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Research Letter
September 14, 2020

Out-of-Pocket Costs for Novel Guideline-Directed Diabetes Therapies Under Medicare Part D

Author Affiliations
  • 1Department of Medicine, University of California, San Francisco
  • 2Daniel K. Inouye College of Pharmacy, University of Hawaii at Hilo
  • 3Pacific Health Research and Education Institute, Honolulu, Hawaii
  • 4Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
  • 5Departments of Medicine, Health Policy, and Informatics, University of Minnesota School of Medicine, Minneapolis
  • 6Department of Family Medicine and Community Health, John A. Burns School of Medicine, University of Hawaii, Honolulu
JAMA Intern Med. Published online September 14, 2020. doi:10.1001/jamainternmed.2020.2922

Diabetes affects 1 in 3 Medicare beneficiaries.1 Treatment guidelines recommend that most patients start treatment with metformin followed by second-line drugs until glycemic goals are reached. For years, these second-line drugs were predominantly inexpensive generic drugs, such as sulfonylureas and thiazolidinediones (TZDs).2 Recent guidelines, however, endorse costly, predominantly brand-name drugs, such as sodium-glucose cotransporter-2 inhibitors (SGLT2is) and glucagon-like peptide-1 receptor agonists (GLP-1RAs), as preferred second-line medications for patients with established or increased risk for atherosclerotic cardiovascular disease, heart failure, or chronic kidney disease.3 Some SGLT2is and GLP-1RAs offer cardiovascular benefits, and certain SGLT2is are protective against renal disease.3 A third novel class, dipeptidyl peptidase-4 inhibitors (DPP-4is), is also increasingly used after metformin.2 Because the cost of medications affects adherence,4 we examined cost sharing for these novel diabetes agents under Medicare Part D, which covers 45 million people.5

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