The Cost of Medication Management in
the Diabetic Patient
By
Paula Straub, RPh
Objectives
■ Review factors for best therapeutic approach for
appropriate pharmacologic choices for diabetes
management
■ Review cost implications for oral medications and noninsulin treatment options
■ Discuss cost impact for insulin therapies
2
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.
3
Treatment Goals
■Management of both hyperglycemia
and risk factors
■Individualized Approach
4
Important Factors for Best Therapeutic
Pharmacologic Approach
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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.
5
Factors Continued
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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.
6
Effectiveness of Therapy Evaluation
■ Evaluated frequently until stable using multiple criteria
1. A1C
2. SMBG records-fasting and post-prandial
3. Documented and suspected hypoglycemia
4. Potential adverse effects..i.e. weight gain, fluid retention, hepatic,
renal or cardiac disease
5. Comorbidities and concomitant drug administration
American Diabetes Association-Diabetes Basics.
7
Oral Medications with Cost Analysis
Biguanides
Metformin

Metformin HCL(500mg, 850mg, 1000mg)-$4.00 list
1.
$4.00/60/30 days
2.
$10.00/180/90 days

Metformin HCL ER
1.
500mg-$4.00/60/30 days, $10.00/180/90days
2.
750mg-$71.82, 1000mg-$124.95(Fortamet)

Fortamet/Glumetza (generic)-Costly!
1.
500mg ER-$421.69
2.
500mg ER-$2549.59, 750mg ER- $3875.59,1000mg ER-$5487.69
Walmart List, 1/2017. WAC. First Data. 2017
8
Sulfonylureas
■ 1st Generation
■ Chlorpropamide-Approximate cost/month-$20
■ Tolazamide-Approximate cost/month-$48
■ Tolbutamide-Approximate cost/month-$70
WAC. First Data. 2017
9
Sulfonylureas
■ 2nd Generation
Drug Name
Cost
Glimepiride
Walmart list $4.00/ 30 days,
$10.00/ 90 days
Glipizide
$4.00/ 30 days, $10.00/ 90
days
Glyburide
$4.00/ 30 days, $10.00/ 90
days
Walmart list. 1/2017
10
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
11
TZDs
■ Pioglitazone (Actos)-Approximate cost/month-$25;
Alogliptin/Pioglitazone (Oseni)-$195
■ Avandia-Approximate cost/month-$115
WAC. First Data. 2017
12
DPP-4 Inhibitors
Drug Name
Januvia/Janumet
Onglyza/Kombiglyze XR
Cost
$381/$381
$385/$485
Tradjenta/Jentadueto
Nesina/Kazano
$381/$381
$374/$399
WAC. First Data. 2017
13
SGLT2 Inhibitors
■ (Canagliflozin)-Invokana-Approximate cost/month$426.60. With Metformin/Invokamet, XR-$426.60.
■ (Dapagliflozin)-Farxiga-Approximate cost/month$430.50. With Metformin/Xigduo XR-$430.50.
■ (Empagliflozin)-Jardiance-Approximate cost/month$430.50. With Linagliptin/Glyxambi-$523.50. With
Metformin-Synjardy, XR-$430.20.
WAC. First Data. 2017
14
Alpha-Glucosidase Inhibitors
■Acarbose (Precose)-Approximate
cost/month-$45
■Miglitol (Glyset)-Approximate
cost/month-$145
WAC. First Data, 2017.
15
Bile Acid Sequestrants
■Colesevelam (Welchol)Approximate cost/month-$470
WAC. First Data, 2017.
16
Cost Analysis for GLP1 Agonists
Drug Name
Cost/Month
Tanzeum
Trulicity
Byetta
Bydureon
$426.36
$585
$574.01
$570.32
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Cost Analysis for GLP1 AgonistsContinued
Drug Name
Cost/Month
Victoza
$612.78
Xultophy
Adlyxin
Soliqua
$850-$950
$600
$740-$760
WAC. First Data. 2017
18
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. 2017.
19
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
20
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
21
Long Acting Insulins
Drug Name
Approximate cost/month
Basaglar Kwikpen
Lantus, Solostar
$316.80/pkg/5 of 3ml
(~$222.08 vial) ,
(~$372.50/pkg/5 of 3ml)
(~$269 vial) , (~$403.50/pkg/5
of 3ml)
(~$335.48/pkg/3 of 1.5ml)
Levemir, Flextouch
Toujeo Solostar
WAC. First Data. 2017.
22
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
23
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
24
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.
25
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 1-844-379-1668
www.reducedrx.com
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Questions
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