Prime Therapeutics Research Finds Increase in Insulin Use, Pharmacy Expense

Hypoglycemia-related emergency department visits uncommon

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Apr 20, 2016, 10:00 ET

ST. PAUL, Minn., April 20, 2016 /PRNewswire/ -- Prime Therapeutics LLC (Prime), a pharmacy benefit manager serving nearly 26 million members nationally, recently conducted two diabetes studies to determine the use and associated cost of insulin therapy to help with modeling future use and cost of insulin therapy in commercial populations. The first study found a 50 percent increase in the use of insulin and an 80 percent increase in the cost of insulin among 4 million of its commercially-insured members over a 4.5 year timeframe. The second study tracked emergency department visits related to hypoglycemia for members by the type of therapy they were receiving, and found those events were infrequent.

According to the Centers for Disease Control and Prevention (CDC), more than 9 percent of the American population has diabetes. And for most insured populations, insulin therapy for the treatment of diabetes is a leading pharmacy cost driver. The drug Lantus^® is the most commonly used long-acting insulin¹, but following its United States patent expiration in February 2015, new long-acting insulins will be entering the market. Lower cost insulin glargines are expected to be marketed by different companies, including Basaglar^®, which has already been approved by the Food and Drug Administration (FDA) but its marketing is delayed until December 2016 by a settlement with the maker of Lantus. Two new ultra long-acting insulins were also approved – a new formulation of insulin glargine Toujeo^® and a new insulin degludec Tresiba^® – both of which may lower the risk of hypoglycemia, a condition that occurs when blood glucose is lower than normal, which may lead to unconsciousness. These new insulins are expected to cost more than Lantus and the new versions of insulin glargine.

From January 2011 to June 2015, Prime's research found the cost for all diabetes drugs increased 168 percent in the insured population studied. In 2011, diabetes drugs were 6.7 percent of all pharmacy benefit costs; they rose to 10.7 percent by June 2015. Also, the cost of insulin rose 200 percent during that same timeframe, from 3 percent of all pharmacy benefit costs to 5.4 percent. Insulin expenditures now consume $1 in every $20 spent for all drugs paid for through the pharmacy benefit.

Emergency department visits for hypoglycemia are an indicator for severe hypoglycemia events that may result in injury or death. In the study population, the nearly 4 million members had a total of 4,128 emergency department visits coded for hypoglycemia over more than four years. Members with Type 1 diabetes had the highest rate of emergency department visits. Members with Type 2 diabetes were more likely to have an emergency department visit for hypoglcyemia if they were using both long-acting and short-acting insulin (basal/bolus therapy) than if they were using the more common therapy of only long-acting insulin. Because the overall rate of emergency department visits was low, new drugs that demonstrate lower hypoglycemia risk will need to be assessed for their clinical and financial value.

"Gaining a deeper understanding of provider prescribing and member behavior in the diabetes category is important as Prime works to control drug, and overall health care, costs," said Kevin Bowen, M.D., M.B.A., principal health outcomes researcher at Prime. "With new diabetes drugs coming to market that may be able to lower the risk of hypoglycemia events for some patients, health plans and employers should carefully weigh the benefits compared with lower cost drugs currently available. Seeing the full picture can help members manage their diabetes so they can get the medicine they need to feel better and live well."

Prime has programs in place to help control the cost of diabetes drugs and help keep members adherent to their medicine so they can avoid the emergency department. Prime encourages the use of generic medicines with known long term safety and effectiveness profiles, such as metformin, through its utilization management step therapy program. Through its GuidedHealth^® program, Prime can provide interventions for members to help improve adherence to diabetes drugs.

This research will be presented as two separate posters at the Academy of Managed Care Pharmacy's (AMCP) annual meeting April 19-22 in San Francisco. AMCP recognized the first study as a bronze award winning research poster.

About Prime Therapeutics
Prime Therapeutics LLC (Prime) helps people get the medicine they need to feel better and live well. Prime manages pharmacy benefits for health plans, employers, and government programs including Medicare and Medicaid. The company processes claims and delivers medicine to members, offering clinical services for people with complex medical conditions. Headquartered in St. Paul, Minn., Prime serves nearly 26 million people. It is collectively owned by 13 Blue Cross and Blue Shield Plans, subsidiaries or affiliates of those plans. Prime has been recognized as one of the fastest-growing private companies in the nation.

For more information, visit www.primetherapeutics.com or follow @Prime_PBM on Twitter.

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1. Prime internal data