Type 2 Diabetes | Access and Reimbursement | US | 2020
The treatment of type 2 diabetes places a significant economic burden on the U.S. healthcare system. Given the intense competition between antidiabetic therapies, the type 2 diabetes access and reimbursement space is both extremely dynamic and highly influential on treatment patterns. Branded therapies experience high rates of prescribing restrictions as payers steer prescriptions toward less-expensive drug. Manufacturers of agents like the SGLT-2 inhibitors, GLP-1 receptor agonists, and insulins must carefully navigate contract agreements/rebates with payers to gain favorable formulary coverage.
QUESTIONS ANSWERED
- On what tiers do payers place leading brands such as Novo Nordisk’s Ozempic and Eli Lilly’s Trulicity, and what restrictions do they impose?
- What clinical factors most influence formulary coverage of type 2 diabetes therapies?
- What contracting agreements do MCOs report are in place for long-acting insulins such as Sanofi’s Lantus, Novo Nordisk’s Tresiba, and Boehringer Ingelheim / Eli Lilly’s Basaglar?
- What role do reimbursement restrictions and patient cost play in physicians’ decisions to prescribe therapies such as Johnson & Johnson’s Invokana, AstraZeneca’s Farxiga, and Boehringer Ingelheim / Eli Lilly’s Jardiance for type 2 diabetes?
- What percentage of MCOs use pharmacoeconomic or health economic models such as cost-utility analysis?
Geography: United States
Primary Research: Survey of 140 U.S. endocrinologists and primary care physicians (PCPs). Survey of 30 U.S. managed care organization (MCO) pharmacy and medical directors (PDs/MDs).
