Contact

Payer

Pharma

Provider

Formulary guidance and transparency from P&T to point of care

MMIT Reality Check on Diabetes (March 2016)

Posted by Matt Breese on Mar 31, 2016

Find me on:

MMIT's team analyzes the market access landscape for diabetes treatments in our most recent Reality Check. The following brief highlights some of our key takeaways from the piece.

Payer Coverage: Diabetes treatments face a complex coverage landscape, specifically within the health exchange marketplace where over half of lives are restricted by a PA or step therapy. However, Medicare Part D formularies fail to cover products for the greatest percentage of pharmacy benefit lives.

reality-check-diabetes-channels.png

Source: MMIT data as of Q1 2016

Trends: Recent diabetes news reveals some key trends within the market basket, including increasing investment in production plants to meet the demands of a growing diabetic population and increasing public awareness for type 2 diabetes. Novo Nordisk, a key manufacturer player, breaks ground on a massive new U.S. plant that will support a more stable supply of GLP-1 and insulin products. Over the past decade, the prevalence of type 2 diabetes increases at an alarming pace. Recent analysis reveals that treatment strategies also intensify, given the need to treat patients with high glycemic levels quickly to avoid complications.

Key Findings: MMIT's pharmacists reveal several key findings when taking a closer look at the market access data for diabetes. A comprehensive review of utilization management policies reveals the inconsistencies in PA and step therapy criteria format across major health plans and PBMs. Due to the diversity of the market basket, from orals to insulins and SGLT2 & GLP-1 inhibitors to combination therapies and DPP-4 inhibitors, the complexity of policies provides challenges to prescribers. With a substantial portion of treatments required to step through metformin, sulfonylurea, and/or established branded products, understanding the utilization management landscape is crucial. Diabetes treatments face a complex coverage landscape, specifically within the health exchange marketplace where over half of lives are restricted by a PA or step therapy. Massive pharmacy benefit managers, like CVS and Express Scripts include several anti-diabetic products on their 2016 formulary exclusion lists, noting mutual preferred alternatives.

In the full Reality Check on diabetes below, MMIT's team of experts takes a deeper look into the clinical characteristics, drug market access and payer coverage to summarize key findings within type 2 diabetes.

 View Reality Check

Topics: Market Access