Payers Seize Opportunities to Control Diabetes Drug Costs


Diabetes drug spending is on the rise, but there are ways to control it.

Diabetes remains the top overall traditional drug spend category for commercial, Medicare D, and Medicaid clients, according to the 2017 Drug Trend Report from Prime Therapeutics.

“Drugs used to treat diabetes contribute a large portion of overall drug costs for our health plan clients,” says Patrick Gleason, PharmD, senior director of Health Outcomes at Prime. “Outcomes-based contracts, known at Prime as CareCentered Contracts, are one of the ways we are working to manage costs by aligning drug cost to clinical value for many disease states, including diabetes.”

A Prime Therapeutics study presented in March 2017, determined that the mean total cost of care for members with diabetes was $15,771-2.5 times higher than the cost of care for members without diabetes.

The excess cost for someone with diabetes includes more than three times higher drug cost, and also stems from treating comorbid conditions such as hypertension, hyperlipidemia, and cardiovascular disease, says Gleason.


Farrah Wong, PharmD, senior director, Pipeline and Drug Surveillance at OptumRx, says disease management is key to preventing complications, and that clinical care programs provide enhanced engagement, which leads to faster identification of gaps in care, improved adherence, increased satisfaction, and more “empowered” members. “In addition, clinical management strategies such as step therapy and supply limits will help manage diabetes drug spend.”

Recent approvals

The FDA approved the following diabetes therapies in December 2017:

• Merck’s Steglatro (ertugliflozin) for glycemic control in adults with type 2 diabetes (T2DM). Steglatro is the fourth approved sodium glucose cotransporter (SGLT2) inhibitor and is available as monotherapy as well as in combination with sitagliptin or metformin.

• Sanofi’s Admelog (insulin lispro injection), a follow-on product to Eli Lilly’s Humalog, for adults and pediatric patients aged three years and older with type 1 or type 2 diabetes.

• Novo Nordisk’s Ozempic (semaglutide), for improved glycemic control in adults with type 2 diabetes mellitus. Ozempic is a once-weekly subcutaneously injected glucagon-like peptide 1 (GLP-1) agonist.

Promising pipeline

Currently, all marketed GLP-1 agonists are administered subcutaneously; however, an oral formulation of semaglutide is being studied by Novo Nordisk.

“While the market for GLP-1 agonists has grown substantially through the years, some patients may be reluctant to use an injectable medication,” says Wong. “If approved, oral semaglutide will provide prescribers and patients an alternative to subcutaneous GLP-1 agonists in treating type 2 diabetes.”

Sotagliflozin (Lexicon Pharmaceuticals), an oral SGLT2 inhibitor, is being developed as adjunctive therapy for type 1 diabetes mellitus. If approved, it may be the first oral therapeutic option for these patients.  

“Typically, type 1 diabetes is more difficult to manage than type 2 diabetes and has limited options; the cornerstone of type 1 diabetes therapy is insulin,” says Wong. “If approved, sotagliflozin will provide another treatment option for patients with type 1 diabetes whose glucose levels are not controlled with insulin.

While the diabetes drug pipeline is fairly active and robust, much of the innovation is in formulation of the drug rather than novel drug class, Wong says. “As these drugs come to market with easier to administer dosages, it will provide alternative treatment options for diabetic patients.”


Erin Bastick, PharmD, RPh, is staff pharmacist at Southwest General Health Center, Middleburg Heights, Ohio.



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