Out-of-Pocket Costs for Novel Guideline-Directed Diabetes Therapies Under Medicare Part D

Abstract

Drs Jaiswal and Quer had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. Drs Jaiswal and Quer equally contributed to the analysis of the data, the discussion, and the preparation of the manuscript and are co-first authors.

Comparative Effectiveness of Sodium-Glucose Cotransporter 2 Inhibitors vs Sulfonylureas in Patients With Type 2 Diabetes

“…A recent analysis estimated that, among Medicare Part D plans in 2019, the total annual and out-of-pocket cost for sulfonylureas was $31, the total annual cost for SGLT2 inhibitors ranged from $5967 to $6118, and annual out-of-pocket-cost for SGLT2 inhibitors ranged from $1298 to $1615. 57 However, despite higher treatment cost and owing to their salutary properties in reducing complication costs and gains in qualityadjusted life-years, SGLT2 inhibitors are now considered to be cost-saving or cost-effective. 58 Nevertheless, the substantially higher out-of-pocket cost of SGLT2 inhibitors limits access to many patients who may benefit from these newer agents and might contribute to inequities.…”

Medication adherence to injectable glucagon‐like peptide‐1 (GLP‐1) receptor agonists dosed once weekly vs once daily in patients with type 2 diabetes: A meta‐analysis

“…[30][31][32] Out-of-pocket costs are especially relevant to the use of GLP-1RAs, as 2019 Medicare Part D list prices of novel diabetes drugs, including GLP-1RAs, were 40 to 360 times the cost of other diabetes medications such as sulphonylureas and thiazolidinediones. 33 This difference in price then translated to a one to eightfold increase in patient out-of-pocket costs, where patients paying $250 to $355 annually for traditional medications are projected to pay $1231 to $1981 for novel regimens. 33 The use of oral vs injectable GLP-1RAs may also impact adherence.…”

“…33 This difference in price then translated to a one to eightfold increase in patient out-of-pocket costs, where patients paying $250 to $355 annually for traditional medications are projected to pay $1231 to $1981 for novel regimens. 33 The use of oral vs injectable GLP-1RAs may also impact adherence. 34 As the first oral GLP-1RA (oral semaglutide) 8 was approved by the US FDA in 2019, there were no real-world studies evaluating adherence to this agent to include in our meta-analysis and thus, future studies are needed.…”

Socioeconomic status and use of obesogenic and anti-obesity medications in the United States: A population-based study

“…In addition, alternatives are often more expensive for the patient: SGLT2i and GLP1RA resulted in annual out-of-pocket costs for those with Medicare Part D plans in 2019 of $1298 to $1615, and $2102 to $2520, respectively, compared to $31 for sulfonylureas. 36 Pricing is further complicated by the use of rebates and discounts provided by the pharmaceutical industry. 37 In addition, patients with lower SES tend to have lower health literacy and lower trust of the health care systems, 38 while clinicians tend to believe that patients with lower SES are less likely to comply with medical advice.…”