More competition, access could reduce prices for diabetes therapies
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Key takeaways:
- The cost to manufacture most insulins, SGLT2 inhibitors and GLP-1 receptor agonists is much lower than the lowest market price.
- Generic and biosimilar medications could cut prices for people with diabetes.
Prices for most diabetes medications exceed their manufacturing costs, and the addition of generic or biosimilar medications could help to lower prices, according to study findings published in JAMA Network Open.
“Increasing costs for type 2 diabetes treatments are already placing disproportionate burdens on low- and middle-income countries: Health expenditures for diabetes as a proportion of the gross domestic product are higher in South America, Central America, the Middle East and North Africa than in Europe,” Melissa J. Barber, PhD, a postdoctoral associate in the Yale Collaboration for Regulatory Rigor, Integrity and Transparency and in the department of internal medicine at Yale School of Medicine, and colleagues wrote. “Additionally, a large proportion of primary care expenditures in low- and middle-income countries are out-of-pocket, and about half of those expenditures are on medical goods.
“In countries with higher prices, major cost savings could be attained through increased availability of lower-cost generics and biosimilars. At the present, this is restrained by a mix of regulatory challenges, intellectual property barriers and business practices discouraging competition,” they wrote.
Researchers conducted an economic evaluation study that estimated manufacturing costs for insulins, SGLT2 inhibitors and GLP-1 receptor agonists. A sustainable cost-based price was calculated to estimate the cost of producing each medication. The lowest-reported price for each medication was collected for 13 countries from public databases in January 2023. All costs and prices were reported in U.S. dollars.
Cost-based prices for most medications were lower than the current market prices. Regular human insulin and human insulin neutral protamine Hagedorn (NPH) formulated in vials ranged from 97% lower to 24% higher than the lowest market prices. For prefilled pens, regular human insulin and human insulin NPH had a cost-based price ranging from 7% to 88% less than the lowest current market prices.
The cost to make insulin analogs formulated in vials was 25% to 97% less than market prices. For prefilled pens, cost-based prices for insulin analogs were 52% to 96% less than the lowest market price. Cost-based prices for insulin cartridges ranged from 61% to 98% less than market prices with the exception of insulin detemir (Levemir, Novo Nordisk), which had a cost 38% to 66% lower than market price. Cost-based prices could allow twice-daily mixed insulin NPH to cost as little as $61 per person per year or basal-bolus treatment with insulin glargine and insulin aspart to cost as little as $111 per person per year.
“For all insulins, cost-based prices were only slightly higher for disposable pens and cartridges compared with vials,” the researchers wrote. “However, current market prices were far greater for pen formulations than for vials, suggesting greater markups that are not justified by differences in manufacturing costs.”
Cost-based prices for SGLT2 inhibitors except for canagliflozin (Invokana, Janssen) ranged from $1.30 to $3.45 per month. GLP-1 receptor agonists’ cost-based prices ranged from 75 cents to $72.49 per month. Cost-based prices for dapagliflozin (Farxiga, AstraZeneca), empagliflozin (Jardiance, Boehringer Ingelheim/Eli Lilly) and all GLP-1 receptor agonists were lower than the current lowest market price.
“Our analysis suggests that major cost reductions could be achieved for the SGLT2 inhibitors dapagliflozin and empagliflozin and the GLP-1 receptor agonists dulaglutide (Trulicity, Eli Lilly), exenatide (Bydureon, AstraZeneca), liraglutide (Saxenda, Novo Nordisk) and oral and injectable semaglutide (Ozempic/Rybelsus, Novo Nordisk),” the researchers wrote.
The researchers cited several factors that contribute to the high market prices for diabetes treatments, including limited access to the medications, limited competition and public policy that restricts competition from generics and biosimilars.
“Our findings suggest that, for nearly all insulins, SGLT2 inhibitors, and GLP-1 receptor agonists, in nearly all countries surveyed, prices could be reduced substantially if robust generic and biosimilar manufacture was enabled,” the researchers wrote.
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