Type 2 Diabetes – Access & Reimbursement – Detailed, Expanded Analysis (US)

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).

Table of contents

  • Type 2 Diabetes - Access & Reimbursement - Detailed, Expanded Analysis (US)
    • Type 2 Diabetes_U.S. Access & Reimbursement_US_May 2020

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