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).
Type 2 Diabetes_U.S. Access & Reimbursement_US_May 2020
David Rees, Ph.D.
David Rees, M.Biochem., Ph.D., is a senior analyst on the Cardiovascular, Metabolic, Renal, and Hematologic (CMRH) Disorders team at Clarivate. He has authored reports on osteoporosis, autosomal dominant polycystic kidney disease, pulmonary hypertension, and type 2 diabetes. Previously, he was a postdoctoral research associate at Imperial College London and the Institute of Cancer Research. For his doctoral research, he studied the structures of molecular machines in the Nobel Prize-winning laboratory of Prof. Sir John Walker at the University of Cambridge. Dr. Rees earned his undergraduate degree at the University of Bath.
