SGLT2 Inhibitors' Cardiorenal Expansion Reshaping Formulary Strategy

Welcome back to another AJMC Insights series. In "SGLT2 Inhibitors' Cardiorenal Expansion Reshapes Formulary Strategy," Ryan Haumschild, PharmD, MS, MBA, CPEL opens the series by reframing SGLT2 inhibitors as foundational cardiorenal therapy rather than diabetes-only agents.

Dr. Haumschild opens by explaining that his organization no longer treats SGLT2 inhibitors as simple diabetes medications. He now views them as cardiorenal therapies that touch multiple specialties at once. That shift changes the math for a P&T committee in a meaningful way. Historically, a committee might have weighed A1C reduction, acquisition cost, and rebate value alone. Today, the calculation includes preventing heart failure hospitalization and slowing chronic kidney disease progression. It also includes broader cardiovascular outcomes and potentially delaying progression toward dialysis. Dr. Haumschild argues formulary strategy has to become far more indication-sensitive as a result. A patient with uncomplicated type 2 diabetes may still see flexibility around preferred products. But a patient with heart failure or CKD needs a different approach entirely. Utilization management, he says, must not inadvertently create barriers to guideline-directed therapy for these patients. That requires rethinking how health plans view economics beyond the pharmacy budget alone. A plan should not optimize pharmacy spend in isolation while ignoring medical expense elsewhere. Pharmacy leaders, he explains, have to be stewards of both medical and pharmacy costs together. Preventing a hospitalization or delaying dialysis matters more than acquisition cost alone. His overall goal is aligning formulary design with the evolving evidence base as it grows. That means positioning therapies with demonstrated outcomes and minimizing unnecessary prior authorization. He wants to remove any undue barriers that keep eligible patients from getting access. Cost sharing and patient out-of-pocket expense should never become the reason a patient goes without what he calls a foundational cardiorenal therapy.

Our next episode, "Closing the Gap: Why SGLT2 Inhibitors Remain Underused," turns to why SGLT2 inhibitors remain underused even where guidelines clearly support them.