PCMS Member Corner: Recent Observations of Diabetic Drug Pricing

Recent Observations of Diabetic Drug Pricing

According to the CDC, $1 out of every $4 of US health care expenditures are incurred caring for people with diabetes. Both the treatment and complications of diabetes cost a significant amount for individuals, insurance companies and governments. Like everything else in medicine, much of why medications cost what they do is opaque and shrouded in mystery.

Two of the better classes of diabetic medications are GLP-1 receptor agonists and SGLT2 inhibitors. Both classes are recommended by the American and European Diabetes organizations for their benefit in treating blood sugar and in prevention of other problems like atherosclerosis. However, in a recent study, only 12% of patients were prescribed one of these classes of drugs. The expense of the medications limits their adoption. The best-known GLP-1 agonist, Ozempic/semaglutide, costs about $1000/month without insurance; the best-known SGLT2, Jardiance/empagliflozin, runs about $600/month. Even with their cardiovascular advantages, it is estimated that both drugs would need their prices cut by 70% for them to be considered cost effective.

Presumably, a factor in the high cost of semaglutide (at a typical dose of 1 mg/week injection) is that demand has been outstripping supply. With the frequent use of the medication for treatment of obesity, there has been less of the medication available and consequently “free market” costs have risen. Given this, it is interesting that Novo Nordisk, the manufacturer, is testing a new dose of oral semaglutide for treatment of adults who are overweight or obese. The oral dose will be 50mg/day, the amount of semaglutide a typical diabetic would use in year if given by injection. What is this about a shortage, again? It just doesn’t make sense.

But there is some good news out there, as well. There is a long history of “me-too” drugs in medicine, compounds structurally related to a pre-existing drug, but made by competitor companies to share in the market of the original drug. Usually, when me-too drugs are released, they try to gain market share by aggressive marketing rather than aggressive pricing. In a novel marketing “gimmick” the newest SGLT2 inhibitor, Brenzavvy/bexaglifozin, is changing that. While most SGLT2 inhibitors (Invokana, Farxiga, Jardiance) cost between $550-$600 a month, in a refreshing change, the cash price for bexagliflozin is about $50/month.

The manufacturer of bexaglifozin is TheracosBio, a company whose mission is to “provide access to new medications for patients with common diseases.” The company believes at $50/month for bexaglifozin they can meet their overhead. Here’s hoping this catches on and we see the company release more drugs soon.

Written by Dr. Roy Loewenstein
September 2023