Journal of managed care pharmacy: JMCP (J MANAGE CARE PHARM)

Publisher: Academy of Managed Care Pharmacy

Journal description

JMCP publishes peer-reviewed original research manuscripts, subject reviews, and other content intended to advance the use of the scientific method, including the interpretation of research findings in managed care pharmacy. JMCP is dedicated to improving the quality of care delivered to patients served by managed care pharmacy by providing its readers with the results of scientific investigation and evaluation of clinical, health, service, and economic outcomes of pharmacy services and pharmaceutical interventions, including formulary management. JMCP strives to engage and serve professionals in pharmacy, medicine, nursing, and related fields to optimize the value of pharmaceutical products and pharmacy services delivered to patients. The Journal of Managed Care Pharmacy is a peer-reviewed journal, with 9 publication dates per year: separate issues for the months of March, April, May, June, September, and October and combined issues for January/February, July/August, and November/December.

Current impact factor: 2.71

Impact Factor Rankings

2015 Impact Factor Available summer 2016
2014 Impact Factor 2.713
2013 Impact Factor 2.682
2012 Impact Factor 2.414
2011 Impact Factor 2.25
2010 Impact Factor 2.392
2009 Impact Factor 2.412
2008 Impact Factor 1.509

Impact factor over time

Impact factor

Additional details

5-year impact 3.03
Cited half-life 5.70
Immediacy index 0.37
Eigenfactor 0.00
Article influence 1.04
Website Journal of Managed Care Pharmacy website
Other titles Journal of managed care pharmacy, JMCP
ISSN 1083-4087
OCLC 32803871
Material type Periodical, Internet resource
Document type Journal / Magazine / Newspaper, Internet Resource

Publications in this journal

  • [Show abstract] [Hide abstract]
    ABSTRACT: BACKGROUND: Dabigatran is a direct thrombin inhibitor approved by the FDA in October 2010 for the treatment of nonvalvular atrial fibrillation. Little is known regarding patient adherence to this therapy. OBJECTIVE: To examine adherence and persistence to dabigatran among adults with atrial fibrillation. METHODS: We used IMS Health's LifeLink Health Plan Claims Database from 2010 to 2012 to identify patients with atrial fibrillation who were new users of dabigatran. We derived adherence and persistence for continuously enrolled patients at 6 months, 9 months, and 12 months of follow-up. We measured adherence using the medication possession ratio (MPR), defined as individuals with MPRs of 0.80 or greater as adherent, and examined persistence by identifying individuals with gaps in drug possession of 60 days or greater. RESULTS: Of 5,951 adults with atrial fibrillation who were new users of dabigatran, 49% had prevalent atrial fibrillation and at least 6 months of continuous follow-up. Of these, 89% used dabigatran as the only oral anticoagulant, whereas the remainder filled prescriptions for at least 1 other oral anticoagulant during the follow-up period. Among those using dabigatran alone (n = 2,713), the mean MPR was 0.73 (standard error = 0.30), 41% were nonadherent with therapy, and 32% had gaps of 60 days or greater. Among those observed for 9 (or 12) months who used dabigatran alone, rates of nonadherence were 47% (49%), whereas 48% (49%) discontinued therapy during follow-up. Rates of adherence and persistence were similar for patients with incident atrial fibrillation. CONCLUSIONS: Nonadherence to dabigatran was common among patients with atrial fibrillation. Future studies are needed to understand the reasons for nonadherence.
    Journal of managed care pharmacy: JMCP 11/2015; 21(11):1054-62.
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    ABSTRACT: Oral paliperidone and lurasidone are new second-generation antipsychotics (SGAs). Empirical evidence on the comparative costs and persistence of these 2 agents are absent in the literature. To assess health care use and persistence associated with the 2 new agents oral paliperidone and lurasidone and other SGAs. Schizophrenia patients who initiated SGA therapy were identified in the January 2007-June 2013 claims databases of a large managed care organization. Multivariate regressions using aripiprazole as the comparator were conducted. Ordinary least squares regressions were used to estimate the total medical and pharmacy costs associated with each drug. Poisson regressions were conducted to evaluate the frequency of hospitalizations and emergency department (ED) visits associated with each drug. A censored regression model was used to evaluate the comparative persistence. Sensitivity analyses using generalized linear models, two-part models, hurdle models, and instrumental variable regressions were also performed. Compared with aripiprazole, paliperidone was not associated with significantly different total costs, yet lurasidone was associated with lower total costs (-$7,052; 95% CI = -$9,221, -$4,882). Lurasidone was also associated with significantly lower medical services costs (-$5,025; 95% CI = -$7,096, -$2,955), drug costs (-$2,026; 95% CI = -$2,695, -$1,357), hospital costs (-$3,026; 95% CI = -$4,731, -$1,321), outpatient costs (-$1,999; 95% CI = -$2,536, -$1,463), and ED costs (-$2,284; 95% CI = -$3,069, -$1,499), whereas paliperidone did not have significant effects on any types of costs. Paliperidone users had fewer ED visits (-0.25; 95% CI = -0.42, -0.08), while lurasidone users had fewer hospitalizations (-5.98; 95% CI = -6.61, -5.35) and fewer ED visits (-2.51; 95% CI = -2.92, -2.10). Both paliperidone and lurasidone were associated with lower levels of treatment persistence. Paliperidone does not associate with lower total costs compared with commonly used SGAs, whereas lurasidone is associated with lower total health costs. Thus, high access fees of lurasidone are not necessarily a major concern in prescription.
    Journal of managed care pharmacy: JMCP 09/2015; 21(9):780-92.
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    ABSTRACT: Natalizumab disease-modifying therapy for relapsing-remitting multiple sclerosis (MS) is efficacious in randomized controlled trials. Few studies have estimated the association between real-world natalizumab persistence behavior and relapse-related outcomes.OBJECTIVES: To (a) examine the impact of using natalizumab consistently (i.e., persistent) on relapse-related outcomes as compared with transitioning to inconsistent natalizumab use (i.e., nonpersistent) and (b) examine the impact of other treatment patterns on relapse-related outcomes for those who initiated natalizumab. METHODS: Using the IMS PharMetrics Plus claims database (years 2006-2012), we identified MS subjects who initiated natalizumab (no natalizumab claims in year prior) and had at least 2 years of follow-up. Persistence in annual follow-up periods was defined as no 90-day or greater gap in natalizumab therapy. Relapse was an MS-related hospitalization or outpatient visit with intravenous or oral steroid burst claim within 7 days. Analyses compared observations based on changes in natalizumab persistence and natalizumab nonpersistence status from 1 year to the next (e.g., transitioning from persistent to nonpersistent), estimating differences in mean annual relapses and mean annual relapse-related costs. RESULTS: A total of 2,407 natalizumab initiators had at least 2 years of follow-up, yielding 4,770 year-to-year natalizumab treatment patterns where each subject contributed 1, 2, or 3 year-to-year treatment patterns. In the year prior, 3,187 treatment patterns were persistent; 731 (22.9%) of these transitioned to nonpersistence. The remaining 1,583 treatment patterns were nonpersistent in the year prior; 132 (8.3%) of these transitioned to persistence. Persistent to nonpersistent treatment patterns were associated with a mean relapse-rate increase of 0.23 (95% CI = 0.12, 0.35), and a mean increase in relapse-related costs of $1,346 (95% CI = $97, $2,595). Nonpersistent to persistent treatment patterns were associated with a mean relapse-rate decrease of -0.15 (95% CI = -0.32, 0.017) and a mean decrease in relapse-related costs of -$1,369 (95% CI = -$2,761, $23). CONCLUSIONS: Findings suggest that real-world persistent natalizumab users who become nonpersistent have statistically significant increases in annual relapses and relapse-related costs. Those who transition from nonpersistent to persistent have nonsignificant reductions in relapses and their associated costs.
    Journal of managed care pharmacy: JMCP 03/2015; 21(3):210-218.
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    ABSTRACT: Although oral antidiabetic medications are the mainstay for managing type 2 diabetes mellitus (T2DM), patients often require insulin therapy to achieve optimal glycemic control. Given the prevalence of insulin use among patients with T2DM, this study evaluated the economic impact of this treatment modality in patients treated in a managed care setting.OBJECTIVE: To estimate costs and resource utilization associated with using insulin therapy among patients with newly diagnosed T2DM who were initially treated with other noninsulin antidiabetic (NIAD) medications.METHODS:An observational, retrospective study design was implemented using integrated medical and pharmacy claims data. Adults with a diagnosis of T2DM from July 1, 2003, through March 31, 2008, were identified. The date of first diagnosis was deemed the index date. The 24-month period after the index date was used to assess treatment patterns. Based on the treatment patterns, the following 2 cohorts were selected: NIAD-only cohort, users who received greater than1 NIAD class medication but never received insulin, and insulin-use cohort, NIAD users who switched to/added on insulin therapy (duration ≥ 60 days). Patients were matched in a 1:3 (insulin-use:NIAD-only) ratio based on propensity scores and other key covariates of interest. Hypoglycemia rates, monthly costs, and resource use during the outcome assessment period were compared between cohorts. RESULTS:After matching, 1,400 patients (350 insulin users and 1,050 NIAD-only users) were included in the analysis (42% women; mean age, 56 years). After controlling for covariates, the insulin-use cohort incurred $71 per patient per month higher total T2DM-specific costs than the NIAD-only cohort ($241/month vs. $170/month, P = 0.0003). Pharmacy costs and utilization of physician visits were drivers of cost differences between cohorts. The rate of hypoglycemic events was 10.2 per 100 person-years for the insulin-use cohort versus 2.9 per 100 person-years in the NIAD-only cohort (P less than 0.0001). CONCLUSIONS: Use of insulin therapy is associated with increased hypoglycemic events, increased pharmacy and medical costs, and greater utilization of T2DM-specific health care services.
    Journal of managed care pharmacy: JMCP 03/2015; 21(3):220-228.
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    ABSTRACT: Medication nonadherence is widespread, but there are few efficient means of detecting medication nonadherence at the point of care. Visit-to-visit variability in clinical biomarkers has shown inconsistent efficiency to predict medication adherence.OBJECTIVE: To examine the performance of visit-to-visit variability (VVV) of hemoglobin A1c to predict nonadherence to antidiabetic medications.METHODS: In this cross-sectional study using a clinical and administrative database, adult members of a managed care plan at a safety-net medical center from 2008 to 2012 were included if they had ≥ 3 noninsulin antidiabetic prescription fills within the same class and ≥ 3 A1c measurements between the first and last prescription fills. The independent variable was VVV of A1c (within-subject standard deviation of A1c), and the dependent variable was medication adherence (defined by medication possession ratio) determined from pharmacy claims. Unadjusted and adjusted multivariate logistic regression models were created to examine the relationship between VVV of A1c and medication nonadherence. Receiver-operating characteristic (ROC) curves assessed the performance of the adjusted model at discriminating adherence from nonadherence.RESULTS: Among 632 eligible subjects, mean A1c was 7.7% ± 1.3%, and 83% of the sample was nonadherent to antidiabetic medications. Increasing quintiles of VVV of A1c and medication nonadherence were both associated with increased within-subject mean A1c and younger subject age. The logistic regression model (adjusted for age, sex, race/ethnicity, within-subject mean A1c, number of A1c measurements, number of days between the first and last antidiabetic medication prescription fills, and rate of primary care visits during the study period) showed a nonsignificant association of VVV of A1c and medication nonadherence (OR = 1.19, 95% CI = 0.42-3.38 for the highest quintile of VVV). Adding VVV of A1c to a model including age, sex, and race only modestly improved the C-statistic of the ROC curve from 0.6786 to 0.7064.CONCLUSIONS: VVV of A1c is not a robust predictor of antidiabetic medication nonadherence. Further innovation is needed to develop novel methods of detecting nonadherence.
    Journal of managed care pharmacy: JMCP 03/2015; 21(3):229-237.
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    ABSTRACT: The Affordable Care Act of 2010 allows for the adjustment of reimbursement to health care centers based on 30-day readmission rates. High readmission rates may be explained by multiple events at discharge, including medication errors that occur during the transition of care from inpatient to outpatient. Pharmacist involvement at discharge has been shown to improve health outcomes in patients with chronic disease; however, there is limited knowledge regarding the benefits of a clinic appointment with a pharmacist postdischarge. OBJECTIVE: To compare hospital readmission rates and interventions in a multidisciplinary team visit coordinated by a clinical pharmacist practitioner with those conducted by a physician-only team within an internal medicine hospital follow-up program.METHODS: A retrospective observational study was completed. Patients seen between May 2012 and January 2013 in 1 of the 2 hospital follow-up program models (multidisciplinary team or physician-only team) were included. RESULTS: A total of 140 patient visits were included for 124 patients. Patients seen by the multidisciplinary team had a 30-day readmission rate of 14.3% compared with 34.3% by the physician-only team (P=0.010). Interventions completed during the visits, including addressing nonadherence, initiating a new medication, and discontinuing a medication were also statistically different between the groups, with the multidisciplinary team completing these interventions more frequently.CONCLUSIONS: Hospital follow-up visits coordinated by the multidisciplinary team decreased 30-day hospital readmission rates compared with follow-up visits by a physician-only team.
    Journal of managed care pharmacy: JMCP 03/2015; 21(3):256-260.
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    ABSTRACT: Pazopanib was noninferior to sunitinib in progression-free survival in a phase III, open-label, randomized clinical trial comparing the efficacy and safety of the 2 drugs for treatment of patients with advanced renal cell carcinoma (RCC). A secondary analysis of this trial conducted on patient-reported health care resource utilization (HCRU) endpoints revealed significantly fewer monthly telephone consultations and emergency department visits among patients treated with pazopanib over the first 6 months of treatment. To (a) compare total costs of HCRU and adverse events (AEs) in patients with advanced RCC receiving first-line pazopanib or sunitinib from the phase III clinical trial and (b) perform a post hoc economic analysis that applied direct medical care and pharmacy unit costs, obtained from the Truven Health MarketScan Databases, to HCRU and AE rates. Total HCRU costs included components for provider contacts, diagnostics, hospitalizations, procedures, and study/nonstudy drugs. Patients were stratified by the presence or absence of an AE in order to estimate costs attributable to AEs. Costs were adjusted to 2013 U.S. dollars. The highest 1% of cost outliers were equally excluded from each group. Univariate (t-test and Kaplan-Meier sample average [KMSA]) and multivariate (using treatment group and region as covariates) analyses were performed. A total of 906 patients (pazopanib, n = 454; sunitinib, n = 452) reported HCRU; higher rates were observed for sunitinib. In unadjusted cost analyses, the mean total costs for pazopanib-treated patients were 29.7% lower than those treated with sunitinib ($12,120 vs. $15,727; P = 0.017). The difference in KMSA-estimated costs was also significantly higher for sunitinib versus pazopanib ($29,043 vs. $21,026; P = 0.006). Adjusted cost differences between arms also remained significant. A cost increase of $1,094 for pazopanib and $2,247 for sunitinib was associated with patients who experienced ≥ 1 designated AEs. The findings suggest that health care costs were significantly lower among patients with advanced RCC treated first-line with pazopanib versus sunitinib.
    Journal of managed care pharmacy: JMCP 01/2015; 21(1):37-44.
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    ABSTRACT: BACKGROUND: The Biologics Price Competition and Innovation Act, introduced as part of the Affordable Care Act, directed the FDA to create an approval pathway for biologic products shown to be biosimilar or interchangeable with an FDA-approved innovator drug. These biosimilars will not be chemically identical to the reference agent. Investigational studies conducted with biosimilar agents will likely provide limited real-world evidence of their effectiveness and safety. How do we best monitor effectiveness and safety of biosimilar products once approved by the FDA and used more extensively by patients? OBJECTIVE: To determine the feasibility of developing a distributed research network that will use health insurance plan and health delivery system data to detect biosimilar safety and effectiveness signals early and be able to answer important managed care pharmacy questions from both the government and managed care organizations. METHODS: Twenty-one members of the AMCP Task Force on Biosimilar Collective Intelligence Systems met November 12, 2013, to discuss issues involved in designing this consortium and to explore next steps. RESULTS: The task force concluded that a managed care biosimilars research consortium would be of significant value. Task force members agreed that it is best to use a distributed research network structurally similar to existing DARTNet, HMO Research Network, and Mini-Sentinel consortia. However, for some surveillance projects that it undertakes, the task force recognizes it may need supplemental data from managed care and other sources (i.e., a "hybrid" structure model). CONCLUSIONS: The task force believes that AMCP is well positioned to lead the biosimilar-monitoring effort and that the next step to developing a biosimilar-innovator collective intelligence system is to convene an advisory council to address organizational governance. Copyright
    Journal of managed care pharmacy: JMCP 01/2015; 21(1):23-34.
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    ABSTRACT: Current first-line treatments for metastatic renal cell carcinoma (mRCC) include the multityrosine kinase inhibitors pazopanib and sunitinib. Both agents had similar progression-free survival (PFS) and overall survival (OS) in the COMPARZ trial (Comparing the Efficacy, Safety and Tolerability of Pazopanib versus Sunitinib); however, the adverse event profiles of the 2 agents are different. In the PISCES trial (Patient Preference Study of Pazopanib versus Sunitinib in Advanced or Metastatic Kidney Cancer), patients and physicians preferred pazopanib primarily because it offered better health-related quality of life (HRQoL) and caused less fatigue. To compare the cost-effectiveness of pazopanib versus sunitinib from a U.S. health care system perspective in the first-line treatment of patients with mRCC. A partitioned-survival analysis model with 3 health states (preprogression, postprogression, and dead), data from 2 randomized controlled trials of pazopanib versus sunitinib (COMPARZ and PISCES), and secondary sources were used to calculate the incremental cost per quality-adjusted life-year (QALY) gained for pazopanib versus sunitinib. A time horizon of 37.5 months was used in the base case, consistent with the duration of follow-up used in the COMPARZ trial. The proportion of patients in each health state over time was based on Kaplan-Meier survival distributions for PFS and OS from the COMPARZ trial. Utility values were obtained from the PISCES trial. Costs were based on medical resource utilization data from the COMPARZ trial and unit costs from secondary sources. Probabilistic sensitivity analyses and deterministic sensitivity analyses were conducted. In the base case, pazopanib was estimated to provide more QALYs at a lower cost compared with sunitinib (pazopanib dominant). In probabilistic sensitivity analyses, pazopanib was projected to be dominant in 69% of the simulations. The probability that pazopanib was more cost-effective than sunitinib was ≥ 90% for threshold values of cost-effectiveness between the range of $10,000-$160,000 per QALY gained. In deterministic sensitivity analyses, pazopanib was dominant in all scenarios examined. Results of this study suggest that pazopanib is cost-effective compared with sunitinib as the first-line treatment of patients with mRCC in the United States.
    Journal of managed care pharmacy: JMCP 01/2015; 21(1):46-54.
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    ABSTRACT: The Advisory Committee on Immunization Practices (ACIP) recommends the use of tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) vaccine for routine wound management in adolescents and adults who require a tetanus toxoid-containing vaccine who were vaccinated ≥5 years earlier with tetanus toxoid, reduced diphtheria toxoid (Td) vaccine, and who have not previously received Tdap. To estimate the overall budget and health impact of vaccinating individuals presenting for wound management with Tdap instead of Td vaccine, the current standard of care in practices that do not use Tdap for purposes of wound management. A decision-analytic economic model was developed to estimate the expected increase in direct medical costs and the expected number of cases of pertussis avoided associated with the use of Tdap instead of Td vaccine in the wound management setting. Patients eligible for Tdap were aged 10+ years and required a tetanus-containing vaccine. Age-specific wound incidence data and Td and Tdap vaccination rates were taken from the National Health Interview Survey and the National Immunization Survey for the most recent available year. Age-specific pertussis incidence used in this analysis (151 per 100,000 for adolescents, 366 per 100,000 for those aged 20-64 years, and 176 per 100,000 for those aged 65+ years) used reported incidence rates adjusted by a factor of 10 for adolescents and by a factor of 100 for adults, based on assumptions previously made by ACIP to account for underreporting. Vaccine wholesale acquisition costs without federal excise tax were assumed in the base case. Efficacy of vaccination with Tdap in preventing pertussis was based on clinical trial data. Possible herd immunity effects of vaccination were not included in the model. Costs associated with vaccination and treatment of pertussis cases were reported as total annual costs and per-member-per-month (PMPM) costs for hypothetical health plans and for the U.S. population. Aggregate and incremental costs and pertussis cases avoided were presented undiscounted (as recommended for budget-impact analyses) annually and cumulatively over a 3-year time horizon in 2012 U.S. dollars. Scenario analyses were conducted on key parameters, including wound incidence, pertussis incidence, vaccine efficacy and waning protection against pertussis, uptake rates for Tdap, and vaccine prices using alternative data sources or alternative clinically relevant assumptions. For a health plan with 1 million covered lives aged less than 65 years, vaccination with Tdap instead of Td was estimated to cost an additional $132,364 ($0.01 PMPM) in the first year and an additional $368,640 ($0.01 PMPM) cumulatively over 3 years. For a health plan with 1 million covered lives aged 65+ years, vaccination with Tdap instead of Td was estimated to cost an additional $201,165 ($0.02 PMPM) in the first year and an additional $549,568 ($0.02 PMPM) cumulatively over 3 years. For the U.S. population aged 10+ years, vaccination with Tdap instead of Td was estimated to result in protection against pertussis for an additional 2.7 million patients with wounds annually and was estimated to cost an additional $121,101,671 to avoid 42,104 cases of pertussis over the 3-year time horizon. Results were sensitive to input parameter values, particularly parameters associated with the number of patients with wounds vaccinated with Tdap (range 2.7 to 5.1 million patients). However, for all of the alternative scenarios tested, the expected increase in PMPM costs ranged from less than $0.01 to $0.03. Vaccination of adolescents and adults with Tdap for wound management may result in an increase in PMPM costs for health plans of less than $0.01 to $0.03. Given the potential reduction in pertussis cases at the population level, vaccination with Tdap for routine wound management could be considered as another strategy to help address the pertussis public health concern in the United States.
    Journal of managed care pharmacy: JMCP 01/2015; 21(1):88-99.
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    ABSTRACT: The increased use of central nervous system depressants (CNSD) and psychotropics are one of the many factors that contribute to suicidal behavior in soldiers. U.S. Army policy requires medication screening for any soldier prescribed 4 or more medications when at least 1 of the medications is a CNSD or psychotropic. Constant deployments challenged health care provider ability to comply with required screenings, and senior leaders sought proactive intervention to reduce medication risks upon return of the 101st Airborne Division (Air Assault) from deployment in 2011.A pharmacy-led team established the Polypharmacy Clinic (PC) at Blanchfield Army Community Hospital. Of the 3,999 soldiers assigned, 540 (13.5%) met the initial screening criteria. Success of the pilot program led to the mandatory screening of all other Fort Campbell, Kentucky, brigades. During the first 12 months, 895 soldiers were seen by a clinical pharmacist, and 1,574 interventions were documented. Significant interventions included medication added (121), medication changed (258), medication stopped (164), lab monitoring recommended (172), adverse reaction mitigated (41), therapeutic duplication prevented (61), and drug-drug interaction identified (93). Additionally, 55 soldiers were recommended for temporary duty profiles based on their adverse drug effects. Ten soldiers were recommended for enhanced controlled substance monitoring.Placing soldiers on clinically appropriate medications and removing potentially harmful medications from their possession are examples of how the PC positively impacted the Commanding General's ability to deploy a fully medically ready force. Soldiers consistently remarked favorably on the thorough medication counseling provided at their PC appointments. Innovative notes within the electronic health record summarized relevant findings regarding soldiers' medications, which allowed providers to quickly pinpoint and adjust medication regimens. With each identified high-risk soldier, we decreased the potential for postdeployment medication issues. Additionally, the PC generated over $70,000 in relative value units for the hospital.
    Journal of managed care pharmacy: JMCP 01/2015; 21(1):8-11.
  • Sloan C · Park C · Tan X · Chang J ·

    Journal of managed care pharmacy: JMCP 10/2014; 20(10-a):S51.
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    ABSTRACT: Background: Patients with multiple sclerosis (MS) who are adherent to their treatment regimens are less likely to experience relapses and the cost associated with relapse. Pharmacists whose practice involves these specialty pharmaceuticals used to treat MS are striving for ways to improve outcomes by achieving treatment adherence in their patients. Specialty pharmacies have reported higher adherence rates than traditional pharmacies, which may translate to improved outcomes. Identifying patients who warrant increased adherence intervention is critical. Models using administrative health care claims to predict adherence have typically included demographic characteristics, comorbidities, and/or previous consumption of health care resources. Addition of a measure of early adherence may improve the ability to predict future adherence outcomes. Objective: To evaluate early adherence with disease-modifying drugs (DMDs) as a predictor of future adherence in patients with MS. Methods: The first DMD claim (i.e., index event) for adult MS patients (aged ≥18 years and aged ≤ 65 years) who received self-injected DMDs between January 1, 2006, and May 31, 2010, was identified in a national U.S. managed care database. Patients were required to have continuous eligibility for 12 months pre- and 24 months post-index. Multiple regression models were used to predict future adherence as measured by the proportion of days covered (PDC). The base model included age, gender, a medication intensity measure, presence of a non-MS-related hospitalization pre-index, and markers for physical difficulty, forgetfulness, or depression/stress. Models adding early DMD adherence as a covariate were analyzed using incrementing 30-day periods predicting the subsequent 360 days. Results: There were 4,606 patients included with an average age of 46.0 (SD 9.4) years, and 78.7% were female. Average PDC in the first 360 days post-index was 80.0% (SD 26.0). Using the first 60 days of early adherence as the only predictor in the model showed an R2 of 20.6%. The base model (i.e., no early adherence measure but other covariates included) yielded an adjusted R2 of only 2.3%. As the time period of early adherence is increased (from 60 to 360 days), the explained variance as measured by adjusted R2 values increased from 20.6% to 53.5% (early adherence-only models). Addition of the covariates, other than early adherence, increased the R2 by 1% to 2%. Conclusions: Statistical predictive models that include early adherence with DMDs were able to explain the variance in future adherence outcomes to a greater extent than models based solely on baseline characteristics. The efficiency of an adherence intervention in reaching its intended target can be improved by using models such as these with enhanced specificity and selectivity.
    Journal of managed care pharmacy: JMCP 08/2014; 20(8):800-7.
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    ABSTRACT: Background: Medication adherence, defined as taking medications as prescribed, is a key component in controlling disease progression and managing chronic illnesses such as diabetes, hypertension, and high blood cholesterol. These diseases constitute 3 of the top 5 most prevalent conditions among Medicare beneficiaries, warranting further attention to find ways to promote better medication adherence. The scientific literature has established the clinical and financial benefits of medication adherence and the role of dispensing channel in impacting adherence to medications. However, a common limitation in channel-adherence studies is the failure to control for healthy adherer effect (HAE), referring to individuals who are likely to engage proactively in activities that improve their adherence. Healthier individuals may choose the home-delivery channel to ensure continuity in their medication regimens and to minimize obstacles to adherence, such as inadequate access, inconvenience, and financial concerns. Thus, better medication adherence in home delivery may reflect healthier patients' predisposition to self-select for home delivery options. To accurately attribute the impact of dispensing channel on adherence, research would need to control for bias from a patient's predisposition to be adherent. Objective: To examine the association of pharmacy dispensing channel (home delivery or retail pharmacy) with medication adherence for Medicare Part D beneficiaries taking medications for diabetes, hypertension, or high blood cholesterol, while controlling for low-income subsidy status, differences in days supply, and prior adherence behavior (PAB) as a way to partly control for HAE. Methods: A retrospective analysis using de-identified pharmacy claims data from a large national pharmacy benefits manager between October 2010 and December 2012. Continuously eligible Medicare Part D beneficiaries (Medicare Advantage and prescription drug plans participants only) aged 65 years or older who had an antidiabetic, antihypertensive, or antihyperlipidemic prescription claim between October and December 2010, were identified and followed for the next 2 years. Those enrolled in a home delivery auto refill program were excluded from this analysis. Multivariate logistic regression was used to evaluate the impact of dispensing channel on medication adherence, controlling for differences in demographics, low-income subsidy status, disease burden, and drug-use pattern. Patients with a proportion of days covered of ≥ 80% were considered to be adherent. The analysis controlled for PAB by using patients' adherence status in the year 2011. Results: The final analytical samples consisted of 150,389 diabetic patients, 615,618 hypertension patients, and 358,795 high blood cholesterol patients. The adjusted odds of being adherent for beneficiaries using home delivery were 1.25 times higher (CI = 1.20-1.30) for diabetes medications, 1.29 times higher (CI = 1.27-1.32) for hypertension medications, and 1.26 times higher (CI = 1.23-1.29) for high blood cholesterol medications, compared with beneficiaries using retail channels to obtain their prescriptions. PAB was the strongest contributor to the odds of a patient being adherent across all 3 therapy classes, ranging from odds ratio of 4.48 to 8.09. Conclusions: After excluding patients who received any prescriptions via home delivery auto refill programs and controlling for PAB, differences in days supply, low-income subsidy status, demographics, and disease burden, Medicare beneficiaries who use home delivery for antidiabetics, antihypertensives, or antihyperlipidemics have a greater likelihood of being adherent than patients who fill their prescriptions at retail. The results of this study provide evidence that where medications are received may impact adherence, even when controlling for PAB. Use of the home delivery dispensing channel may be an effective method to improve adherence for Medicare beneficiaries.
    Journal of managed care pharmacy: JMCP 08/2014; 20(8):851-61.