This article commemorates the 30th anniversary of the Journal of Managed Care & Specialty Pharmacy (JMCP), reflecting on its evolution to a central voice in managed care pharmacy. Launched in 1995, JMCP has chronicled the profession's growth while shaping the national conversation around value, access, and outcomes. The journal's early content addressed educational gaps and shared practical insights from the field, developing over time to feature rigorous health economics and outcomes research studies. JMCP and its authors played a pivotal role in elevating real-world evidence, as well as guiding stakeholders through transformative policy shifts like Medicare Part D and the Inflation Reduction Act. Over the years, JMCP has delved into complex topics such as management of high-cost drugs, value assessment, equity, and access. Acknowledging its most influential contributors and publications, this article illustrates how JMCP has remained a dynamic forum for scholarly dialogue. With an enduring legacy of connecting researchers, practitioners, and policymakers, JMCP remains poised to guide managed care pharmacy through future challenges in pursuit of improved patient health through evidence-based decision-making.

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: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. OBJECTIVE:To quantify the time trends in Medicare Part D spending and utilization, the concentration of spending, and the share of spending accounted for by specialty drugs from 2012 to 2021. METHODS:In this repeated cross-sectional study, we used data from the Centers for Medicare & Medicaid Services Part D Drug Spending Dashboard to investigate the time trends in total gross spending, prescriptions claims, and the average cost of a prescription claim for Part D drugs. We assessed the concentration based on the share of total gross spending and prescriptions by the drugs with the top 1%, 5%, and 10% of the highest spending and Lorenz curves and Gini coefficients. In addition, we stratified our analyses by specialty and nonspecialty drugs. RESULTS:Over the last 10 years, total gross drug spending in Medicare Part D increased by 103.5%, with a compounded annual growth rate of 8.2%. This change was driven by both increases in prescription claims and price increases of existing drugs to a similar degree. The concentration of spending intensified, with the top 1% of drugs accounting for an escalating share of total spending (from 31.4% to 41.1%). Over the 10-year study period, these top-spending drugs accounted for 5.6% of prescriptions but 34.6% of spending. Lorenz curves and increased Gini coefficients similarly showed that a smaller number of drugs accounted for increased spending over the study period. Specialty drug spending increased by 566.5%, with a compounded annual growth rate of 23.5%. The share of total spending on specialty drugs increased from 21.7% in 2012 to 71.1% in 2021. In 2021, specialty drugs accounted for 6.2% of prescriptions but 71.1% of total spending. CONCLUSIONS:Medicare Part D gross drug spending became increasingly more concentrated from 2012 to 2021, which was especially pronounced for specialty drugs. Increases in prices for specialty and other brand-name drugs will likely continue to drive gross spending upward. Although the Inflation Reduction Act provisions will likely reduce net spending on selected drugs, other policy changes may be warranted.

This primer defines the practice of managed care pharmacy and introduces key competencies of managed care pharmacy organizations, including pharmacy benefit design and implementation, formulary and medication utilization management, clinical program development and implementation, quality and safety program management, and promotion of affordability.

INTRODUCTION:The University of Florida College of Pharmacy, Department of Pharmaceutical Outcomes and Policy hosted a seminar 6-7 March 2021, on the quality of pharmaceutical products in the United States. This meeting report summarizes the topics presented at the seminar and highlights the expert opinions offered by the presenters.AREAS COVERED:The seminar, held virtually due to the COVID-19 pandemic, included slide presentations and faculty-moderated panel discussions from experts in the field. These experts from regulatory, academic, and private sectors discussed bioequivalence standards, existing and emerging efforts to promote quality in brand and generic manufacturing, as well as market-based solutions throughout the drug supply chain.EXPERT OPINION:The time spent understanding bioequivalence standards during the seminar felt especially important and relevant in our current pandemic environment, given the present need to have confidence in the science of drug development and to advocate for the safety of pharmaceuticals. Also an important point to emphasize from the seminar, was that every stakeholder along the drug supply chain has a responsibility to do their part to maintain its quality. And those in attendance, many of whom were students of healthcare sciences, were encouraged to be leaders in their fields and develop strategies to advance innovative improvements.

To the Editor: Nonmelanoma skin cancer (NMSC) is the most common malignancy in the United States (US), with substantial associated morbidity, cost, and small but significant mortality1; yet, its incidence is not nationally reported and must be estimated. The most recent peer reviewed study analyzed data from 2012 and calculated the total number of incident NMSCs in the US population at 5,434,193 and the total number of individuals treated for NMSC at 3,315,554.2

Managed care pharmacists apply real-world evidence (RWE) to support activities such as pipeline forecasting, clinical policy development, and contracting for pharmaceutical products. Managed care pharmacy researchers strive to produce studies that can be applied in practice. While asking the right research question is necessary, it is not sufficient. As with all studies, consumers of RWE look for internal and external validity, as well as sources of bias, to determine how the study findings can be applied in their work. To date, however, some of the safeguards that exist for clinical trials—such as public registration of study protocols—are lacking for RWE. Several leading professional organizations have initiatives dedicated to improving the credibility and reliability of such research. One component common to these initiatives is enhanced transparency and completeness of methodologic reporting. Graphical representations of study designs can improve the reporting and design of research conducted in health care databases, specifically by enhancing the transparency and clarity of often complex studies. As such, Schneeweiss et al. (2019) proposed a graphical framework for longitudinal study designs in health care databases. Herein, we apply this framework to 2 studies published in the Journal of Managed Care & Specialty Pharmacy that represent common research designs and report how application of the framework revealed deficiencies in reporting. We advocate for adoption of this framework in the effort to increase the usability of RWE studies using health care databases by managed care pharmacy. DISCLOSURES: No funding was provided for this work. Gatwood has received research funding from Merck & Co., AstraZeneca, and GlaxoSmithKline, unrelated to this work. Schneeweiss is a consultant to Aetion, of which he also owns equity. He is the principal investigator of investigator-initiated grants to the Brigham and Women’s Hospital from Bayer, Genentech, Boehringer Ingelheim, and Vertex. Wang reports support from investigator-initiated grants from Novartis, Boehringer Ingelheim, and Johnson & Johnson to Brigham and Women’s Hospital, unrelated to this work. Happe and Brown have nothing to disclose.

The AMCP NEXUS 2020 VIRTUAL will be held online the week of October 19, 2020. The AMCP abstracts program provides a forum through which authors can share their insights and outcomes of advanced managed care practice. For NEXUS 2020 VIRTUAL, abstract posters are scheduled to be presented Wednesday, October 21, from 1:00 pm EDT to 2:30 pm EDT. At that time, poster presenters will be available for live chats and will also share additional information about their research. Professional abstracts that have been reviewed are published in the Journal of Managed Care & Specialty Pharmacy’s (JMCP) Poster Abstracts supplement.

DISCLOSURES: No funding supported the writing of this letter. The authors have nothing to disclose.

The preponderance of journals with dubious publishing practices has resulted in a new term in academic publishing: predatory journals. Although there is no standard definition, predatory journals generally subvert the traditional peer-reviewed system for financial gain. Common practices of predatory journals include publishing almost all submissions, a lack of transparency about publication fees, aggressive solicitation of contributors irrespective of relevant expertise and credentials, and even closely mimicking names of reputable journals—effectively acting as a decoy to attract authors and readers. Left unchecked, these journals have the potential to threaten the evidence base relied on by managed care pharmacists. Given the importance of peer-reviewed literature to managed care pharmacy practice, how is one to discern between a predatory journal and a reputable one? There are 5 key practices that distinguish reputable journals. First, reputable journals rely on peer reviewers who are experts in their respective fields to carefully review submitted manuscripts for suitability to publish. Second, reputable journals have a board of experts in relevant areas that serve in an advisory capacity to the editorial staff. Third, reputable journals follow recognized publishing standards to guide their policies, which range from determining authorship, to journal management, to handling allegations of misconduct. Fourth, reputable journals are transparent and fair about their levied fees, avoiding any real or perceived conflict of interest. Finally, reputable journals are indexed in searchable databases that have quality selection criteria for inclusion. These 5 criteria should be used by managed care authors and researchers when determining where to publish their papers and whether to serve as an editorial board member or peer reviewer when requested. Studies published in journals meeting these criteria can be deemed as reputable and suitable for review by managed care and health policymakers. It is essential that everyone involved in producing and using peer-reviewed literature is informed about the threat of predatory publishing and avoids engaging in any activities with these journals. DISCLOSURES: No funding was received for the writing of this article. The author is editor-in-chief of the Journal of Managed Care & Specialty Pharmacy and has nothing to disclose.

The abstracts presented in this program were originally slated to be presented at the AMCP 2020 meeting in Houston, Texas, April 21-24. The meeting was canceled because of the COVID-19 crisis. In lieu of the scheduled poster presentations, many poster presenters have shared additional information about their research at https://plan.core-apps.com/amcp2020. Professional abstracts that have been reviewed are published in the Journal of Managed Care & Specialty Pharmacy’s Meeting Abstracts supplement.

Research agendas play valuable roles in clearly identifying high-priority topics that reflect potential to improve health care quality. The purpose of this report is to present work completed by the Academy of Managed Care Pharmacy (AMCP) and AMCP Foundation Joint Research Committee. This committee set forth to develop a research agenda for our 2 organizations that focuses on critical evidence needs in managed care pharmacy. This document reviews results from 2 surveys that were conducted to better understand unmet research needs within managed care pharmacy and to inform professional efforts of managed care pharmacists. The first survey collected qualitative data from key opinion leaders (KOLs) regarding the top evidentiary gaps in managed care pharmacy and barriers to closing those gaps. The second survey was sent to AMCP members and AMCP Foundation stakeholders, used a mixed methods quantitative-qualitative design, and incorporated concepts from initial KOL responses. The key outcome from these proceedings is the research agenda, which identifies and prioritizes 4 evidentiary gaps in managed care pharmacy: (1) real-world evidence to inform managed care pharmacy decision making, (2) value-based models in managed care pharmacy to address total cost of care, (3) impact of benefit design or utilization management strategies on patient outcomes, and (4) impact of direct patient care services provided by managed care pharmacy on patient outcomes. The agenda was intended to be broad and will evolve over time. AMCP and the AMCP Foundation hope that this research agenda inspires the AMCP membership, researchers, and funding agencies to close these gaps in knowledge and understanding.

DISCLOSURES:No funding contributed to the writing of this commentary. The authors have nothing to disclose.