Journal of managed care & specialty pharmacy最新文献

Background: Improved medication adherence, represented as an increase in the proportion of days covered (PDC), to chronic medications is associated with better patient outcomes, yet effective strategies to improve adherence are often resource intensive. OBJECTIVE: To quantify the impact of a pharmacist-supported electronic outreach initiative on medication adherence measures and to qualitatively evaluate patient engagement with and response to electronic messaging.

Methods: This retrospective cohort evaluation used mixed methods to assess the impact of a population health quality improvement program to address medication adherence for Medicare Advantage enrollees. The intervention was performed between January 1, 2023, and December 31, 2023, by population health teams supporting the University of Colorado Primary Care practices. The teams reviewed insurer-provided lists to identify patients late to refill a medication and sent an electronic health message, a mailed letter, or a phone call conveying concern for adherence. Patient responses requiring clinical intervention or education were triaged to clinical pharmacists for management per their clinical discretion. The proportion of Medicare Advantage enrollees classified as adherent, defined as PDC value of 0.8 or higher, was compared before (2022) and after implementation of the population-based outreach intervention for the 2023 plan year. Qualitative methods were used to evaluate patient response to electronic messages. The text of all patient replies to electronic messages was thematically analyzed and categorized.

Results: The proportion of patients classified as adherent to diabetes medications was higher in the postintervention group (87.5%) compared with the preintervention group (83.4%, P = 0.021), whereas the adherence rates in the post- vs prehypertension (89.3% vs 88.7%, P = 0.517) and cholesterol (89.4% vs 89.2%, P = 0.721) groups were not significantly different. The population health teams sent 1,593 electronic health record messages, 1,185 (74.4%) of which were opened, and patients responded to 516 (32.4%). The most common patient response was patients self-reporting being adherent (306, 59.3%); fewer patients admitted to some degree of nonadherence (111, 21.5%). An equal number of patients reported appreciation for (111, 21.5%) and confusion about or irritation with the outreach (111, 21.5%).

Conclusions: The University of Colorado Medicine's population health initiative provided mixed results on medication adherence metrics. Electronic health record messaging provided insight into ways to improve the intervention to better engage and assist patients.

Background: Schizophrenia is a chronic psychiatric disorder, affecting 1.1% of the adult population in 2020 in the United States. Antipsychotic treatment is commonly used in schizophrenia management to help reduce the likelihood of symptom recurrence and relapse. Aripiprazole once every month, a long-acting injectable antipsychotic formulation with an established efficacy and safety profile, is approved by the United States Food and Drug Administration as a maintenance treatment for schizophrenia. A new ready-to-use formulation of aripiprazole for administration once every 2 months (Ari 2MRTU) has been shown to have similar efficacy to aripiprazole once every month and was designed to improve medication adherence in order to provide antipsychotic treatment and prevent relapses.

Objective: To estimate the financial impact of introducing Ari 2MRTU as a treatment option for adult patients diagnosed with schizophrenia in the United States.

Methods: A cohort of adult patients with schizophrenia was selected from a hypothetical health plan of 1 million members. Treatment costs were modeled with a 3-year time horizon from 2024 to 2026, in scenarios with or without the addition of Ari 2MRTU. Inputs into the model included estimated current and projected market share of the available antipsychotics, expected uptake of Ari 2MRTU, as well as the acquisition, initiation, and administration costs, hospitalization costs, time on treatment, and patient member medication adherence. The budget impact was estimated as the difference in the annual cost for the total cohort for the current and new scenarios, the cost per member per month and per treated member per month. Deterministic sensitivity analyses were conducted to examine the extent to which the model results were affected by a change in individual all-input parameters.

Results: The total budget impact of Ari 2MRTU being adopted as an alternative maintenance monotherapy for treating eligible patients with schizophrenia from a hypothetical US health plan of 1 million members was estimated to be a saving of $26,998 over 3 years. This represented a per member per month saving of $0.001 and a per treated member per month saving of $0.11, whereas a sensitivity analysis indicated that these savings were sensitive to treatment adherence and the acquisition cost of the new formulation.

Conclusions: The introduction of Ari 2MRTU as a maintenance treatment for adults with schizophrenia is expected to be cost neutral (with a modest saving) with respect to payer budgets in the United States. This merits consideration as is a potentially favorable option for patients who benefit from less frequent dosing.

Background: Over the past 5 years, managed care pharmacy has been shaped by a global pandemic, advancements in generative artificial intelligence (AI), Medicare drug price negotiation policies, and significant therapeutic developments. Collective intelligence methods can be used to anticipate future developments in practice to help organizations plan and develop new strategies around those changes.

Objective: To identify emerging trends in managed care pharmacy.

Methods: In this sequential mixed-method study, we invited experts to participate in a multidisciplinary advisory panel to develop a survey with 5 overarching domains. The qualitative analysis for our advisory panel meetings used a thematic analysis approach. To analyze the cross-sectional survey results, we used descriptive statistics and exploratory bivariate statistics to test for possible relationships with survey respondent demographics and likelihood predictions. To assess respondent opinions on the overall likelihood of an event occurring in the next 5 years, we combined "Highly likely/Somewhat likely" responses and compared with "Highly unlikely/Somewhat unlikely" responses.

Results: Following our advisory panel focus groups, a total of 53 scenarios were developed for inclusion in the quantitative survey under the domains of (1) information technology, (2) therapeutics and diagnostics, (3) payment models, (4) pharmacy operations, and (5) public policy. A total of 1,238 individuals were invited to participate in the survey. Of eligible participants, 201 complete survey responses were received for a final response rate of 16.2%. Survey participants rated increased use of glucagon-like peptide-1 receptor agonists by at least 25%, at least 1 major data breach, more than 10 new orphan drug approvals, and AI use in more than half of prior authorization reviews as the most likely scenarios to occur in the next 5 years. Respondents identified the following broad issues as those most likely to impact their organizations (employers) in the next 5 years: federal and state policy changes impacting managed care, cell and gene therapies, impact of AI on managed care operations, and emerging payment models.

Conclusions: This study provides valuable insights into the emerging trends that are expected to shape managed care pharmacy over the next 5 years. The integration of advanced technologies, such as AI, along with the increasing focus on specialty therapeutics, represents both opportunities and challenges for managed care organizations. However, areas with lower consensus highlight the need for caution in strategic planning.

Background: Geographic atrophy (GA) is a form of advanced age-related macular degeneration (AMD) that can cause irreversible vision impairment and is responsible for approximately 20% of legal blindness in the United States. There is limited real-world evidence assessing health outcomes and health care resource use (HCRU) among individuals with GA.

Objective: To examine the progression from GA without subfoveal involvement (SFI) to GA with SFI, progression to irreversible blindness, and HCRU among older individuals with GA enrolled in Medicare Advantage Prescription Drug (MAPD) plans.

Methods: This retrospective study used claims data for MAPD-plan enrollees aged at least 65 years with an AMD diagnosis between 2018 and 2021. To assess progression of GA, development of blindness, and HCRU, propensity score matched cohorts of individuals with GA and without GA were identified and compared. For GA progression analysis, at least 12 months of follow-up was required, and patients were followed until the end of either follow-up or study period.

Results: Total 9,511 individuals with GA were matched 1:1 to individuals without GA. Among individuals with GA, initial diagnosis was primarily by an ophthalmologist (58.6%) followed by an optometrist (30.9%). The most common diagnostic imaging procedure at index was optical coherence tomography (53.0%). Mean follow-up time was 2.3 years. At index, 4,781 (50.3%) individuals had GA without SFI and 4,697 (49.4%) had GA with SFI. Among individuals with GA without SFI at index, 479 (10.2%) progressed to GA with SFI during the 12-month follow-up. Among individuals with GA without SFI at index, 173 (3.6%) developed irreversible blindness, compared to 312 (6.6%) of those with SFI, and 51 (0.5%) individuals without GA. Kaplan-Meier analysis indicated fastest progression to irreversible blindness among individuals with GA with SFI, followed by those without SFI (log-rank test P < 0.001). Both diagnosis of GA without SFI (hazard ratio [HR] [CI] = 6.77 [4.98-9.35], P < 0.001) and diagnosis of GA with SFI (HR [CI] = 12.59 [9.43-17.16], P < 0.001) were strongly associated with increased risk of developing irreversible blindness. Significant predictors of progression to GA with SFI were wet AMD at baseline (HR [CI] = 5.70 [4.63-6.99], P < 0.001), Elixhauser comorbidity score of 4-5 (HR [CI] = 1.46 [1.12-1.91], P = 0.006), and more than 5 (HR [CI] = 1.40 [1.02-1.89], P = 0.035).

Conclusions: GA with or without SFI was associated with progression to irreversible blindness in an MAPD-plan population. Patients with GA with SFI progressed to irreversible blindness faster than patients with GA without SFI. With the recent approval of GA treatments, future research is needed to assess the impacts on disease progression, including blindness.

Background: The introduction of cyclin-dependent kinases 4 and 6 inhibitors (CDK4/6is) has transformed the treatment landscape for patients with hormone receptor positive (HR+) and human epidermal growth factor receptor 2 negative (HER2-) metastatic breast cancer (MBC). To our knowledge, no studies have quantified health care resource utilization (HRU) or economic burden following CDK4/6i initiation in the Medicare population.

Objective: To describe HRU and quantify health care costs among Medicare-enrolled patients with HR+ HER2- MBC treated with CDK4/6is in the first-line setting.

Methods: We conducted a retrospective cohort study on Medicare-enrolled patients with HR+ HER2- MBC who initiated a CDK4/6i in the first-line setting between February 2, 2016, and December 31, 2022, using claims from the Merative MarketScan database. We examined all-cause HRU by summarizing the number of inpatient (IP), outpatient (OP), and emergency department (ED) visits as well as the length of stay during the 6 months following CDK4/6i initiation. Additionally, we assessed all-cause health care costs, including IP, OP, ED, and pharmacy, over the 1 year following CDK4/6i initiation using the Kaplan-Meier sample average estimator to account for censoring. We reported total health care costs as the sum of IP, OP, ED, and pharmacy costs.

Results: 901 patients met the inclusion criteria with a mean age of 74 years (SD = 6.84). Nearly 24% (n = 214) had an IP admission in the 6 months following CDK4/6i initiation. Among patients with an IP admission, the mean number of admissions per patient was 1.65 (SD = 0.98) with a mean length of stay per admission of 5.98 (SD = 6.25) days. Roughly 30% (n = 271) of patients had an ED visit, with a mean of 2.1 (SD = 1.54) visits per patient among those who had a visit. Most patients (n = 868, 96.44%) had an OP service, and among those with an OP service, the mean number of days with OP services was 19.96 (SD = 12.29). Mean total health care costs over the 1-year period following CDK4/6is were $62,228 (95% CI = 52,281-73,029) per patient with the main drivers being OP services ($31,686 [95% CI = 27,168-36,925]) and pharmacy costs ($22,727 [95% CI = 19,273-25,931]).

Conclusions: There are numerous sources of HRU and cost in patients following CDK4/6i initiation in the Medicare population. Patients with HR+ HER2- MBC incur high HRU, providing insights for health care decision-makers to optimize treatment strategies and resource allocation for this population.