Cancer and diabetes remain top therapeutic areas for managed healthcare executives to watch in 2019, and are joined by heart disease, chronic obstructive pulmonary disease (COPD), and mental health.
“These five conditions are extremely complex with disease processes that often impact multiple systems. Diagnosis and effective, individualized treatment for these conditions are also very important,” says Christopher Peterson, PharmD, director, Emerging Therapeutics, Express Scripts.
Eric Bricker, MD, chief medical officer and cofounder of Compass Professional Health Services, an Alight healthcare technology company based in Dallas, says diabetes is a key area of concern because of its prevalence. As many as 30.3 million Americans have diabetes, with 23.1 million diagnosed and 7.2 million undiagnosed, according to the CDC. Bricker says it is due to the obesity epidemic that is a primary risk factor for type 2 diabetes
“It’s hard to treat and difficult to control without medications, and patients face the consequences of stroke, heart disease, kidney failure, neuropathy, and retinopathy,” he says. “In addition, physicians don’t always diagnose patients soon enough because they are asymptomatic.”
One concern of Bricker’s is failure of physicians to initiate or intensify therapy when people with type 2 diabetes do not achieve glycemic control right after diagnosis.
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“Treating diabetes as a population might get worse before it improves because of childhood obesity. As younger people get type 2 diabetes, they will suffer the consequences at an earlier age,” Bricker says.
Bricker doesn’t believe insulin is a magic bullet. “While it can effectively control type 1 diabetes, it inhibits the body’s ability to breakdown fat. Insulin for type 2 diabetics may treat the short-term high blood sugar with insulin, but that insulin prevents reducing an underlying cause—obesity. You have short-term gains for a long-term problem,” he says.
He is optimistic, however, that diabetes prevention will draw more attention. For one thing, manufacturers will be required by January 1, 2021, to include the percent of added sugars in grams and percent daily value on their food labels.
Although Bricker says no breakthrough diabetes drugs are expected for 2019, there are some medications hitting the marketplace.
Oncology is also a top therapy class because of the large population affected. More than 1.7 million new cases of cancer are diagnosed each year in the United States, according to the American Cancer Institute. “In many cases, cancer can be treated as a chronic disease,” says Aimee Tharaldson, PharmD, a senior clinical consultant in Emerging Therapeutics for Express Scripts.
She says cancer therapies represent about one-third of all specialty drugs in the pipeline, so a significant number of cancer drug approvals are expected into the future.