Watch list 2017: Top therapeutic areas
Lassen at Prime Therapeutics calls diabetes the number one nonspecialty drug category, accounting for 13% of the PBM’s total drug spend.
“The majority of that increase is due to more utilization and inflation,” he says, “but also to new, higher cost brands that are being promoted—an average cost of $300 a month for a combination of oral and injectables compared to $20 for a generic. We want to better understand the data to determine if the much higher costs justify incremental improvement in overall treatment.”
Some injectibles might be more convenient because they only need to be taken once or twice a week vs. daily oral medications. “But do they improve outcomes?” he asks.
There is currently no generic insulin available for diabetes.
Rubin sees diabetes as ripe for advancements in treatment, starting with less stringent warnings from the FDA on using metformin, which is a first-line medication prescribed for type 2 diabetes.
In December 2015, the FDA approved Basaglar (insulin glargine injection) as a follow-on product to Lantus for treating types 1 and 2 diabetes. Basaglar is the first insulin product approved through an abbreviated approval pathway under the Federal Food, Drug, and Cosmetic Act. It became available in December 2016.
Chris Peterson, director of emerging therapeutics for Express Scripts, says Basaglar should help bring down the cost of Lantus, providing a negotiation tool with manufacturers.
Xultophy, a combination of two existing drugs—Victoza (liraglutide), a glucagon-like peptide-1 receptor agonist, and basal insulin Tresiba (insulin degludec), was approved in November 2016. Soliqua 100/33, a combination of Lantus and lixisenatide, was also approved in November. Regardless of price, the once-a-day administration for both might make the drugs more palatable.