JAMA Health Forum最新文献

Can Prevention Save Money? 预防能省钱吗？

IF 9.5

JAMA Health Forum Pub Date : 2025-04-04 DOI: 10.1001/jamahealthforum.2025.1464

Katherine Baicker, Amitabh Chandra

引用次数: 0

Trends in Access to Medications for Opioid Use Disorder. 阿片类药物使用障碍药物获取的趋势。

IF 9.5

JAMA Health Forum Pub Date : 2025-04-04 DOI: 10.1001/jamahealthforum.2025.0393

Sumedha Gupta, Aditya James, Jennifer Miles, Hillary Samples, Stephen Crystal, Kosali Simon

{"title":"Trends in Access to Medications for Opioid Use Disorder.","authors":"Sumedha Gupta, Aditya James, Jennifer Miles, Hillary Samples, Stephen Crystal, Kosali Simon","doi":"10.1001/jamahealthforum.2025.0393","DOIUrl":"10.1001/jamahealthforum.2025.0393","url":null,"abstract":"Importance: Medicaid, the largest payer for medications for opioid use disorder (MOUD), disenrolled more than 19.1 million individuals by March 2024 after the continuous coverage requirement ended in April 2023-a process termed Medicaid unwinding-but the impact on buprenorphine receipt remains unknown.Objective: To assess the association between Medicaid unwinding and dispensing of prescription buprenorphine, overall and by payment sources nationally and by state.Design, setting, and participants: Cross-sectional study of buprenorphine dispensing (age ≥18 years) from April 2020 to March 2024 using the IQVIA Longitudinal Prescription (LRx) database containing more than 90% of US retail pharmacy claims. Interrupted time-series estimated levels and trends of buprenorphine prescription dispensation before and after Medicaid unwinding.Main outcomes and measures: The number of patients with filled buprenorphine prescriptions each month was analyzed by payer type (Medicaid, Medicare, commercial, or self-pay) and by state. Stratified analyses assessed state factors, including automated (ex parte) Medicaid renewal rates (higher or lower than the median), income verification sources used for automated renewals (≤3, 4-5, or 6-7), and Affordable Care Act Medicaid expansion status.Results: Of the 2 405 970 adults who filled buprenorphine prescriptions between April 2020 and March 2024, 1 154 866 (48%) had at least 1 fill covered by Medicaid, 288 716 (12%) by Medicare, 1 106 746 (46%) by commercial insurance, and 264 657 (11%) by self-pay. Medicaid unwinding was associated with reversal of previously increasing trends in buprenorphine prescriptions, with 2.9% fewer patients (-23 855 [95% CI, -32 661 to -15 054]) receiving buprenorphine each month by 8 months after unwinding vs the month before unwinding began. This decline was driven by a 12.7% drop in patients with Medicaid-paid fills (-46 545 [95% CI, -51 362 to -41 730]), partially offset by increases in patients with commercial (6.12%, 19 809 [95% CI, 12 109 to 27 509]) and self-paid (7.24%, 2525 [95% CI, 1246 to 3805]) fills. Sixteen states saw overall declines in buprenorphine use after unwinding, with reductions among patients with Medicaid-covered prescriptions in 36 states, partially offset by increases in patients with commercial insurance covered fills (32 states) and self-paid fills (23 states). Buprenorphine prescriptions remained stable in states with above-median automated Medicaid renewal rates and more income verification sources, whereas states with below-median automated renewal rates, fewer verification sources, and nonexpansion state status experienced smaller offsets for Medicaid-related losses, highlighting importance of state-specific policies.Conclusions and relevance: This cross-sectional study of Medicaid unwinding and filled buprenorphine prescr","PeriodicalId":53180,"journal":{"name":"JAMA Health Forum","volume":"6 4","pages":"e250393"},"PeriodicalIF":9.5,"publicationDate":"2025-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11971676/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143781917","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Error in Supplement 1. 补充1中的错误。

IF 9.5

JAMA Health Forum Pub Date : 2025-04-04 DOI: 10.1001/jamahealthforum.2025.0650

引用次数: 0

Reforming Markets to Strengthen Independent Pharmacies. 改革市场，加强独立药店。

IF 9.5

JAMA Health Forum Pub Date : 2025-04-04 DOI: 10.1001/jamahealthforum.2025.0142

Priyanka A Abraham, Jacob T Kannarkat, Dima Mazen Qato

引用次数: 0

Omitted Additional Contribution. 省略额外贡献。

IF 9.5

JAMA Health Forum Pub Date : 2025-04-04 DOI: 10.1001/jamahealthforum.2025.0690

引用次数: 0

Use of Patient Portal Messaging and Self-Reported Copays Among US Adults 50 Years or Older. 美国50岁及以上成人患者门户信息和自我报告共付费用的使用

IF 9.5

JAMA Health Forum Pub Date : 2025-04-04 DOI: 10.1001/jamahealthforum.2025.0168

Terrence Liu, Matthias Kirch, Erica Solway, Dianne C Singer, J Scott Roberts, Jeffrey T Kullgren, Tammy Chang

引用次数: 0

JAMA Health Forum. JAMA健康论坛。

IF 9.5

JAMA Health Forum Pub Date : 2025-04-04 DOI: 10.1001/jamahealthforum.2024.4962

引用次数: 0

State Substitution Laws and Uptake of an Interchangeable Insulin Biosimilar. 国家替代法和可互换胰岛素生物仿制药的摄取。

IF 9.5

JAMA Health Forum Pub Date : 2025-04-04 DOI: 10.1001/jamahealthforum.2025.0406

Youngmin Kwon, Ameet Sarpatwari, Stacie B Dusetzina

{"title":"State Substitution Laws and Uptake of an Interchangeable Insulin Biosimilar.","authors":"Youngmin Kwon, Ameet Sarpatwari, Stacie B Dusetzina","doi":"10.1001/jamahealthforum.2025.0406","DOIUrl":"10.1001/jamahealthforum.2025.0406","url":null,"abstract":"Importance: Although biosimilars have potential to reduce drug spending, their use remains low. Automatic substitutions of biologic drugs by their biosimilars at pharmacies can facilitate biosimilar uptake. Yet, state regulations limiting the types and circumstances under which biosimilars may be substituted could discourage efficient biosimilar adoption.Objective: To examine associations of state substitution laws in the US with biosimilar adoption in the insulin glargine market, in which an interchangeable biosimilar was recently launched.Design, setting, and participants: This retrospective cohort study using MarketScan commercial claims data examined fills for insulin glargine among users who were younger than 65 years and had fills for the insulin glargine Lantus (Sanofi) and its biosimilars, interchangeable insulin glargine-yfgn (Semglee [Mylan Pharmaceuticals]) and a noninterchangeable insulin glargine (Basaglar [Lilly]). Data were analyzed from August 2024 to January 2025.Main outcomes and measures: Market share of the insulin glargine, interchangeable insulin glargine-yfgn, and the noninterchangeable insulin glargine. Unit of analysis was the per-person prescription fill. Changes in fills between those residing in states with less vs more restrictive substitution laws in a 1-year period before and after the launch of interchangeable glargine-yfgn (November 16, 2021) were compared.Results: A total of 487 281 per-person prescription fills (mean [SD] age, 49.5 [13.3] years; 56.9% male) were included, with 158 141 and 329 140 per-person prescription fills from less vs more restrictive states, respectively. Following the launch of insulin glargine-yfgn, its market share differentially increased by 7.03 percentage points (pp; 95% CI, 1.89-12.18 pp; P = .008), coinciding with a 6.48 pp (95% CI, -11.70 to -1.26 pp; P = .02) differential reduction in the insulin glargine market share in states with less vs more restrictive laws. In the last quarter, the market share for insulin glargine-yfgn was 20.6% and 12.1% in states with less and more restrictive laws, respectively. There were not statistically significant differential changes in fills for the noninterchangeable insulin glargine (-0.24 pp; 95% CI, -1.40 to 0.92 pp; P = .68). Three restrictions had more pronounced associations with a lower uptake of insulin glargine-yfgn: enhanced physician notification (-8.15 pp; 95% CI, -12.49 to -3.81 pp; P < .001), refill notifications (-4.68 pp; 95% CI, -8.78 to -0.58 pp; P = .03), and patient notification (-3.52 pp; 95% CI, -8.44 to 1.40 pp; P = .16).Conclusions and relevance: In this cohort study, insulin users in states with less restrictive substitution laws were more likely to fill the biosimilar alternative to insulin glargine, underscoring the role of state regulations of substitution as an important determina","PeriodicalId":53180,"journal":{"name":"JAMA Health Forum","volume":"6 4","pages":"e250406"},"PeriodicalIF":9.5,"publicationDate":"2025-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11971668/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143781982","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Calibrating AI Reliance-A Physician's Superhuman Dilemma. 校准人工智能的依赖——一个医生的超人困境。

IF 9.5

JAMA Health Forum Pub Date : 2025-03-07 DOI: 10.1001/jamahealthforum.2025.0106

Shefali V Patil, Christopher G Myers, Yemeng Lu-Myers

引用次数: 0

Health Characteristics of Adults Unable to Complete Medicaid Renewal During the Unwinding Period. 在解除期间无法完成医疗补助续期的成年人的健康特征。

IF 9.5

JAMA Health Forum Pub Date : 2025-03-07 DOI: 10.1001/jamahealthforum.2025.0092

Aparna Soni, Justin Blackburn

{"title":"Health Characteristics of Adults Unable to Complete Medicaid Renewal During the Unwinding Period.","authors":"Aparna Soni, Justin Blackburn","doi":"10.1001/jamahealthforum.2025.0092","DOIUrl":"10.1001/jamahealthforum.2025.0092","url":null,"abstract":"Importance: Medicaid redetermination affects millions of people annually in the US, but little is known about beneficiaries who lose coverage during the process. In early 2023, after the COVID-19 pandemic mandate to provide continuous coverage was lifted, states resumed redetermination of eligibility and disenrollment of individuals who were no longer eligible. Medicaid disenrollment rose rapidly during this unwinding period, yet little is known about the health and financial characteristics of individuals who were unable to complete the Medicaid renewal process.Objective: To assess levels of self-reported mental health, functional health, and financial security among current and former Medicaid enrollees during the Medicaid unwinding period.Design, setting, and participants: This repeated cross-sectional study used nationally representative survey data from multiple waves of the US Census Bureau Household Pulse Survey to assess the health and financial characteristics of 131 384 current and former working-age (19-64 years) Medicaid enrollees interviewed between January 2023 and September 2024. Estimated linear regression models were used to compare measures among current Medicaid enrollees, former enrollees who could not complete renewal (procedural disenrollees), and former enrollees who dropped Medicaid for other reasons (nonprocedural disenrollees). Analysis was performed in December 2024.Exposure: Medicaid enrollment status and likely reason for disenrolling (procedural vs nonprocedural).Results: The total sample comprised 131 384 current and former working-age Medicaid enrollees (mean [SD] age, 41.9 [12.5] years; 82 378 females [62.7%]; 22 467 Black [17.1%], 32 715 Hispanic/Latino [24.9%], 62 276 White [47.4%], and 13 927 individuals of other races or multiracial [10.6%]), more than half of whom were parents and of lower socioeconomic status. Compared with current Medicaid enrollees, procedural disenrollees were 3.3 percentage points (pp) more likely to report anxiety (95% CI, 1.6 to 4.9 pp); frequent worrying, 3.3 (95% CI, 1.8 to 4.8) pp; little interest in things, 2.4 (95% CI, 1.0 to 3.8) pp; depression, 2.5 (95% CI, 1.1 to 3.9) pp; food insecurity, 3.6 (95% CI, 2.6 to 4.7) pp; difficulty seeing, 2.0 (95% CI, 1.0 to 3.0) pp; difficulty hearing, 1.1 (95% CI, 0.4 to 1.8) pp; and difficulty remembering things, 1.4 (95% CI, 0.1 to 2.7) pp; however, they were 1.3 pp less likely to report difficulty with mobility (95% CI, -2.5 to -0.2 pp). There was no statistically significant difference between groups in difficulty with bathing and dressing or difficulty understanding things.Conclusions and relevance: This cross-sectional study found that adults who could not complete the Medicaid renewal process and were procedurally disenrolled during the unwinding period had higher mental health needs, worse functional","PeriodicalId":53180,"journal":{"name":"JAMA Health Forum","volume":"6 3","pages":"e250092"},"PeriodicalIF":9.5,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11929023/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143674718","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0