Recommendations for payers to reanalyze the cost-effectiveness of SGLT2 inhibitors in light of more recent evidence supporting their cardiovascular benefits.
Darren K. McGuire, MD, MHSc: Now we get to the question of access, cost, and availability to our patients. As I mentioned, I work in a county health care system. It is a safety net hospital system, Parkland Hospital and Health System in Dallas, Texas, and the system has determined that both the GLP1 receptor agonists and SGLT2 inhibitors are not only cost-effective but likely cost-dominant when you’re in a closed health care system. The cost of complications avoided by the use of these drugs is close to, or even pays for, the cost that’s been negotiated. We probably have a cheaper per-dose cost because of the potency of our negotiation of such a large health care system.
In the open market, cost is a big deal and access is a big deal. There are prior authorizations required. It’s a bit of a nuisance at times for physicians or providers to have to go through the steps to get prior authorizations. There’s variable coverage by third-party payers. And of course, a lot of people have no insurance. Navigating the cost around these remains a real and important issue to work out with the patients.
I do think cost efficiency should be formally reanalyzed. Initially, it was based on the glucose effects. Now that we have measurable clinical benefits, the cost efficiencies should be reassessed. Hopefully at the same time, as we have multiple drugs in each class, competition will take care of some of the pricing issues. Ideally, we’ll see some of these medications dropping in price and becoming more affordable and accessible. Of course, some of the SGLT2 inhibitors will go off patent fairly soon. I think the first generic SGLT2 inhibitor will be available in 2022.
Cost is a big deal, but from a societal perspective, the potency of these drugs—especially SGLT2 inhibitors reducing heart failure—has a major impact on health care costs and utilization. My suspicion is that we should be able to demonstrate the cost efficiency of these medications reasonably soon.