Type 2 Diabetes | Access and Reimbursement | US | 2018

Market Outlook

The treatment of type 2 diabetes places a significant economic burden on the U.S. healthcare system. Given the intense competition among 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 drugs with lower prices. Manufacturers of agents such as SGLT-2 inhibitors, GLP-1 receptor agonists, and insulins need to skillfully 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 Victoza 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 does reimbursement, restriction, and patient cost play in physicians’ decisions to prescribe therapies for this indication?
  • What percentage of MCOs use pharmacoeconomic or health economic models such as cost-utility analysis?
  • What is the most compelling type of pharmacoeconomic data in formulary decision-making for type 2 diabetes?
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