A Survey of Primary Care Physicians, Endocrinologists, and Managed Care Organization Pharmacy and Medical Directors

Type 2 diabetes is a complex metabolic disorder characterized by a declining ability to produce or utilize insulin. The chronic and progressive nature of the disease, as well as its complications and common comorbidities, often leads to patients requiring multiple medications. The type 2 diabetes market represents a crowded treatment landscape. Despite this crowded landscape, patients typically follow a relatively well-defined treatment progression, beginning with oral therapies before adding injectable agents such as the glucagon-like peptide-1 (GLP-1) receptor agonists and insulins as the disease progresses. However, these injectable therapies are among the most efficacious on the market, and with growing individualization of patient therapy, their use is becoming increasingly prominent in the early lines of therapy. Over the next few years, new GLP-1 receptor agonists and rapid- and long-acting insulin analogues are expected to launch. As these new agents compete for positioning and uptake, physicians and managed care organizations (MCOs) must consider how best to incorporate them into their respective treatment and reimbursement strategies as they seek to optimize value for money.

Drawing on insight from a survey of 142 physicians and 30 MCO pharmacy or medical directors (PDs or MDs), this report examines the dynamics that limit or promote—now and in the near future—market access for the new market entrants and emerging therapies for type 2 diabetes.

Questions Answered in This Report:

  • Understand US primary care physicians’ (PCPs’) and endocrinologists’ perceptions and attitudes toward currently marketed type 2 diabetes therapies and uncover prescribing trends: What are clinicians’ views of the currently available treatments for type 2 diabetes, and what key unmet needs do they identify? How will medical practice for the treatment of type 2 diabetes change in light of the new GLP-1 receptor agonists and insulin analogues poised to enter the US market? For which lines of therapy do physicians typically prescribe approved therapies, and what factors, including reimbursement and prescribing restrictions by MCOs, most strongly influence and constrain physician prescribing of these agents?

  • Learn how prescribers plan to integrate novel GLP-1 receptor agonists and insulin analogues into their treatment plans: What are US clinicians’ and payers’ perceptions of the safety and side-effect profiles of the new agents in these drug classes? How will these new agents’ product profiles set them apart from one another and from currently available drugs? Which drug and patient characteristics will most influence prescribing decisions by clinicians and formulary positioning by payers? What value do prescribers and payers place on greater convenience and treatment compliance, compared with efficacy and safety?

  • Gain insight into the changing dynamics of the US managed care reimbursement environment as they pertain to pharmacotherapy for type 2 diabetes: What are payers’ and prescribers’ expectations for the efficacy, safety and tolerability, and delivery of novel antidiabetic drugs? What kind of reimbursement restrictions will be applied to novel GLP-1 receptor agonists and insulin analogues? How do MCO PDs/MDs for commercial and Medicare prescription drug plans assign tier positioning for new entrants to the type 2 diabetes market? How will the price of novel agents influence formulary placement?


This U.S. Physician & Payer Forum reveals physicians’ and payers’ insights into the changes in prescribing practices in the United States for novel GLP-1 receptor agonists and insulin analogues. This report is based on a survey of 142 physicians, including 71 endocrinologists and 71 PCPs, as well as 30 MCO PDs/MDs. We examine the reimbursement and treatment decisions that affect prescribing of and access to select branded agents used to treat type 2 diabetes. The report explores opportunities for drug developers to advocate for their brands consistent with accountable care organization (ACO) goals and to protect or expand their market share. Specific therapies examined include the following GLP-1 receptor agonists: Intarcia Therapeutics/Servier’s ITCA-650, Sanofi/Zealand Pharma’s Lyxumia (lixisenatide), and Novo Nordisk’s semaglutide. The insulin analogues examined include the following: Sanofi’s Toujeo (insulin glargine U300), Novo Nordisk’s Tresiba (insulin degludec), Boehringer Ingelheim/Eli Lilly’s Basaglar (insulin glargine), Eli Lilly’s insulin peglispro, and Novo Nordisk’s FIAsp (NN-1218).

Markets covered: United States.

Primary research: Online survey of 71 endocrinologists, 71 PCPs, 20 MCO PDs, and 10 MCO MDs.

Author(s): Eamonn O’Connor, Ph.D.

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