Diabetes is a high-cost category with an increasing number of therapies that treat the condition. To help stakeholders absorb datapoints and perceptions from all directions and synthesize those insights into a tangible strategy for diabetes, Zitter Insights surveys a leading panel of pharmacy and therapeutics (P&T) decision makers at payers and integrated delivery networks. The Managed Care Biologics and Injectables Index combines deep payer insights with the industry standard in market access information to produce quarterly reports and insights summaries on leading specialty brands.
Among the therapies prescribed by endocrinologists, the top dipeptidyl-peptidase 4 (DPP-4) inhibitors were Merck & Co., Inc.’s Januvia (sitagliptin), Janumet (sitagliptin and metformin HCl) and Janumet XR (sitagliptin and metformin HCl extended-release). Among the glucagon-like peptide 1 (GLP-1) agonists, the most prescribed were Eli Lilly and Co.’s Trulicity (dulaglutide), as well as Victoza (liraglutide) and Ozempic (semaglutide), both from Novo Nordisk.
Sanofi Genzyme’s insulin glargines Lantus and Toujeo were the most-prescribed insulin/insulin glargines, and Jardiance (empagliflozin) from Boehringer Ingelheim Pharmaceuticals, Inc. and Eli Lilly and Co. was the most popular sodium-glucose co-transporter 2 (SGLT2) inhibitor. Endocrinologists said Ozempic is their most ideal first-line therapy, while Jardiance is their top second-line agent (see chart).
On Sept. 20, 2019, the FDA approved Novo Nordisk’s Rybelsus (semaglutide), the first oral GLP-1 agent for Type 2 diabetes. Payers with the majority of lives say the drug’s method of administration is more influential to them than its once-daily dosing. Almost three-fourths of endocrinologists said its method of administration is highly influential, while less than half ranked its dosing similarly.
Some diabetes therapies have been approved for treating patients with a risk of major adverse cardiovascular events. These include the SGLT2 inhibitors Jardiance and Invokana (canagliflozin), Invokamet (canagliflozin and metformin) and Invokamet XR (canagliflozin and metformin extended-release) from Janssen Pharmaceuticals Inc., a Johnson & Johnson company, as well as the GLP-1 agonists Victoza, Ozempic and Trulicity. A majority of endocrinologists say this added benefit has a high influence on their prescribing.
On June 11, 2020, the FDA approved Mylan N.V. and Biocon Ltd.’s Semglee (insulin glargine) to control high blood sugar in adults with Type 2 diabetes and adult and pediatric patients with Type 1 diabetes. Semglee has an identical amino acid sequence to Lantus. Payers with one-third of lives plan to prefer Semglee over Lantus, while one-third of endocrinologists plan to prescribe Semglee over Lantus (see chart).
Pricing & Rebates
Message: “CKD in diabetes increased the risk of death (CV and all cause) that results in increased cost along with risk of dialysis and transplant. SGLT2 inhibitors help with renal effects by lowering intraglomerular pressure. Invokana demonstrated renal protective benefits in the CREDENCE trial.”
Payer Thoughts: “We’re starting to think of diabetes as more and more linked with renal and cardiovascular outcomes. The CREDENCE trial is timely.”
Commercial Patients May Have Better Access
A new study published in JAMA Network Open suggests commercial insurance members have better access to newer diabetes drugs than members of Medicare Advantage plans — especially MA members with low incomes. “Better understanding of nonclinical factors contributing to treatment decisions and efforts to promote greater equity in diabetes management appear to be needed,” the study concluded.
Plan Sees Promise in Diabetes Reversal Platform
Diabetes prevention and diabetes management are both key tenets of Medicare Advantage insurers’ approach to addressing this costly condition that impacts one in three Medicare enrollees. But one tech-savvy startup aims to popularize a third category — diabetes reversal — and early adopter Blue Shield of California says the program has achieved very desirable results in less than two years.