Diabetes medications were the most expensive among traditional therapy drug classes with an overall trend of 14% in 2015, according to the Express Scripts 2015 Drug Trend Report. The positive trend is reflective of increases in both utilization and unit cost.
“Diabetes is a national epidemic with more people being diagnosed on an annual basis” says April Kunze, PharmD, senior director, clinical formulary development and trend management strategy, Prime Therapeutics. “Overall, Prime has seen a 20% increase in trend from the third quarter of 2015 to that of 2016. This is driven by approximately a 7% increase in utilization and a 12% inflationary increase.”
An increase in brand drug use is contributing to the spend, Kunze explains. Prime is seeing more use of glucagon-like peptide-1 receptor agonists (GLP-1s), sodium-glucose co-transporter 2 (SGLT-2) inhibitors and dipeptidyl peptidase 4 (DPP-4) inhibitors and less use of low-cost generics, such as the sulfonylureas. Insulin is also a mainstay in therapy, with the basal insulins such as insulin glargine (Lantus, Sanofi) and insulin detemir (Levemir, Novo Nordisk) garnering a significant portion of the utilization and spend.
The Drug Trend Report also predicts that diabetes will continue to be a significant contributor to trend as new cases continue to occur with approximately 27.8% of adults with diabetes currently undiagnosed. Additionally, as type 2 diabetes progresses, patients may require more than one therapy to adequately control the disease. As patients switch from older regimens that require multiple tablets per day to new combination products, increased spend is anticipated, since these combination therapies are branded.
Diabetes drugs that lower CVD risk
Diabetes and cardiovascular disease (CVD) are intimately linked, according to Kathleen Kaddis, BS, PharmD, senior clinical pharmacist, Priority Health.
According to the CDC, death from cardiovascular disease is 70% higher in adults with diabetes, and patients with diabetes have a decreased life expectancy driven in large part by premature cardiovascular death.
“Some argue that diabetes is a metabolic disease with cardiovascular complications, while others claim that it is a cardiovascular disease with metabolic complications,” Kaddis says. “Regardless of your opinion, management of diabetes and cardiovascular risk is of utmost importance. Diabetic patients are given medications for glycemic control, as well as for treatment and prevention of cardiovascular risk factors, like aspirin and statins. Cardiovascular morbidity and mortality are still too common in diabetics.”
Recently, empagliflozin (Jardiance, Boehringer Ingelheim) was the first diabetes drug shown to decrease cardiovascular mortality, says Kaddis. The FDA recently approved Jardiance’s secondary indication to reduce the risk of cardiovascular death in adult patients with type 2 diabetes mellitus and cardiovascular disease.
Empagliflizon also decreased hospitalization and death from heart failure, says Kaddis. “While other diabetes drugs have been able to show neutrality with regard to CVD outcomes, this is the first one to show a significant decrease.”
Novo Nordisk’s liraglutide (Victoza) significantly reduced the risk of major cardiovascular events and death in adults with type 2 diabetes in the Liraglutide Effect and Action in Diabetes — Evaluation of Cardiovascular Outcome Results trial. Results from the trial, conducted at 410 sites in 32 countries, showed that, over a mean of 3.8 years, the glucagon-like peptide 1 receptor agonist Victoza, reduced risk for three-point major adverse cardiac events by 13%, for all-cause death by 15% and for CV death by 22% vs. placebo, while reducing HbA1c and body weight.
“The results showed very impressive results including a 13% lower overall risk of having a heart attack, stroke or death from cardiovascular disease,” says Andrew Lyle, director of business development at Curexa Pharmacy. “Overall, there was a 22% lower risk of cardiovascular mortality and a 15% lower risk of all-cause death.