Formulary Decisions and GLP-1/Insulin Combinations

Louis S. Christos, RPh: We have an open coverage policy for the combination of insulin with GLP-1 [glucagon-like peptide-1]. Obviously, this is a new category for us, but we do allow access because we do have an open coverage policy for the therapies for diabetes. What we don’t know, specifically, again, now, is who the right patient is for these combination insulin/GLP-1 products. We don’t know where they fit into the treatment algorithm. We don’t know what sort of real world experience we’re going to see with these products, but we do provide open access. We don’t restrict access to the product. Again, we leave it up to the provider to determine the appropriate patient for the combination insulin/GLP-1 product.

By combining a GLP-1 and insulin, that’s obviously 1 less injection that the member would require. So, you are going from 2 injections down to 1 injection, which could potentially improve compliance for members because of the less frequent administration and the less number of injections that are required to obtain a similar clinical benefit.

Frequency of administration, the number of doses per day, those considerations do become part of the P & T [Pharmacy and Therapeutics] committee review. We do look at route of administration, and we look at frequency of administration. And the perception is, obviously, that the less frequently somebody has to administer a product and the less medication they need, the more compliant they tend to be. That’s just, again, one aspect of the overall clinical profile of a product that we look at during a formulary discussion. But reducing frequency is a potential benefit for members and for patients because of the less frequent administration of the therapies.

The benefit of the GLP-1/insulin products is that they are a fixed-dose combination. As a result, you are able to titrate slower, the dosing, which will allow the patient to better manage any potential adverse events, such as those associated with the GLP-1s. They would be able to manage them more easily or favorably.