Investigating top diabetes trends by lines of business.

• 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

COMMERCIAL

• 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

MEDICARE

• 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

MEDICAID

• 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