HEALTH AT WHAT COST? MANAGING THE HIGH PRICE OF DIABETES CARE - PowerPoint PPT Presentation

HEALTH AT WHAT COST? MANAGING THE HIGH PRICE OF DIABETES CARE Hayley Miller, MD Montana Pharmacy Association January 2019

DIABETES IN THE US

ANNUAL COST OF CARE FOR DIABETES: ~$245 BILLION Direct medical costs: $176 billion 8% nursing/residential facilities 9% doctor visits 43% 12% Inpatient Care diabetes meds supplies 18% rx for complications Extracted from: http://www.diabetes.org/advocacy/news-events/cost-of-diabetes.html. American Diabetes Association, June 2015. Accessed February 28, 2016

INDIRECT COST OF CARE: $69 BILLION increased absenteeism 7% lost production d/t early death 27% Reduced productivity at work 30% Disease related disability 31% reduced productivity not working 4% Extracted from: http://www.diabetes.org/advocacy/news-events/cost-of-diabetes.html. American Diabetes Association, June 2015. Accessed February 28, 2016

Sokol et al. Medical Care , 2005.

INSULIN: A BRIEF HISTORY

1923: DISCOVERY OF INSULIN

Courtesy Irl Hirsch via Medscape.

INSULIN PRICING HISTORY • 1921: Patent sold for $1. • 1924: Insulin could be purchased for 7¢/week • 1960: Insulin <$1/vial • 1975: insulin $1.50 - $3/vial Lantus: 774% Increase • 1982: Genetically engineered Humulin Regular Insulin: 5833% Increase • 1996: Lispro $24/vial • 2001: Lantus $35/vial; Human Insulin $20/vial • 2015: Lantus $234/vial; Human insulin $131/vial • 2018: Lantus $297/vial; Humalog R insulin $178/vial, Humalog $319/vial Von Wartberg, L: Diabetes Health, May 23 2007.

EXPECTED PRICE WITH INFLATION

Insulin detemir (Levemir) Insulin glargine (Lantus)

LONG AND SHORT ACTING INSULIN Insulin lispro (Humalog) Insulin aspart (Novolog) Insulin detemir (Levemir) Insulin glargine (Lantus)

SOLUTION: BIOSIMILAR (AKA GENERIC) INSULIN Biosimilar glargine (LANTUS): $379 Biosimilar lispro (HUMALOG): $240.42

Hirsch IB. Changing Cost of Insulin Therapy in the U.S. March 6, 2016.

INTERNATIONAL SALES • In 2013, North America accounted for 7% of the world’s population with diabetes • It accounted for 14% of the insulin treated patients • And 52% of the sales of insulin • Conversely, 50% of diabetes in this world is international • Yet only accounts for 8% of the profit generated by the drug companies Gal A: Bernstein Research, September 24 2013.

WHY?

2003 MEDICARE PART D FORBID PRICE NEGOTIATION BETWEEN FEDERAL GOVERNMENT & PHARMACEUTICAL INDUSTRY

LOBBYING $$ PER INDUSTRY From https://www.investopedia.com/investing/which-industry-spends-most-lobbying-antm-so/

Tsai A. Diabetes Forecast . March 2016.

INDUSTRY ADVOCACY? = $1MILLION+/YR = $500K/yr

IMPLICATIONS

CHANGES IN PATIENT COST SHARING & MEDICATION ADHERENCE Eaddy MT, Cantrell CR et al. Pharmacy & Therapeutics , Jan 2012; 37(1) 45-55.

WHAT CAN WE DO? COMMERCIALLY INSURED • Ask every single patient how much he/she pays for insulin/test strips/medications. • Copay cards DO increase prescriptions for brand-name drugs • However, they can decrease the out-of-pocket expense for insured patients substantially • Sample insulin/GLP-1 RA can help with patients. • Have patient assistance applications available for any patient who may need it.

WHAT CAN WE DO? MEDICARE • Understand what is covered under Medicare Part B: • One T ouch test strips → <$3/box • Insulin when used in insulin pumps • Pump supplies • Application for Extra Help With Medicare Prescription Drug Plan Costs (Form SSA-1020) • Patient assistance programs can help patients in the donut hole. • Samples can help

SUMMARY • We are facing a crisis with regard to the increasing demand for diabetes medications and the exorbitant escalation of these prices. • The current system is stacked against the patients’ best interests. • It is imperative that cost and affordability is discussed with every patient with diabetes. • Consider strategies to improve access to medications.

Economic Costs of Diabetes in the U.S. in 2017 American Diabetes Association. Diabetes Car e Mar 2018