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Type 2 diabetes and obesity are chronic diseases that affect millions of Americans and represent a costly expense for the nation’s healthcare payers. In the effort to manage quality and costs associated with treating these conditions, many health insurers have turned to accountable care organizations (ACOs) to better coordinate care for large patient populations. Given the large affected population and the availability of a range of effective drugs and measurable outcomes, type 2 diabetes represents the low-hanging fruit for the ACO. As a contributor to diabetes, obesity has also become a focus of ACO management, especially since the emergence of novel branded therapies—including the latest, Orexigen Therapeutics/Takeda Pharmaceutical’s Contrave (naltrexone SR/bupropion SR)—that illicit greater weight loss but are much more expensive than generic phentermine. As ACOs work to manage diabetes care, they are faced with a broad array of branded, non-insulin therapies whose distinct mechanisms of action improve upon the effectiveness of generic metformin. These classes have become familiar to payers over the past decade: oral DPP-IV inhibitors, such as Merck’s Januvia (sitagliptin); the oral SGLT-2 inhibitors, such as Johnson & Johnson’s Invokana (canagliflozin); and the injectable GLP-1 agonists, such as Novo Nordisk’s Victoza (liraglutide). ACOs are making PCPs and endocrinologists more conscious of the long-term consequences of each prescribing decision by linking their reimbursement to the achievement of goals such as reducing hospital readmissions and total medical costs, as well as saving on prescription drug costs.
Markets covered: United States.
Primary research: Online survey of 70 PCPs and 71 endocrinologists, 30 MCO medical directors, and 11 MCO pharmacy directors.
Commercial context: Drug profiles, epidemiology tables, drug-treatment algorithms, and ACO background information.
Therapies covered: Weight-loss therapies and three classes of antidiabetic drugs: DPP-IV inhibitors, GLP-1 receptor agonists, and SGLT-2 inhibitors.
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Chris Lewis serves as primary research manager, Access and Reimbursement, with responsibility for coordination, content review and content generation of the market access and reimbursement insights at DRG. Content is based on online surveys of managed care organizations and physicians and expert analysis of reimbursement and prescribing patterns of key therapies treating various disease states. Lewis was an analyst/senior analyst for the group’s HealthLeaders-InterStudy subsidiary for eight years, specializing in the managed care and pharmacy benefit management industries. Throughout her tenure, she has produced the Health Plan Analysis reports for California, New York, New Jersey, Connecticut, and Pennsylvania and authored DRG’s series of pharmacy benefit manager profiles. She has also conducted numerous webinars for the group. She is a seasoned journalist with a in communications from California State University, Sacramento.