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Investigating top diabetes trends by lines of business.

Diabetes spending will continue to increase as new pipeline agents like oral semaglutide enter the market. For now, insulin still dominates the diabetes therapeutic class, accounting for 49% of market share. Newer generation, non-insulin products, like DPP4, SGLT2 or GLP-1s, or combinations that contain them, now make up a combined 50% of market share.

  • GLP-1 receptor agonists (GLP-1) help lower blood glucose levels, by stimulating insulin release and delaying gastric emptying which increases feelings of fullness
  • Sodium-glucose co-transporter-2 (SGLT2) inhibitors are oral anti-hyperglycemic agents that help inhibit glucose reabsorption in the kidney to lower blood sugar
  • DPP-4 inhibitors (DPP4) block the enzyme that destroys incretins (gastrointestinal hormones that stimulate insulin production) to help regulate blood sugar levels

GLP-1 agonists and SGLT2 inhibitors have recently gained more market share than DPP-IV inhibitors due to their greater ability to reduce glucose levels and achieve positive morbidity and mortality study results.

Over the past five years, the rapidly growing GLP-1 market has experienced a remarkable 76% cost increase. GLP-1 list prices are increasing at a higher rate than insulin, which has increased by 54% since 2014.5

Top Diabetes 2018 Trends by Line of Business


  • Diabetes drugs accounted for the top four branded agents, with Humalog topping the list, followed by Lantus, Trulicity, and Victoza respectively
  • Diabetes kept its rank as the second highest therapeutic class in 2018 and saw an 8.9% unit-cost spike
  • For the second year in a row, the highest trend increase in traditional branded drugs was Trulicity, a GLP-1 receptor agonist, which moved from #8 to #3


  • Diabetes remained the top therapeutic class in 2018 and accounted for 18.4% of overall Medicare spend
  • Five different diabetes drugs made the top 10 list, accounting for 43% of total diabetes PMPY spend. However, with increasing pressure on insulin pricing, these agent's ranking could decrease in 2019
  • Insulin medication Lantus topped the list for 2018 traditional brand spend while Januvia ranked the highest for non-insulin therapies


  • Diabetes was the highest ranked Medicaid therapeutic class in 2018 and saw an 11.2% trend increase from 2017
  • Five diabetes drugs appeared in the top 10, with Lantus remaining as the first ranked drug in 2018
  • Basaglar, the first follow-on insulin product approved in 2015, ranked #3 on the top 10 list for traditional Medicaid drug spend, moving up from 20th in 2017


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