Exploring Diabetes Prescription Drug Spending

Jun 2, 2015
Express Scripts summarizes diabetes pharmacy data and forecasts in advance of the American Diabetes Association 75th Scientific Sessions.
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  • Diabetes

This week, researchers and healthcare professionals will gather at the American Diabetes Association’s Scientific Sessions to discuss the latest research, drug therapies and clinical care for diabetes.

More than 29 million Americans live with diabetes, and a quarter of those patients are over age 65.

As attendees recognize the 75th anniversary of these Scientific Sessions, we investigate another annual trend.

For the fourth consecutive year, medications used to treat diabetes were the most expensive traditional therapy class when ranked by per-member-per-year (PMPY) spend. Annual spending increased 18%, primarily from a 16.3% increase in drug prices.

Components of Trend Traditional Diabetes 2014 

Brand Innovation Continues

Diabetes medications were the only nonspecialty therapy class to have a significant increase in PMPY drug spend in 2014, largely due to two newly approved medications known as sodium-glucose co-transporter 2 (SGLT2) inhibitors. SGLT2 inhibitors work with the body’s natural processes to remove excess glucose from the bloodstream. The FDA approved the first SGLT2 inhibitor in 2013, two more were approved in 2014 and many more are in the development pipeline.

Four new diabetes treatments – Farxiga™ (dapagliflozin), Tanzeum™ (albiglutide),

Jardiance® (empagliflozin) and Invokamet™ (canagliflozin/metformin) – were also approved in 2014.

Top Diabetes Drugs by Market Share

A Robust Pipeline, Continued Cost Increases

Drug spend for diabetes medications is expected to increase 18.3% in each of the next three years. Although only slight year-over-year increases in utilization are projected, substantial continued increases in unit price are likely to come from brand innovation, steady inflation for branded drugs and switches from older generic monotherapies to newer combination products.

New, longer-acting dipeptidyl peptidase-4 (DPP-4) and human glucagon-like ptide (GLP-1) formulations are in the development pipeline. Although they will carry lower risks of causing hypoglycemia at night, they may be priced higher than similar drugs that are currently available.

In 2014, 20% of patients with annual Rx spending at or greater than $100,000 had diabetes.

Potential of Biosimilars

Drug cost increases have been particularly significant among insulins, such as Lantus® (insulin glargine [rDNA origin] injection) and Levemir® (insulin detemir [rDNA origin] injection). Because insulins are manufactured by biological processes, true generics for them are not possible. However, biosimilar formulations being developed are expected to cost between 20% and 40% less than the branded innovators.

Impact to Medicare and Medicaid

Diabetes also saw a higher PMPY spend ($358.93) than any other traditional therapy class among Medicare beneficiaries. Annual spending increased for diabetes medications by 26.4%, driven by a small increase in utilization (4.9%) and a significant increase in unit price (21.5%). The magnitude of this spending increase for the diabetes therapy class was greater for Medicare clients than for commercial clients because the prevalence of disease is higher in older individuals.

Also, for the second year in a row, medications used to treat diabetes were the most expensive traditional therapy class, contributing 16.6% of overall Medicaid traditional drug spend.

Value of Clinical Specialization in Diabetes Care

Nonadherence to diabetes medication therapy was 38.9% in 2014. With such a large population undergoing diabetes treatment, clinical expertise for the condition is even more important. Specialist pharmacists in the Express Scripts Diabetes Therapeutic Resource Center® possess the disease-specific training to counsel patients on their therapy regime to ensure effective treatment and better health outcomes.

Author Bio

Lab Staff
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