Generic SGLT2 Inhibitors and Interpreting Divergent CKD Trial Data

In "Generic SGLT2 Inhibitors and Interpreting Divergent CKD Trial Data," Dr. Haumschild turns to generic tiering strategy and how to read two differently designed CKD outcomes trials.

Dr. Haumschild addresses generic competition first, noting that affordability matters as costs continue rising. He believes evidence-based therapies still need provider input even as generic options expand access. Generic availability is an opportunity, he says, but not a reason to chase lowest cost alone. If a generic meaningfully lowers net cost, a lower-tier placement may make sense. That affordability directly affects adherence and access for many members over time. He splits the population in two: new starts and patients already stable on therapy. For new starts with multiple SGLT2 inhibitor options, steering toward a cost-effective choice benefits everyone. For patients already stable, disruption requires real justification tied to clinical impact and adherence risk. He would not set EGFR restrictions more conservative than KDIGO and ADA guidelines allow. Those guidelines support initiation down to an EGFR of 20 in appropriate CKD patients. Therapy can continue below that threshold until kidney replacement therapy becomes appropriate. Generics should lower cost, he says, but never at the expense of guideline-concordant care. Dr. Haumschild then turns to interpreting differing trial designs across the SGLT2 class. He warns against converting a single trial's inclusion criteria into an arbitrary coverage restriction. Different populations, endpoints, and baseline risks mean these numbers cannot be compared head-to-head. Instead, Dr. Haumschild looks at the totality of evidence across both trials together. That evidence shows kidney protection extends across a broader CKD population than once appreciated. Payer policy, he argues, should follow contemporary guidelines rather than any single trial's enrollment criteria.

Up next, in "Payer Strategies for Earlier CKD Screening and Identification," Dr. Haumschild lays out how a familiar screening measure can catch CKD earlier.