From healthline.com
- Researchers report that 80% of U.S. adults with type 2 diabetes aren’t getting treatments that they are eligible for.
- The treatments involve two types of medications, including the drug Ozempic.
- Experts say cost is a major issue, although they hope that barrier will lessen with more alternative and generic drugs coming on the market.
More than eight in 10 adults with type 2 diabetes in the United States could benefit from a pair of drug treatments that only a small fraction of them are currently being prescribed, a new study published today in the Annals of Internal Medicine finds.
Researchers analysed data on 1,330 nonpregnant adults aged 20 years or older and reported that 82% — about 22 million Americans — with type 2 diabetes qualified for treatment with either glucagon-like peptide-1 receptor agonists (GLP-1 RAs) or sodium-glucose cotransport protein 2 (SGLT2) inhibitors.
However, researchers discovered that less than 4% of these adults used GLP-1 RAs therapy who were eligible for it. Only about 5% of the adults who were eligible for SGLT2 treatment used it.
That eligible population includes nearly all Medicare beneficiaries with type 2 diabetes, the study authors wrote.
GLP-1 RAs, marketed under brand names such as Victoza and Ozempic, are used to help control blood sugar, either in a short-acting or long-acting form.
SLGT2 inhibitors, sold under brand names such as Invokana and Farxiga, also help control blood sugar and reduce the risk of complications from diabetes. They have also demonstrated some fringe benefits in studies such as the lower risk of stroke, heart attack, and death from cardiovascular disease in people with atherosclerosis.
“[These are] some of the exciting new drug classes that have become available over the past decade,” said Joyce Yu-Chia Lee, PharmD, a health sciences clinical professor at the University of California Irvine School of Pharmacy and Pharmaceutical Sciences.
“They have quickly moved up to the top of the treatment ladder for the management of type 2 diabetes in view of strong evidence on added benefits in atherosclerotic cardiovascular disease risk reduction and for some weight loss and kidney protection,” she told Healthline.
The study authors agreed.
Based on these findings, “we encourage clinicians to be aware that many of their patients with type 2 diabetes may be eligible for these medications, and we encourage patients to talk to their healthcare providers about what treatment may be best for them,” Shichao Tang, PhD, a study co-author and a health economist at the Centres for Disease Control and Prevention, told Healthline.
In the study, researchers noted that these two classes of drugs are significantly more expensive than current diabetes medications.
The report suggests prices might have to go down by as much as 70% for the medications to be cost-effective.
“These new medications are much more expensive than older treatments like metformin, sulfonylureas, and TZDs [thiazolidinediones],” said Brandy Lipton, PhD, a visiting associate professor of health, society, and behaviour at the University of California, Irvine Program in Public Health.
“Copays for Medicare beneficiaries can be substantial, especially during the Part D coverage gap, with out-of-pocket costs for a 30-day supply of some of the newer medications exceeding $100,” she told Healthline. “Medicaid coverage for these newer treatments and out-of-pocket payments will vary by state and managed care plan. Even small out-of-pocket payments can discourage use, especially among people with lower incomes covered by Medicaid.”
“There is evidence that the newer treatments can be more clinically effective relative to the older medications, but the cost differential is large and some insurers may not be willing to bear the majority of those higher costs,” Lipton added.
“More research is needed to evaluate the cost-effectiveness of these drugs and to determine the best ways to offset the high cost. More information about the cost-effectiveness of these drugs may help target these treatments at a sustainable cost,” Tang noted.
That said, more people may be already being prescribed these drugs than the study indicated.
Both of these classes of medications are now considered potential first-line diabetes treatments, which they were not during the study period.
There is also hope these prices will decrease and that drugs will become more accessible in the coming years.
The patents of the majority, if not all of these agents, have not expired yet, and this explains the high cost,” Lee said. “However, the drug price will likely decline with the loss of market exclusivity and when generic alternatives become available. Patients in the future will likely benefit from the cost-effectiveness of these medications, but for now, we will have to be creative and take extra steps to help those who would benefit most from these newer classes of agents.”
