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)

Author(s): David Rees, Ph.D

David Rees, M.Biochem., Ph.D, is a Business Insights Analyst with the Cardiovascular, Metabolic, and Renal Disorders team at Decision Resources Group. Prior to joining Decision Resources Group, Dr. Rees was a Postdoctoral Research Associate at Imperial College London, and the Institute of Cancer Research. For his doctoral research, he studied the structures of molecular machines in the Nobel Prize winning laboratory of Prof. Sir John Walker at the University of Cambridge. Dr. Rees earned his undergraduate M.Biochem. from the University of Bath.


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