Type 2 Diabetes – Access & Reimbursement – Access & Reimbursement – Type 2 Diabetes (US)

The sodium-glucose cotransporter-2 (SGLT-2) inhibitors and glucagon-like peptide-1 (GLP-1) receptor agonists are frequently prescribed for type 2 diabetes (T2D). These classes, along with glucose-dependent insulinotropic polypeptide (GIP) / GLP-1 receptor agonists, have demonstrated strong efficacy and safety data and offer cardiovascular, renal, and weight management benefits to T2D patients. Eli Lilly’s first-in-class GIP / GLP-1 receptor agonist, Mounjaro, launched in the United States in June 2022 and is well received by physicians owing to its hugely positive clinical evidence; the use of Novo Nordisk’s oral Rybelsus is supported by its advantages over SC-administered GLP-1 receptor agonists; the growing demand for GLP-1 receptor agonists like Novo Nordisk’s Ozempic has led to shortages and created new challenges for payers and physicians in managing their use. The increasing use of these high-priced branded drugs has created a restrictive market access environment that often relegates their use to the second or later lines of T2D treatment.

QUESTIONS ANSWERED

• Which SGLT-2 inhibitor and GLP-1 receptor agonist have the highest rates of preferred tier coverage on MCO’s largest fully insured commercial plans? How do these rates compare with the coverage of Mounjaro?
• How do various cost-control measures impact physicians’ decisions to prescribe SGLT-2 inhibitors and GLP-1 receptor agonists to T2D patients? How are these measures impacting the coverage of Mounjaro?
• How has the Rybelsus FDA label update that removes the limitation of use as a first-line therapy impacted the prescribing of and access to the product for T2D?
• How are MCOs addressing the high demand for Ozempic as a weight control drug in their tiering and restrictions policies?

PRODUCT DESCRIPTION

U.S. Access & Reimbursement provides integrated brand- and disease-level insight on reimbursement dynamics and the impact of U.S. payer policy on physician prescribing behavior in the market access environment. Each report includes up-to-date analyses of drug coverage and restriction policies as well as payer and prescriber perspectives on key marketed drugs and their receptivity to emerging therapies.

Key drugs: Byetta, Farxiga, Invokana, Jardiance, Mounjaro, Ozempic, Rybelsus, Trulicity

Key companies: AstraZeneca, Eli Lilly, Novo Nordisk, Boehringer Ingelheim, Janssen