1. The Cost of Medication Management in the Diabetic Patient By Paula Straub, RPh

2. Objectives
Review factors for best therapeutic approach for appropriate pharmacologic choices for diabetes management
Review cost implications for oral medications and non- insulin treatment options
Discuss cost impact for insulin therapies

3. Diabetes Facts
Nearly 86 million Americans have pre-diabetes and another 30 million have diabetes
Overall cost to treat pre-diabetes and diabetes has escalated to $322 Billion
As the number of cases increases, the cost of diabetes treatment and medications is rising
Diabetes patients incur medical expenses 2.3 times higher than those without diabetes
Significant increase in vital diabetes medications has occurred over the past few years, especially insulin therapy
Managed Healthcare Executive-4/17. Advancements in Diabetes.

4. Treatment Goals Management of both hyperglycemia and risk factors
Individualized Approach

5. Important Factors for Best Therapeutic Pharmacologic Approach
Assessment of patient’s health and comorbid conditions
Extent of A1C elevation
Patient motivation
Adherence-approach should be simple
Cost
Risk of Hypoglycemia
Patient’s weight
Patient’s age
AACE/ACE Comprehensive Diabetes Mgmt Algorithm, 2017.

6. Factors Continued Ease of use
Safety impact of kidney, liver and liver disease
Individual circumstances
Formulary Restrictions
Combination therapy usually required and should involve agents with complementary actions
Monitoring requirements
Other Adverse Effects
AACE/ACE Comprehensive Diabetes Mgmt Algorithm, 2017.

7. Effectiveness of Therapy Evaluation
Evaluated frequently until stable using multiple criteria
A1C
SMBG records-fasting and post-prandial
Documented and suspected hypoglycemia
Potential adverse effects..i.e. weight gain, fluid retention, hepatic, renal or cardiac disease
Comorbidities and concomitant drug administration
American Diabetes Association-Diabetes Basics.

8. Oral Medications with Cost Analysis Biguanides
Metformin
Metformin HCL(500mg, 850mg, 1000mg)-$4.00 list
$4.00/60/30 days
$10.00/180/90 days
Metformin HCL ER
500mg-$4.00/60/30 days, $10.00/180/90days
750mg-$71.82, 1000mg-$124.95(Fortamet)
Fortamet/Glumetza (generic)-Costly!
500mg ER-$421.69
500mg ER-$ , 750mg ER- $ ,1000mg ER-$
Walmart List, 1/2017. WAC. First Data. 2017

9. Sulfonylureas 1st Generation Chlorpropamide-Approximate cost/month-$20
Tolazamide-Approximate cost/month-$48
Tolbutamide-Approximate cost/month-$70
WAC. First Data. 2017

10. Sulfonylureas 2nd Generation Glimepiride
Drug Name
Cost
Glimepiride
Walmart list $4.00/ 30 days, $10.00/ 90 days
Glipizide
$4.00/ 30 days, $10.00/ 90 days
Glyburide
Walmart list. 1/2017

11. Meglitinides Nateglinide (Starlix)- Approximate cost/month-$85
Repaglinide (Prandin)- Approximate cost/month- $50/Prandimet-$55
Repaglinide/Metformin (Prandimet)-Approximate cost/month- $65
WAC. First Data. 2017

12. TZDs
Pioglitazone (Actos)-Approximate cost/month-$25; Alogliptin/Pioglitazone (Oseni)-$195
Avandia-Approximate cost/month-$115
WAC. First Data. 2017

13. DPP-4 Inhibitors Drug Name Cost Januvia/Janumet $381/$381
Onglyza/Kombiglyze XR
$385/$485
Tradjenta/Jentadueto
Nesina/Kazano
$374/$399
WAC. First Data. 2017

14. SGLT2 Inhibitors
(Canagliflozin)-Invokana-Approximate cost/month- $ With Metformin/Invokamet, XR-$
(Dapagliflozin)-Farxiga-Approximate cost/month- $ With Metformin/Xigduo XR-$
(Empagliflozin)-Jardiance-Approximate cost/month- $ With Linagliptin/Glyxambi-$ With Metformin-Synjardy, XR-$
WAC. First Data. 2017

15. Alpha-Glucosidase Inhibitors
Acarbose (Precose)-Approximate cost/month-$45
Miglitol (Glyset)-Approximate cost/month-$145
WAC. First Data, 2017.

16. Bile Acid Sequestrants
Colesevelam (Welchol)- Approximate cost/month-$470
WAC. First Data, 2017.

17. Cost Analysis for GLP1 Agonists
Drug Name
Cost/Month
Tanzeum
$426.36
Trulicity
$585
Byetta
$574.01
Bydureon
$570.32

18. Cost Analysis for GLP1 Agonists-Continued
Drug Name
Cost/Month
Victoza
$612.78
Xultophy
$850-$950
Adlyxin
$600
Soliqua
$740-$760
WAC. First Data. 2017

19. Cost Analysis for Rapid Acting Insulins
Humalog-100 units/ml: $254.80/10 ml vial;
$414/5 of 3ml cartridge, $430.25/5 of 3ml Kwikpen
200units/ml: $393.60/2 of 3ml Kwikpen
Novolog-$275.58/10 ml vial; $393.60/5 of 3ml Penfill, $532.20/5 of 3 ml Flexpen
Apidra-$255.11/10 ml vial; $492.83/5 of 3ml Solostar Pen
WAC. First Data

20. Short Acting Insulins
Humulin R-$137.90/10 ml vial; $1379/20ml vial (U500); $514.56/2 of 3 ml Kwikpen (U-500)
Novolin R-$137.70/ 10 ml vial
WAC.First Data. 2017

21. Intermediate-Acting Insulins
Humulin N-$137.90/ 10 ml vial; $437.25/5 of 3ml Kwikpen
Novolin N-$137.70/ 10 ml vial
WAC. First Data. 2017

22. Approximate cost/month
Long Acting Insulins
Drug Name
Approximate cost/month
Basaglar Kwikpen
$316.80/pkg/5 of 3ml
Lantus, Solostar
(~$ vial) , (~$372.50/pkg/5 of 3ml)
Levemir, Flextouch
(~$269 vial) , (~$403.50/pkg/5 of 3ml)
Toujeo Solostar
(~$335.48/pkg/3 of 1.5ml)
WAC. First Data

23. Ultra Long-Acting Insulins
Tresiba-$443.85/5 of 3ml Flextouch (100 unit/ml), $532.62/3 of 3ml Flextouch (200 unit/ml)
WAC. First Data. 2017

24. Insulin Mixtures
Novolog Mix 70/30-$285.83/10ml vial, $532.20/5 of 3ml FlexPen
Humalog Mix 75/25-$264.10/10ml vial, $430.20/5 of 3ml KwikPen, $591.90/3 ml KwikPen-200u/ml
Humalog Mix 50/50-$264.10/10ml vial, $430.20/5 of 3ml KwikPen, $591.90/3ml KwikPen-200u/ml
Humulin 70/30-$137.90/10 ml vial, $437.25/5 of 3ml KwikPen
Novolin 70/30-$137.70/10 ml vial
WAC. First Data. 2017

25. Cost Analysis of Amylin Analog
Symlin-Pramlintide- Initial dosing (60 mcg SC prior to major meals)- $546.54/month. Maintenance dosing- $973/month
WAC. First Data, 2017.

26. Reduced RX Program Savings Program between CVS Health and Novo Nordisk
Assist patients who are facing high out-of-pocket costs
Provides a lower option for diabetes patients to obtain insulin
Offers Novolin R, Novolin N and Novolin 70/30 at cost of $25 per vial
Patients present card at any of the more than 67,000 participating pharmacies nationwide in the CVS Caremark Network
Program starts 5/10/2017
Phone Number for patients

27. Questions