AJMC® Pharmacy Benefits Special Issue Features Long-Acting Insulins, Switching Rheumatoid Arthritis Drugs, Adherence in ADHD and More

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A special issue of The American Journal of Managed Care® answers questions asked by payers through studies that compare adherence and cost-effectiveness of drugs within a class.

Do people with diabetes who use long-acting insulin have lower overall healthcare costs? Does forcing a patient with rheumatoid arthritis to switch biologics for nonmedical reasons create other costs?

Questions like these are top-of-mind for payers and pharmacy benefit managers this time of year as they decide which drugs will be on formulary for 2019. A special pharmacy benefits issue of The American Journal of Managed Care® published this month examines a range of topics in health economics outcomes research, which decision makers are evaluating more than ever.

This issue includes:

  • A review article by researchers at Merck and Xcenda, which found that patients with type 2 diabetes using long-acting insulin analogues had higher drug costs than those using older insulins (neutral protamine Hagedorn) or oral antidiabetics. However, use of long-acting insulin appeared to yield overall medical costs that were the same or lower than with use of the alternatives, and some evidence suggests that new insulin pens may boost adherence. (Merck’s follow-on insulin, Lusduna, has received tentative FDA approval but cannot receive final authorization until patent litigation is resolved.)
  • Researchers from Amgen and IMS Health found there is much room for improvement in adherence among patients with rheumatoid arthritis (RA) who started on biologic disease-modifying antirheumatic drugs. Effective treatment in the first year of therapy was a crucial indicator for adherence in the second year. The study also identified geographic and demographic factors associated with good adherence and called for better strategies to promote effective treatment when patients start taking these drugs. (Amgen markets the RA treatment etanercept, sold as Enbrel.)
  • A separate article by authors from HealthCore and Amgen, which found that making patients switch biologics for RA comes at a cost. Patients who switched therapies had five percent higher overall costs after switching compared with those who stayed on the same drug. The authors find that these costs should be considered, especially when patients are asked to switch drugs for nonmedical reasons, including changes to formulary. Mean costs were $2342 higher after a year for patients who had to switch drugs.
  • Researchers from the Analysis Group and Shire found that patients with attention-deficit/hyperactivity disorder (ADHD) taking long-acting monotherapy had better adherence and were more likely to stick with therapy than those with long-acting combination therapy. Last year, Shire received FDA approval for Mydayis, which has a 16-hour treatment window that can allow patients with ADHD to avoid combination therapy.

About The American Journal of Managed Care®:

The American Journal of Managed Care® (AJMC®) is a peer-reviewed, MEDLINE-indexed journal that keeps readers on the forefront of health policy by publishing research relevant to industry decision makers as they work to promote the efficient delivery of high-quality care. is the essential website for managed care professionals, distributing industry updates daily to leading stakeholders. Other titles in the AJMC® family include The American Journal of Accountable Care®, and two evidence-based series, Evidence-Based Oncology™and Evidence-Based Diabetes Management™. These comprehensive offerings bring together stakeholder views from payers, providers, policymakers and other industry leaders in managed care. To order reprints of articles appearing in AJMC® publications, please contact Jeff Prescott at 609-716-7777, ext. 331.


AJMC® Media:

Theresa Burek, 609-716-7777


Surabhi Verma