The American journal of managed care
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Eosinophilic esophagitis (EoE) is a chronic inflammatory disease driven by a type 2 immune response and characterized by the accumulation of immune cells (eosinophils, basophils, and mast cells) in the esophagus. Patients may present with EoE at any age, and its prevalence is similar across age groups in the United States. If EoE is suspected, an endoscopy with biopsy is required to confirm the diagnosis; endoscopy allows clinicians to evaluate for the presence of rings, furrows, exudates, edemas, and/or strictures and biopsy helps to identify the associated histological changes, including eosinophilic infiltration of the esophageal mucosa. ⋯ The symptoms of EoE, its complications, and disease management considerations (eg, dietary limitations) are associated with diminished quality of life. There remains an unmet need for long-term management options. It is important for stakeholders to understand the current treatment landscape and unmet needs when considering the assessment of future therapies.
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To evaluate whether hospital entry into the 340B Drug Pricing Program, which entitles eligible hospitals to discounts on drug purchases and intends for hospitals to use associated savings to devote more resources to the care of low-income populations, is associated with changes in hospital provision of uncompensated care. ⋯ Relying on hospitals to invest surplus into care for the underserved without marginal incentives to do so or strong oversight may not be an effective strategy to expand safety-net care.
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The frontline treatment paradigm for patients with advanced or metastatic non-small cell lung cancer (NSCLC) has changed dramatically in the past decade amid efforts to tackle this leading cause of cancer-related mortality. Immune checkpoint inhibitors (ICIs) targeting the programmed cell death protein 1 (PD-1) receptor and its ligand PD-L1 are an important therapeutic option for patients whose tumors lack genetic alterations that dictate response to molecularly targeted therapies. ⋯ Presently, PD-L1 expression remains a key biomarker in this setting, in spite of its limitations. This article will evaluate the current and evolving clinical trends in the use of ICIs in the frontline management of metastatic NSCLC, as well as the challenges associated with PD-L1 expression analysis and biomarker implementation.
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Immune checkpoint inhibitors (ICIs) represent a significant benefit for the initial treatment of patients with advanced or metastatic non-small cell lung cancer (NSCLC). Beyond clinical benefit of increased overall survival, it represents a class of medications with a favorable adverse effect profile compared with chemotherapy. Drugs that target programmed cell death protein 1 (PD-1) receptor and its ligand PD-L1 are ICIs that work by taking the brakes off the immune system and promote T-cell-mediated cancer cell destruction. ⋯ However, this recommendation is not always followed and may lead to inappropriate treatment selection and potential increased cost. Through appropriate biomarker testing, subsequent appropriate utilization of ICIs may help to drive down other costs and improve health-related quality of life. Managed care pharmacists should continue to focus on promotion of guideline concordant care that includes appropriate biomarker testing and selection of an evidence-based preferred treatment option.