg/d reduction. One-way sensitivity analysis and PSA indicated that the cost of prescriptions for both study groups as well as the cost of primary care providers and licensed clinical social workers for the BHI group were the biggest drivers of cost-effectiveness.</p><p><strong>Conclusions: </strong>BHI was cost-effective from the health system perspective, with reductions in prescription drug expenses being the primary driver of savings.</p>","PeriodicalId":50808,"journal":{"name":"American Journal of Managed Care","volume":" ","pages":"384-391"},"PeriodicalIF":2.1,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13127833/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147470115","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":"Readability of Hospital Patient Financial Policy Documents.","authors":"Samantha Randall, Sumedha Raghu, Ella Cho, Nina Linh Nguyen, Erin Trish, Erin L Duffy","doi":"10.37765/ajmc.2026.89984","DOIUrl":"10.37765/ajmc.2026.89984","url":null,"abstract":"<p><strong>Objectives: </strong>There are federal and state policies designed to enhance access to information about financial assistance and billing policies at hospitals, particularly nonprofit ones. This information is increasingly important as patients' out-of-pocket costs and medical debt rise, and those with low literacy may struggle in particular. This study assesses the availability and readability of hospital financial assistance and payment policy documents.</p><p><strong>Study design: </strong>Cross-sectional study of online patient financial policy documents collected from a random 10% (N = 336) sample of general nongovernmental hospitals in the US, March to June 2025.</p><p><strong>Methods: </strong>The Flesch-Kincaid Grade Level for readability was calculated for each financial assistance and payment policy document. Hospital characteristics associated with documents' availability and readability were analyzed using multivariate regression models.</p><p><strong>Results: </strong>The mean readability level of each policy document type was at least 10th grade. Nonprofit and system-affiliated hospitals were significantly more likely to provide patient financial policy documents in models adjusting for other hospital characteristics. Hospitals in states with expanded financial assistance requirements had more readable financial assistance policy documents than other hospitals. Teaching hospitals and hospitals receiving Disproportionate Share Hospital (DSH) payments had more readable billing and collections policies than their counterparts.</p><p><strong>Conclusions: </strong>These findings suggest that existing federal requirements for nonprofit hospitals correspond with greater availability of patient financial policy documents. Additionally, state policy environments, system affiliation, and DSH status correspond with better readability. Yet considering that a slim majority of Americans read below a 6th-grade level, the mean readability at the 10th-grade level for \"plain language\" policy documents may challenge some patients.</p>","PeriodicalId":50808,"journal":{"name":"American Journal of Managed Care","volume":"32 7","pages":"400-405"},"PeriodicalIF":2.1,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148814766","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":"Geographical Access to Preferred Pharmacies in Medicare Part D.","authors":"Pinka Chatterji, Yiran Han, Chun-Yu Ho","doi":"10.37765/ajmc.2026.89989","DOIUrl":"https://doi.org/10.37765/ajmc.2026.89989","url":null,"abstract":"<p><strong>Objectives: </strong>Objective: To examine geographic access to preferred pharmacies in Medicare Part D prescription drug plans (PDPs) and Medicare Advantage PDPs (MAPDs).</p><p><strong>Study design: </strong>We conducted a nationwide, retrospective analysis using Part D preferred pharmacies' data, Zip Code Tabulation Areas (ZCTAs) from the US census, and socioeconomic characteristics from the American Community Survey and the Area Health Resources Files from 2010 to 2024.</p><p><strong>Methods: </strong>We computed mean distance from the centroid of each ZCTA to the nearest preferred pharmacy in stand-alone PDPs and in MAPDs. We compared mean distance as well as additional distance to a preferred vs a nonpreferred pharmacy, across rural and urban ZCTAs, and across geographic areas with relatively high densities of different racial/ethnic groups. We employed regression models to evaluate the association between ZCTA-level characteristics and additional distance to a preferred pharmacy.</p><p><strong>Results: </strong>Rural areas in the West North Central, Mountain, and East South Central divisions of the US tended to lack preferred pharmacies in PDPs and MAPDs, as did some urban areas. Among ZCTAs with preferred pharmacies, a rural ZCTA was associated with a 0.734-mile longer additional distance ( P  < .01) among PDPs, which was more than double the mean additional distance. For MAPD plans, the additional distance for rural ZCTAs was 0.320 miles longer ( P  < .01), an 80% increase relative to the mean.</p><p><strong>Conclusions: </strong>Many rural and urban areas in the US lack preferred pharmacies. In areas with preferred pharmacies, distances were generally minimal relative to the cost savings, but rural-urban disparities persist.</p>","PeriodicalId":50808,"journal":{"name":"American Journal of Managed Care","volume":"32 7","pages":"e242-e248"},"PeriodicalIF":2.1,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148814677","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}