Decision Resources, one of the world's leading research and advisory firms for pharmaceutical and healthcare issues, finds that metformin (Bristol-Myers Squibb's Glucophage, generics) is the drug of choice for the treatment of prediabetes -- a condition found in patients with an elevated risk of developing type 2 diabetes. Although primary care physicians overwhelmingly agree that treatment of prediabetes with an insulin-sensitizing agent should be beneficial, safety concerns have resulted in only a minority of physicians prescribing GlaxoSmithKline's Avandia, which is prescribed less often than Takeda's Actos or Merck's Januvia.

For the treatment of prehypertension, a condition that indicates elevated risk for hypertension, King Pharmaceuticals' Altace and Novartis' Diovan are prescribed more often than any other drugs. Prediabetes and prehypertension, along with obesity and dyslipidemia, are comorbidities of metabolic syndrome. Surveyed clinicians expect that, within the next year, the number of patients they will treat for prediabetes and prehypertension will increase. Further evidence of the long-term benefits of drug treatment and stronger guideline recommendations for the use of drugs in treating prediabetes or prehypertension are the factors that many clinicians cite as having the most power to persuade them to prescribe drugs for these indications.

The new Physician & Payer Forum report Metabolic Syndrome: Clinician and Payer Attitudes to Prediabetes and Prehypertension finds that most MCOs allow clinicians a high level of prescribing freedom in relation to prediabetes, but that between five percent and 40 percent of MCOs that cover the antidiabetic agents covered in the survey said they do not reimburse these agents for prediabetes. The report finds that, within the next year, an additional 10 percent of surveyed MCOs expect to extend coverage of Alkermes/Amylin Pharmaceuticals/Eli Lilly's Byetta, Avandia and Actos to prediabetes. Nearly half of surveyed pharmacy directors indicated that evidence of the prevention or delay of progression to type 2 diabetes or hypertension (from prediabetes or prehypertension) would have the most power to influence their formulary inclusion decisions in the future. Additionally, most surveyed pharmacy directors said that evidence of a net cost benefit to pharmacological treatment of prediabetes or prehypertension would also influence their formulary inclusion decision.

"Most MCOs think there likely is a cost benefit to the use of drugs for treatment of prediabetes and prehypertension, and further evidence of this will improve reimbursement rates for either indication," said Christine Helliwell, Ph.D., analyst at Decision Resources.

Metabolic Syndrome: Clinician and Payer Attitudes to Prediabetes and Prehypertension is based on a U.S. survey of 71 cardiologists, 83 primary care physicians and 20 MCO pharmacy directors.

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