Human papillomavirus (HPV) results in 37,000 new cancers each year. HPV-attributable cancers are preventable through vaccination with the completion of the HPV series encouraged by age 13 years. Public uptake has been lower than expected. Blue Cross Blue Shield of Michigan (BCBSM) implemented clinical programs to address low vaccination rates.

Individuals with depression who do not respond to initial antidepressant may switch to a different antidepressant, add a second antidepressant, or add an atypical antipsychotic. Previous studies comparing these strategies' efficacy and safety reported conflicting results, and the impact of these strategies on subsequent health care utilization is unknown.

In 2021, Medicare Part D gross prescription drug spending amounted to $216 billion, a number that has more than doubled over the last 10 years. Spending in Medicare Part D is concentrated on a small number of drugs, and spending on specialty drugs has increased in recent years. However, the extent to which concentration in Part D spending has changed over time and the drivers of this change have not been described.

A comprehensive medication review (CMR) is an annual service offered to eligible Medicare Part D beneficiaries as a component of the Medication Therapy Management program. However, little is known about the most meaningful aspect of CMRs from the patient's perspective. This information is necessary to help improve the service.

The incidence of melanoma has increased significantly in the past few decades, posing a significant public health challenge. However, there is an evidence gap regarding the marginal costs of treating melanoma.

Per capita spending on drugs in the United States is double that of Canada. One commonly debated point when comparing the 2 countries is whether this additional spending allows residents of the United States access to valuable therapies not available in Canada.

Available treatments for relapsed/refractory multiple myeloma (RRMM) include multiclass triplet regimens such as lenalidomide and dexamethasone (Rd backbone) plus ixazomib (proteasome inhibitor [PI]; I) or daratumumab (monoclonal antibody; D). Although prior real-world studies compared PI-Rd triplets, this research extends those findings by comparing health care costs of a PI-based and a monoclonal antibody-based triplet, IRd and DRd, in patients with RRMM in the United States.

Rates of attainment of high-quality diabetes care have been shown to be lower for those living in more disadvantaged and rural areas. Diabetes management relies on access to care and is impacted by physical, social, and economic factors. Area deprivation index (ADI) is one way to quantify geographic disparities in aggregate. We aimed to investigate how ADI impacts outcomes in members with type 2 diabetes enrolled in a large, regional health plan.

Multiple sclerosis (MS) is a lifelong progressive neurological disease treated primarily with disease-modifying therapies (DMTs). Disease activity tends to decline as patients age. Midlife represents a crossroads where the risks of DMT may outweigh the benefits, prompting providers to consider DMT discontinuation to reduce treatment burden. However, real-world evidence on the impact of DMT discontinuation among midlife patients is lacking.

Type 1 diabetes mellitus (T1DM) is a prevalent chronic endocrine disorder and accounts for 5%-10% of all diabetes cases worldwide. T1DM can have a substantial impact on health care utilization. Although it is well known that individuals with diabetes are at a greater risk of mental health disorders, specific evidence addressing the health care burden of comorbid depression/anxiety in people affected by T1DM is lacking.

Outcomes-based agreements (OBAs) are agreements between payers and manufacturers in which payment for medications is tied to patient outcomes. These contracts aim to measure the value of prescription medications on predefined clinical indicators in real-world patient populations. OBAs are gaining traction in the United States as the health care industry shifts from volume-based to value-based care. Multiple sclerosis (MS) is an appealing therapeutic area for OBAs because of its prevalence, high cost of medications, and multiple effective therapeutic options.

Alternative funding programs (AFPs) seek to reduce health plan sponsor costs, for example by excluding specialty drugs from a beneficiary's plan coverage and requiring patients to obtain medications through alternative sources (typically, the manufacturer's patient assistance programs) via an AFP vendor as a third-party.

There has been growing consensus for the health care community to become more patient centered by considering patient needs, preferences, and values in decision-making. To advance partnership between payers and patient representatives to gather patient input and incorporate their perspective on the broad range of managed care pharmacy decisions, the AMCP held a multistakeholder Partnership Forum on December 6 and 7, 2023, in Alexandria, Virginia. Forum participants were asked to (1) identify opportunities for patient representatives to engage with payers and other managed care pharmacy decision-makers, (2) recognize challenges and propose potential solutions to establish patient engagement programs between payers and patient representatives, and (3) review and provide input on draft frameworks created by the 2023-24 AMCP Patient Voice Advisory Group. Key themes that emerged from the participant discussion included to assemble and draw upon successful examples and best practices, recognize different levels of engagement, build trust and relationships proactively, create defined access points and open dialogue channels, incorporate the patient perspective as an element of coverage decision-making, leverage existing patient data and reports, crystallize a key message furthering common goals, and facilitate ongoing education and learning.

The field of digital therapeutics (DTx), software programs that prevent, manage, and treat medical conditions, continues to grow. DTx offers new treatment options and has the potential to close gaps in care caused by unmet patient needs, provider shortages, or socioeconomic or geographical disparities. However, the field of DTx has not seen steady adoption owing to barriers, particularly related to coverage, payer acceptance of the category, provider use, and integration within existing health care delivery tools. One challenge for payers to effectively evaluate and cover DTx products is ensuring that consistent data elements are listed for these products in traditional drug compendia databases. Managed care organizations will need similar information about DTx product features as are available for traditional medications to inform coverage and reimbursement decisions. The Academy of Managed Care Pharmacy DTx Advisory Group developed and distributed a request for information to the 5 top drug compendia companies to assess how compendia products incorporate DTx and prescription DTx. This article summarizes how DTx are listed within different compendia products and offers insights on future data needs to adequately inform payers. As the DTx sector grows and consumer demand rises, compendia listing services will need to evolve to accommodate these new therapies and treatment modalities and facilitate patient access and efficient claims processing. Recommendations for how compendia companies can support managed care in these efforts are outlined.

Wet age-related macular degeneration (AMD) is an acquired degeneration of the retina that can lead to central vision impairment. It is primarily treated with intravitreal injections of vascular endothelial growth factor inhibitors. Although vascular endothelial growth factor inhibitors can effectively prevent progression of vision loss in many patients, they require ongoing regular administration and are therefore associated with considerable treatment burden. To gain insights into the impact of wet AMD and its treatment, AMCP convened an expert panel of managed care stakeholders in April 2024 through its Market Insights program. Key issues related to wet AMD identified by participants included cost and affordability, provider-related considerations, biosimilar adoption, measuring and improving quality, and incorporating the patient voice. Suggested payer best practices related to these issues in wet AMD also emerged from the discussion.

People living with ALS (plwALS) experience motor control loss, speech/swallowing difficulties, respiratory insufficiency, and early death. Advancing disease stage is typically associated with a greater burden on the health care system, and delays in diagnosis can result in substantial health care resource utilization (HCRU).

Increasingly, pharmacists are asked to incorporate social determinants of health (SDoH) identification and referral into clinical practice. However, to date, no studies have evaluated clinical changes from embedding SDoH screening into the delivery of comprehensive medication management (CMM) in patients with chronic conditions.

To examine the real-world impact of continuous glucose monitoring (CGM) use on glycemic management and health care resource utilization (HCRU) in people with diabetes in a large US-insured population.