Even though the costs for specialty medications are skyrocketing, the diabetes medication class has increased 44
% in spend and
16% in utilization when comparing 2016 to 2015. Opportunities exist to save for both our health system and more importantly for our patients for this class of medications and still maintain positive outcomes. See the attached
Step-wise Approach to Selecting Treatments for Type 2DM for information on comparative efficacy, hypoglycemic risk, impact on weight gain/loss, side effects and costs. Some advantages and disadvantages of diabetes medication classes are also included.
Some cost-saving tips for diabetes class of medications:
2. Prescribing a
generic medication is still one of the best ways to save money for patients and the health system, IF a generic is available.
Metformin is the recommended first-line monotherapy treatment for patients with Type 2 DM. Be sure to use the immediate-release formulation of metformin OR the Glucophage XR generic metformin (matrix) available as 500 or 750 mg when a long-acting agent is preferred. The long-acting generic formulations for Glumetza and Fortamet (metformin ER) are significantly more expensive.
|
Generic Metformin Products(mg)
|
Brand Name
|
Formulation
|
Avg Cost / Month
|
Dosing
|
A1C Reduction
|
|
Metformin 500, 850, 1000
|
Glucophage
|
Immediate Release
|
< $25
|
BID
|
1.0 - 1.5%
|
|
Metformin XR 500, 750
|
Glucophage XR
|
Matrix Extended Release
|
< $25
|
Daily
|
|
Metformin ER (MOD) 500, 1000
|
Glumetza
|
MOD (modified release)
|
> $400
|
Daily
|
|
Metformin ER (OSM) 500, 1000
|
Fortamet
|
OSM (osmotic release)
|
> $400
|
Daily
|
3.
Insulins - In cases where patients cannot afford cost of insulin
(Example: patient in Medicare Part D donut hole, insulin could be ~$150+ per month) consider OTC Walmart ReliOn Insulins.
|
Insulins
|
Type
|
Cost / Vial
|
Copays
|
A1C
|
|
OTC ReliOn Regular -Walmart
|
Short-Acting
|
~ $26
|
Cost of vial
|
1.5 - 3.5%
|
|
OTC ReliOn NPH - Walmart Novolin, Humulin N
|
Intermediate
|
|
OTC ReliOn - Walmart Novolin, Humulin 70/30
|
Mixture: 70% NPH, 30% Reg
|
|
Lantus, Levemir, other insulins
|
Basal
|
> $300
|
$30 - $50
|
4.
Combination products -
Oral agents - Generic combinations such as glipizide/metformin should be considered if a patient is on more than one of these individual agents. They are reasonably priced and have only 1 copay for patients. Other combinations of branded DPP-4 inhibitors or SGLT2 inhibitors may be more costly. (See
Step-wise Approach to Selecting Treatments for Type 2 DM for cost information.) Patients should check with their prescription plan to compare coverage of these combination products.
Injectables - Premixed basal/bolus insulin (such as NPH/regular 70/30, NPH/lispro 75/25, or NPH/aspart 70/30) may be advantageous in that they minimize the number of injections a patient needs to self-administer daily. (Traditional basal plus bolus dosing requires 4 total daily injections.) Premixed insulin injections are typically given twice daily, before breakfast and prior to supper. The major disadvantage of this regimen is the increased risk of hypoglycemia from the intermediate-acting NPH. (
See cost of ReliOn products above)
Some new combination injectables have been recently released which may save patients a copay and are only one injection vs. two.
Xultophy (insulin degludec and liraglutide) and
Soliqua
(insulin glargine and lixisenatide) are new combination basal insulin/GLP-1 agonist products. See
Comparison of GLP-1 Agonists for more detailed information and the
Step-wise Approach to Selecting Treatments for Type 2 DM for cost information.
