Here’s What Commercial Payers Spent on Diabetes Medications in 2016

Jun 9, 2017
With the American Diabetes Association 77th Scientific Sessions upon us, here’s a look at current and future drivers of diabetes medication spending, and how to keep these life-saving medications in reach of patients.
  • Diabetes

Rochelle Article

Diabetes is the second costliest class of medications for employers. Employers spent $108.80 per member last year on medications that treat diabetes, a 19.4% increase from 2015. A 5.3% increase in the use of medication contributed to this overall increase in sending, but a 14.1% increase in the cost of a day’s supply of medication was the significant driver of the increased spending.

Let’s take a closer look at what contributed to these increases:

  • The top three drugs in spend across all traditional therapy classes were diabetes medication: Lantus® (insulin glargine), Humalog® KwikPen® (insulin lispro) and metformin.
  • Metformin? The generic? Yes. Spending for metformin increased 160.1% in 2016 due to the February 2016 launch of the very high-priced generic for Glumetza® (metformin extended-release tablets) that is not interchangeable with any other extended-release metformin. Glumetza is excluded from Express Scripts 2017 National Preferred Formulary.
  • Insulins accounted for 40% of spend in the diabetes therapy class. The overall increase in spending for just insulins was 9.9% in 2016.
  • What about that 5.3% increase in utilization? That was mainly influenced by 2% to 11% increases in use for five of the most costly diabetes medications – Lantus, Humalog KwikPen, metformin, Januvia® (sitagliptin), and Invokana® (canagliflozin).
  • Despite increased spending, employers were able to shield most patients from significant increases in cost, particularly for insulins. The average patient out-of-pocket cost for insulin was $36.69 per prescription, an increase of $1.63 (4.6%) more than 2015. This represents both copays and deductibles.

Look Ahead

Diabetes trend will continue to be near 20% for each of the next three years, reflecting increasing drug prices and utilization. The forecasted trend is expected to reflect a continued increase in the utilization of DPP-4 and SGLT2 inhibitors, which are prescribed as additive therapy for controlling blood sugar.

Although unit cost increases are likely to continue due to steady inflation for branded drugs, especially insulins, Express Scripts Diabetes Care Value program is designed to help employers mitigate increased spending by offering 90-day prescriptions for diabetes medication at a quality-based pharmacy network while guaranteeing that payers’ future spend on diabetes medications will remain below a per-patient cap.

The Diabetes Care Value Program is projected to boost the average medication adherence rate for enrolled patients by 5%, reducing downstream health complications and healthcare costs.

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Lab Staff
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