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Cost of Diabetes Drugs Often Overlooked –– But Shouldn’t Be

Biosimilars may provide relief from high costs

An estimated 29 million people have diabetes — about 10 times the number of people with hepatitis C — and many of them will take diabetes drugs for the rest of their lives. Cost increases for both old and new drugs alike are forcing many consumers to scramble to pay for them, according to Kaiser Health News (KHN).

Many people with diabetes take multiple drugs that work in different ways to control their blood sugar. Although some of the top-selling diabetes drugs, such as metformin, are modestly priced generics, new brand-name drugs that act in different ways continue to be introduced. They may be more effective and have fewer side effects, but it often comes at a price, KHN says. For the fourth year in a row, spending on diabetes drugs in 2014 was higher on a per member per year basis than it was for any other class of traditional drug, according to the Express Scripts 2014 Drug Trend Report. Less than half of the prescriptions filled for diabetes treatments were generic.

“The cost of diabetes treatment has been increasing pretty rapidly,” said Dr. Glen Stettin of Express Scripts. A number of factors contribute to the overall cost increase, Stettin said, including price increases for brand-name drugs; the fact that people are often on complicated treatment regimens of three or even four drugs; and the fact that more people with diabetes are receiving treatment.

An analysis by the Health Care Cost Institute looked at per-capita health spending for people with diabetes and found that the average cost was $14,999 –– approximately $10,000 higher than the average $4,305 in per-capita spending for people without the disease. The study examined the health care claims of nearly 40 million individuals younger than age 65 who had employer-sponsored insurance with one of three large insurers.

Higher claims costs were reflected in higher out-of-pocket costs for people with diabetes as well. They spent $1,922, on average, for deductibles, copayments, and coinsurance in 2013, compared with $738 for people without diabetes.

Insurers and pharmacy benefit managers have increasingly devoted resources toward managing patients’ prescription drugs. Requiring patients to try an older, cheaper drug before approving a newer one is common practice, as are prior authorization rules that require providers to obtain approval before prescribing pricey drugs.

Incremental improvements in existing insulin drugs have extended their patent protection in some cases, and some older versions of drugs are no longer sold in the U.S., said Dr. Jeremy Greene of Johns Hopkins University.

Increasingly, drug manufacturers are developing close copies of the biologic drugs that are made with living cells. These “biosimilars” may provide some relief from high costs. The FDA recently established a regulatory pathway for biosimilar drugs to gain approval, and drug experts suggest that as insulin patents expire, biosimilar insulins could reduce the price by up to 40%.

Source: Kaiser Health News; August 18, 2015.

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