Journal of managed care pharmacy: JMCP (J MANAGE CARE PHARM )
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.
- Impact factor2.41Show impact factor historyHide impact factor history
- 5-year impact2.51
- Cited half-life4.70
- Immediacy index0.58
- Article influence0.72
- WebsiteJournal of Managed Care Pharmacy website
- Other titlesJournal of managed care pharmacy, JMCP
- Material typePeriodical, Internet resource
- Document typeJournal / Magazine / Newspaper, Internet Resource
Publications in this journal
- Journal of managed care pharmacy: JMCP 08/2014; 20(8):800-7.
- Journal of managed care pharmacy: JMCP 08/2014; 20(8):851-61.
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ABSTRACT: Adalimumab (Humira [ADA]), etanercept (Enbrel [ETN]), and infliximab (Remicade [IFX]) are tumor necrosis factor (TNF) inhibitors indicated for the treatment of a variety of disorders. While their effectiveness has not been directly compared in a clinical trial, results from the majority of the indirect treatment comparisons suggest comparable efficacy and safety profiles. However, these TNF inhibitor agents differ in administration method and dosing flexibility, which may result in differences in medication use profiles (e.g., adherence, persistence, discontinuation, dose escalation, and switching to a new biologic rheumatoid arthritis drug) and effectiveness in clinical practice. OBJECTIVE: To estimate the effectiveness of ADA, ETN, and IFX in patients with rheumatoid arthritis (RA) using a validated, claims-based algorithm designed for large retrospective databases.METHODS: Adult (aged 18-63 years) patients diagnosed with RA, and receiving ADA, ETN, or IFX, and insured by Texas Medicaid were included. The index date was the date of the first prescription claim for ADA or ETN or infusion record for IFX with no claim or infusion record of a biologic drug in the preceding 6 months (i.e., biologic naïve). The study time frame was from July 2003 to August 2011, and prescription and medical claims for each subject were analyzed over an 18-month period (6 months pre- and 12 months post-index). Based on a RA medication effectiveness algorithm (Curtis et al. 2011), a RA medication was classified as effective if each of the following 6 criteria were met: (1) high medication adherence (i.e., medication possession ratio [MPR] ≥ 80%, defined as the sum of days' supply for all fills or infusions divided by the number of days in the study period); (2) no switching to (or addition of) new biologic RA drugs; (3) no addition of new nonbiologic RA drugs; (4) no increase in dose or frequency of administration of the RA medication currently evaluated; (5) no more than 1 glucocorticoid (GC) joint injection; and (6) no increase in dose of a concurrent oral GC. Propensity score (PS) matching was employed, and paired tests (i.e., McNemar's) and multivariate conditional logistic regression analysis were used to compare groups. Demographic (i.e., age, gender, race) and clinical (i.e., use of nonbiologic disease-modifying antirheumatic drugs [DMARDs], pain medication use, GC medication use, RA-related and non-RA-related health care visits [i.e., ambulatory and inpatient visits], number of nonstudy RA medications, and comorbidity index) characteristics, including total health care utilization cost at baseline, served as study covariates.RESULTS: After PS matching, 822 patients (n = 274 per group) were included. The majority of the sample (69.2%) was between 45-63 years, female (88%), and Hispanic (53.7%). Results for each TNF inhibitor differed significantly for 2 of the 6 effectiveness criteria (i.e., medication adherence and dose escalation). A significantly higher proportion of patients on IFX were adherent compared with patients on ETN or ADA (38.3% vs. 16.4% and 21.2%, P less than 0.0001 for both). Adherence rates between ETN and ADA were not significantly different. A significantly higher (P less than 0.0001) proportion of patients on ETN had no dose escalation compared with patients on ADA or IFX (98.2% vs. 88.7% and 80.3%, P less than 0.0001). Dose escalation rate was also significantly lower (P = 0.0106) for ADA compared with IFX. The multivariate conditional logistic regression analysis indicated no significant difference in overall effectiveness using the claims-based algorithm among the 3 TNF inhibitors nor any significant relationship between effectiveness and the study covariates. CONCLUSION: The study results suggest that when using a medication effectiveness algorithm, IFX, ETN, and ADA have comparable effectiveness in patients with RA. Patient adherence to therapy may be higher if given IFX, and patients who receive ETN are less likely to have a dose escalation.Journal of managed care pharmacy: JMCP 07/2014; 20(7):657-667.
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ABSTRACT: Managed care organizations put great effort into managing the population of patients with type 2 diabetes mellitus (T2DM) because of the health and economic burden of this disease. In patients with T2DM, weight loss and glycemic control are primary treatment aims to help improve patient outcomes, but these goals are not easily achieved. While achieving these aims requires a multifaceted approach of drug therapy management and lifestyle modification, truly understanding the role of medication adherence in achieving these outcomes is important for both patient and population management. This study expands on existing evidence that weight loss is associated with improved glycemic control by examining the role of medication adherence in achieving these goals in a managed care setting. This study is unique in that these associations are evaluated using multiple sources of data, including medical records for treatment outcomes, pharmacy claims, and patient-reported data to assess medication adherence. These data sources represent those typically available to payers or providers. OBJECTIVE: To describe the relationships between medication and adherence, weight change, and glycemic control in patients with T2DM.METHODS: This historical cohort study included adult patients with T2DM in a large integrated health system and was based on electronic health record and pharmacy claims data from November 1, 2010, through October 31, 2011, as well as data from a self-reported adherence survey conducted in March 2012. Included patients received a diabetes medication from a therapeutic class not previously received, between November 1, 2010, and April 30, 2011 (index date), who had blood glucose (HbA1c) and weight values at index date and 6 months follow-up, participated in an adherence survey, and had ≥ 1 prescription claim for the index-date drug. Associations between the dual outcomes of weight loss (≥ 3%) and HbA1c control ( less than 7.0%), while controlling for medication adherence and other demographic, treatment, and clinical variables, were evaluated using structural equation models (SEM). Separate models adjusted for different measures of medication adherence-self-reported using the 5-item Medication Adherence Rating Scale (MARS-5) and a modified medication possession ratio (mMPR) from pharmacy claims data.RESULTS: The study included 166 patients with a mean age of 61.1 (standard deviation = 12.1) years; 56.0% were female. Medication adherence was high, with 72.2% adherent using MARS-5 and 77.1% using mMPR measures. The SEMs found that only self-reported medication adherence is associated with weight loss (MARS-5: OR = 1.70, 95% CI = 1.11-2.60), while both self-reported and claims-based medication adherence were associated with HbA1c less than 7.0% (MARS-5: OR = 1.59, 95% CI = 1.09-2.34; mMPR: OR 2.71, 95% CI = 1.22-5.98). Further, weight loss is significantly associated with HbA1c less than 7.0% (MARS-5: OR = 3.60, 95% CI = 2.39-5.46; mMPR: OR 2.99, 95% CI = 1.45-6.17).CONCLUSIONS: This study has provided additional evidence in a managed, integrated setting that in patients treated for T2DM, weight loss is associated with good glycemic control. Adherence is associated with weight loss according to self-report, but not claims-based adherence measures. Adherence is also associated with glycemic control as measured by the 2 different methods. This study adds to the body of literature highlighting the importance of adherence as well as weight loss in achieving good glycemic control. The fact that the association of weight loss and adherence on glycemic control outcomes was significant regardless of medication adherence method is important in payer-provider collaborations, where access to data sources to evaluate adherence may vary. This study also supports continued investment in weight loss and adherence programs in the management of patients with T2DM.Journal of managed care pharmacy: JMCP 07/2014; 20(7):691-700.
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ABSTRACT: Heart failure is one of the most common reasons for hospital admissions in patients aged 65 years and older, with an estimated 1 million hospitalizations annually. In 2010, health care expenditures for heart failure were estimated to be $32 billion. Nonadherence to medications and lifestyle contributes to hospital admissions in up to one-third of patients. Efforts to reduce readmissions are of critical importance. Pharmacist involvement in the management of heart failure patients has been shown to reduce heart failure hospitalizations, with trends towards a reduction in mortality. Literature is scarce on instruments that clinicians can use to identify patients at risk for medication nonadherence.OBJECTIVES: To (a) describe factors that predict medication adherence for patients with heart failure, (b) evaluate the impact and value of pharmacist interventions on adherence and outcomes, and (c) assess tools to predict medication nonadherence in heart failure patients.METHODS: From inception to September 2013, a search was conducted in the databases MEDLINE, PubMed, CINAHL, and The Cochrane Library to identify relevant studies for 3 separate searches, identifying predictors of medication adherence in heart failure patients, pharmacist involvement to impact medication adherence, and tools to predict medication nonadherence in this population.RESULTS: Many significant predictors of both medication adherence and nonadherence have been identified in heart failure patients. Studies evaluating the effect of pharmacist involvement in the management of heart failure demonstrated improvements in medication adherence that dissipated once the intervention was withdrawn. The Morisky Medication Adherence Scale and the Merck Adherence Estimator are simple and practical tools that may be useful for identifying nonadherence in heart failure patients.CONCLUSIONS: Clinicians should be cognizant of factors that may affect medication adherence in heart failure patients and be aware of instruments available to predict the risk for medication nonadherence. Pharmacist interventions should be part of a multidisciplinary system of care initiated at discharge that involve personal contact and are continued indefinitely in order to sustain these benefits.Journal of managed care pharmacy: JMCP 07/2014; 20(7):741-755.
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ABSTRACT: BACKGROUND: Contraceptives vary by effectiveness, duration of effect, and the total costs related to the method used and unintended pregnancies (UP). Health care payers and women incur higher initial costs for long-acting reversible contraceptives, such as intrauterine contraceptives and implants, than for short-acting reversible contraceptives, such as oral contraceptives (OC). When making coverage decisions for contraceptives, health care payers should take into consideration both product and pregnancy-related costs over the entire time of contraceptive use. OBJECTIVE: To estimate the impact on the cost to a U.S. health care plan over 3 years when switching women from OCs to a low dose levonorgestrel-intrauterine system (LNG-IUS-12). METHODS: A budget impact model was designed to estimate the cost before and after the availability of LNG-IUS-12, over a 3-year time horizon, among females 15-44 years at risk of UP, covered by a health plan. U.S. Census and National Survey of Family Growth data were used to determine the number of women aged 15-44 currently using or requiring contraception. Pregnancy outcomes (i.e., live births, induced and spontaneous abortion, ectopic pregnancy), risk of UP, discontinuation rates, and typical failure rates were estimated using published literature. It was assumed that LNG-IUS-12 garnered 0.5% of the contraceptive market in the first year, an additional 0.3% in the second year, and 0.2% in the third year, resulting in 1% of the contraceptive market at year 3, with LNG-IUS-12 taking direct market share from branded and generic OCs. The model incorporated costs for contraceptives, related physician visits, and pregnancy outcomes from method failures. Pharmacy costs were derived from Wolters Kluwers Health-MediSpan Master Drug Database; medical care costs were gathered from Medicare Reimbursement Rate for physicians; and the pregnancy costs were obtained from the Health Care Utilization Project. Model outputs were reported as cost per plan, per member, per patient, or per member per month (PMPM), as well as the number of UP. All costs accrued in years 2 and 3 were discounted at 3%. A scenario analysis assessed the impact of potential first-year discontinuation rates for LNG-IUS-12, allowing for a 20% switch from LNG-IUS-12 back to OC. RESULTS: In a hypothetical cohort of 1 million plan members, the base case model, with no allowance for discontinuation, estimated a reduction in total costs of $516,166, in PMPM costs of $0.04, and in UP 153. When first-year discontinuation of LNG-IUS-12 was considered, the model estimated a decrease in total costs of $381,032, in PMPM costs of $0.03, and in UP of 134. These results were based on an estimated LNG-IUS-12 uptake of 1% of the total contraceptive market taken from OC users over a 3-year time horizon in women at risk for pregnancy. CONCLUSIONS: Switching contraceptive users from OC to LNG-IUS-12 in a U.S. health care plan may result in less UP and an overall cost savings to the plan.Journal of managed care pharmacy: JMCP 01/2013; 19(2):153.
- Journal of managed care pharmacy: JMCP 01/2013; 19:S41-53.
- Journal of managed care pharmacy: JMCP 01/2013; 19:S1-53.
- Journal of managed care pharmacy: JMCP 01/2013;
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ABSTRACT: BACKGROUND: Current available contraceptive methods vary greatly in efficacy and overall costs. Although long-acting methods, such as intrauterine systems/devices (IUS/IUD) and implants, may have higher upfront medication costs than short-acting methods, such as oral contraceptives (OC), the latter may incur greater medical failure-related costs due to their dependence on user compliance. OBJECTIVE: To develop a framework to estimate the potential cost savings from the introduction of an IUS in a U.S. health plan’s formulary setting. METHODS: A budget impact model (BIM) was developed to assess the potential cost savings using a before-and-after comparison approach. Multiple contraceptive methods, up to a maximum of 8, can be selected across an adjustable time horizon between 1 and 5 years. The number of women using contraception was calculated from the U.S. Census and the National Survey of Family Growth. Contraceptive failure rates (i.e., pregnancies, induced abortions, live births, spontaneous abortions, and ectopic pregnancies) were derived from product labeling and published literature. Total costs included drugs, administration, physician visits, and contraceptive failures. Pharmacy costs were based on wholesale acquisition cost (WAC), whereas medical costs were based on Medicare Reimbursement Rate for physicians. Model outputs included annual health plan cost, per member per month (PMPM) costs, and per treated member per month costs. RESULTS: Assuming a 5% weighted increase in the number of women using IUS from branded OC, generic OC, injectable contraceptive, vaginal ring, transdermal patch, and implant in a hypothetical cohort of 1 million plan members for a 3-year time frame, the model estimates a reduction in total annual cost by $1.8 million and 1,066 contraceptive failures, translating into a cost savings of $0.05 PMPM. Potential cost savings could range from $0.02 PMPM to $0.10 PMPM, depending on different possible scenarios. CONCLUSIONS: Long-acting contraception methods, such as IUS, are highly effective in preventing large number of unintended pregnancies leading to cost savings of the health plan formulary budget.Journal of managed care pharmacy: JMCP 01/2011; 17(3):234.
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ABSTRACT: Patients with bone metastasis secondary to prostate or breast cancer or multiple myeloma are predisposed to skeletal-related events (SREs), such as surgery or radiation to the bone, pathologic fracture, and spinal cord compression. Inpatient costs of these and other SREs represent an estimated 49%-59% of total costs related to SREs. However, information on payer costs for hospitalizations associated with SREs is limited, especially for costs associated with specific SREs by tumor type. To examine costs from a payer perspective for SRE-associated hospitalizations among patients with multiple myeloma or bone metastasis secondary to prostate or breast cancer. Patients with SRE hospitalizations were selected from the MarketScan commercial and Medicare databases (January 1, 2003, through June 30, 2009). Sampled patients had at least 2 medical claims with primary or secondary ICD-9-CM diagnosis codes for prostate cancer, breast cancer, or multiple myeloma and at least 1 subsequent hospitalization with principal diagnosis or procedure codes indicating bone surgery, pathologic fracture, or spinal cord compression. For patients with prostate cancer or breast cancer, a diagnosis code for bone metastasis was also required. If secondary diagnoses or procedure codes for SREs were present in the claim, they were used to more precisely identify the type of SRE for which the patient was treated, resulting in 3 mutually exclusive categories: spinal cord compression with or without pathologic fracture and/or surgery to the bone; pathologic fracture with or without surgery to the bone; and only surgery to the bone. Related readmissions within 30 days of a previous SRE-associated hospitalization date of discharge were excluded to minimize the risk of underestimating costs. Mean health plan payments per hospitalization, measured as net reimbursed amounts paid by the health plan to a hospital after subtracting patient copayments and deductibles, were analyzed by cancer type and type of SRE. A total of 555 patients contributed 572 hospitalizations that met the study criteria for prostate cancer, 1,413 patients contributed 1,542 hospitalizations for breast cancer, and 1,361 patients contributed 1,495 hospitalizations for multiple myeloma. The mean age range was 61 to 72 years, and the mean length of stay per admission was 5.9 to 11.6 days across the 3 tumor types. The ranges of mean health plan payment per hospital admission across tumor types were $43,691-$59,854 for spinal cord compression, with or without pathologic fracture and/or surgery to the bone; $22,390-$26,936 for pathologic fracture without spinal cord compression, with or without surgery to the bone; and $31,016-$42,094 for surgery to the bone without pathologic fracture or spinal cord compression. The inpatient costs associated with treating SREs are significant from a payer perspective. Our study used a systematic process for patient selection and mutually exclusive categorization by SRE type and provides a per episode estimate of the inpatient financial impact of cancer related SREs assessed in this study from a third-party payer perspective.Journal of managed care pharmacy: JMCP 11/2010; 16(9):693-702.
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ABSTRACT: Multiple sclerosis (MS) is a costly and crippling neurologic disease. Approximately 250,000 to 400,000 persons in the United States are currently diagnosed with MS. Most individuals experience their first symptoms between the ages of 20 and 40 years; therefore, this disease may have substantial impact over many years of life on health, quality of life, productivity, and employment. Whereas a number of studies have utilized a cross-sectional design to evaluate the costs associated with MS, no study has used a large administrative claims database to analyze the direct costs associated with newly diagnosed MS. To estimate the additional health care utilization and costs in otherwise healthy patients with newly diagnosed MS. This was a retrospective cohort analysis of the Medstat MarketScan Commercial Claims and Encounters database, which is composed of medical and pharmacy claims for approximately 8 million beneficiaries from 45 U.S. commercial health plans. Cases extracted from the database included adults aged 18 to 64 years with either (a) at least 2 medical claims with a diagnosis of MS (ICD-9-CM code 340) in any diagnosis field on the claim or (b) 1 prescription (medical or pharmacy) claim for injectable MS drug therapy (interferon beta-1a, interferon beta- 1b, glatiramer acetate) for dates of service between January 1, 2004, and December 31, 2006. Natalizumab was not used to identify MS cases, but was used to exclude potential comparison group subjects. The index date for patients with MS was the first qualifying diagnosis or pharmacy claim. Each MS patient was matched to 5 "healthy comparison" cases without MS diagnoses or treatment using the following variables: region, insurance type, gender, relation to employee, age, and enrollment period. Cases with any condition listed in the Charlson Comorbidity Index were excluded from both the MS and "healthy comparison" cohorts. Each "healthy comparison" case was assigned the index date of the matching MS patient. Continuous enrollment 12 months pre- and post-index was required for both the MS and "healthy comparison" groups. Costs broken down by type of utilization were adjusted to 2010 dollars using the appropriate medical component of the Consumer Price Index. Use of services and costs were compared using chi-square, t-tests, parametric and nonparametric tests. 1,411 MS cases (65.6% female) were matched to 7,055 "healthy comparison" cases (65.6% female). In the analyses of all-cause health care services during the 12-month post-index period, MS patients were significantly more likely to use all categories of health services examined. Compared with the "healthy comparison" group, new MS patients were 3.5 times as likely to be hospitalized (15.2% vs. 4.3% for MS vs. comparison, respectively), twice as likely to have at least 1 emergency room (ER) visit (25.5% vs. 12.2%) and 2.4 times as likely to have at least 1 visit for physical, occupational, or speech therapy (23.7% vs. 9.9%; P < 0.001 for all comparisons). MS patients also had higher mean 12-month costs related to each category of service (inpatient services $4,110 vs. $836; radiology services $1,693 vs. $259; ER $432 vs. $189; office visits $849 vs. $310; therapies $295 vs. $81, respectively; all P values < 0.001). Total mean 12-month all-cause health care costs were significantly higher for MS patients than for the "healthy comparison" group ($18,829 vs. $4,038, respectively, P < 0.001). Claims attributed to MS by diagnosis code in any field on the claim or use of an MS injectable drug accounted for a mean cost of $8,839 (46.9%), and MS injectable drugs accounted for $4,573 (24.3%) of total all-cause health care costs. Newly diagnosed MS patients have significantly higher rates of hospitalizations, radiology services, and ER and outpatient visits compared with non-MS "healthy comparison" patients. MS presents a considerable burden to the U.S. health care system within the first year of diagnosis.Journal of managed care pharmacy: JMCP 11/2010; 16(9):703-12.
- Journal of managed care pharmacy: JMCP 11/2010; 16(9):718-28.
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