by Matt Kuhrt | Jan 30, 2019 8:15am
Sometimes simple methods
for bending the healthcare cost curve have a way of hiding in plain sight.
A study published on Tuesday in the
Journal of the American Medical Association adds to a growing body of evidence
suggesting that human-derived formulations of insulin are as clinically
effective at treating Type 2 diabetes as pricier “designer” analogues that get
used more commonly.
That could offer patients
relief from rising drug costs.
Given how the cost of
insulin has risen rapidly across the board lately,
that could be welcome news for a large and growing patient population. Of the
several million Americans using insulin today, the vast majority find
themselves on newer, higher-cost analogue formulations of the drug, according
to the study’s lead author, Jing Luo, M.D., M.P.H., of Brigham and Women’s
Hospital and Harvard Medical School.
The newer insulins have
been modified for attributes such as more-rapid onset or longer duration, and
they’ve been marketed aggressively enough to make them blockbuster medications
for pharmaceutical manufacturers. Despite some indication that they may perform
better with respect to some safety events, however, very little information
existed to suggest they were clinically superior.
“We were wondering
whether patients with Type 2 diabetes might do as well on older formulations
that don’t have as ideal a profile of action, but are clinically comparable and
come from the same manufacturers—so we think the quality is good—and they’re
less expensive,” Luo said.
In terms of potential
savings, the study notes that the cheapest human-derived insulins can cost as
little as a tenth as much as analogue therapies. Other potential benefits to
patients could include greater convenience, since specialized insulin
formulations can require more than twice-a-day dosing.
An op-ed piece
accompanying the study points out that the least-expensive human-derived
insulins typically do not come in a convenient format. But Luo said the overall
cost differential between analogue and human-derived formulations would likely
be more than enough to justify switching in many cases.
The study’s conclusion
isn’t particularly earth-shattering, Luo said. But despite the cost of insulin
and the danger to patients for whom its growing expense might become an
enticement to ration its use, neither payers nor clinicians have shown a broad
inclination to change their prescribing practices yet.
This adds to the
evidence that switching from analogue to human-derived insulin in a
real-world setting could be safe and effective where some might not realize a
viable alternative exists, Luo said.
“Unless you practice at a
place like Kaiser, you’re more likely to have more clinical experience with
newer analogue insulins,” he said.
Unlike situations such as
dialysis, where CMS can play a role in dictating the cost of a drug, with
insulin, the players are much more fragmented and decentralized. Luo said
there have been entities willing to experiment, but the majority haven’t
gotten there yet. And as much as he’d like these results to provide the tipping
point that moves the industry toward wider use of human-derived insulin, he
sees it more realistically as another data point in what’s likely to prove a
longer-term journey.
At the very least, the
study’s results may offer a useful path for physicians seeking ways to help
patients struggling with higher insulin costs.
“For docs with patients
who have issues paying for their insulin, this should make them feel more
confident about switching patients to a cheaper, human-derived insulin
prescription,” he says.
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