For the fifth consecutive year, diabetes is the costliest traditional therapy class for payers. Plans spent an average $77.60 per member per year (PMPY) on diabetes medications in 2015, a 14% increase from 2014, driven equally by increases in use and cost of medications in the class.
Three of the top five medications leading traditional drug spending in 2015 were diabetes medications: Lantus® (insulin glargine), Januvia® (sitagliptin) and Humalog® (insulin lispro).
With 27.8% of adults with diabetes currently undiagnosed, and a rich pipeline of new therapies, diabetes will remain a major contributor to drug spending in the years to come.
As researchers and clinicians gather to discuss the latest in diabetes care at the American Diabetes Association 76th Annual Scientific Sessions, here are 5 things to know about diabetes medication use and spending in the U.S.:
1. Insulins dominate market share. Four of the top 10 diabetes drugs by market share in 2015 were insulins, three of which were pre-filled insulin pens. Another pre-filled pen, Levemir®FlexTouch® (insulin detemir), which was approved in late 2014, quickly rose to the seventh place on the list of top 10 diabetes medications driving spend.
2. Brand inflation is responsible for unit costs increases. The average cost of diabetes medications, after rebates, was $94.21, which represents an increase of 7.4% between 2014 and 2015. With the exception of a 13.7% price decrease for Lantus – the preferred insulin on the Express Scripts National Preferred Formulary – unit cost trend reflects prices increases for most pre-filled insulin pens and new therapies, and the use of new therapies, such as Trulicity® (dulaglutide). In addition, new therapies Invokana® (canagliflozin) and Janumet® (sitagliptin/metformin), added to utilization and unit cost increases.
3. Greatest spending increases seen among Medicare plans. Diabetes is also the costliest traditional therapy class for Medicare, Medicaid and Public Health Exchange plans. However, for Medicare, the impact of diabetes spending is much more profound: plans spent $309.17 PMPY on diabetes medications in 2015, a nearly 20% increase from 2014, driven mostly by 15% year-over-year increases in drug costs. Utilization in this population is more driven by oral diabetes medications than insulins. PMPY spending on diabetes for other government plans is similar to what we see among the commercially insured.
4. Generics are only half of the story, but soon to be more. Four of the most commonly used diabetes medications are available as a generic, leading to a 52.5% generic fill rate for the class. Currently, no generic insulins are available; however, Basaglar® (insulin glargine), the first follow-on to Lantus, is expected to launch in December 2016, which will offer financial relief to plans who prefer Lantus on their formulary.
5. Double-digit spending increases expected for 2016-2018, Spending on diabetes medications is expected to increase 18% in 2016, and then stabilize in the mid-high teens in 2017 and 2018. Greater availability of generics will help slow increases in spending.
Improving Diabetes Care
Express Scripts has several programs in place to help plans derive the best patient outcomes possible for their members with diabetes.
Most recently, we announced our Diabetes Care Value program, which will help plans who implement our National Preferred Formulary move patients to a more affordable, clinically equivalent therapy without disruption when Basaglar, and other Lantus follow-ons, come to market in late 2016.
The other component of this program involves bringing the enhanced clinical care provided by our Diabetes Therapeutic Resource Center® (TRC) to pharmacies participating in our diabetes quality retail network. We believe so much in the potential success of this program that we are willing to put our own skin in the game by taking on financial risk to protect our clients from skyrocketing costs and budget uncertainty.
Improving patient outcomes and affordability also means improving medication adherence in the therapy class. Currently, 42.8% of patients with diabetes are nonadherent to therapy. Over the last several months, Express Scripts and nearly 200 of our clients have been working on an award-winning partnership to test a diabetes remote monitoring solution.
We use connected glucose meters, a smartphone app and ongoing monitoring from our Diabetes TRC to teach patients how to control their blood sugar levels and adhere to their medications.
So far, we’ve observed an 8% increase in average adherence to oral diabetes medications. In addition, 61% of patients lowered their A1c levels; 15% of those who started with high A1c levels are now in control (<7.0).
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