Type 2 diabetes and obesity are chronic diseases that affect millions of Americans and represent a costly expense for the nation’s healthcare payers. In the effort to manage quality and costs associated with treating these conditions, many health insurers have turned to accountable care organizations (ACOs) to better coordinate care for large patient populations. Given the large affected population and the availability of a range of effective drugs and measurable outcomes, type 2 diabetes represents the low-hanging fruit for the ACO. As a contributor to diabetes, obesity has also become a focus of ACO management, especially since the emergence of novel branded therapies—including the latest, Orexigen Therapeutics/Takeda Pharmaceutical’s Contrave (naltrexone SR/bupropion SR)—that illicit greater weight loss but are much more expensive than generic phentermine. As ACOs work to manage diabetes care, they are faced with a broad array of branded, non-insulin therapies whose distinct mechanisms of action improve upon the effectiveness of generic metformin. These classes have become familiar to payers over the past decade: oral DPP-IV inhibitors, such as Merck’s Januvia (sitagliptin); the oral SGLT-2 inhibitors, such as Johnson & Johnson’s Invokana (canagliflozin); and the injectable GLP-1 agonists, such as Novo Nordisk’s Victoza (liraglutide). ACOs are making PCPs and endocrinologists more conscious of the long-term consequences of each prescribing decision by linking their reimbursement to the achievement of goals such as reducing hospital readmissions and total medical costs, as well as saving on prescription drug costs.
Markets covered: United States.
Primary research: Online survey of 70 PCPs and 71 endocrinologists, 30 MCO medical directors, and 11 MCO pharmacy directors.
Commercial context: Drug profiles, epidemiology tables, drug-treatment algorithms, and ACO background information.
Therapies covered: Weight-loss therapies and three classes of antidiabetic drugs: DPP-IV inhibitors, GLP-1 receptor agonists, and SGLT-2 inhibitors.