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(Bloomberg) – A private health insurance system owned by insurer Anthem Inc. has enabled thousands of elderly diabetic patients with diabetes to switch from expensive new insulin medications, such as Sanofi's Lantus, to insulins older and less expensive.
The health system saved millions. But many patients also had a better financial situation: fewer of them have hit the Medicare coverage gap, in which patients pay a large share of the costs. Although blood glucose levels increased slightly on average, there was no increase in the number of emergency visits or hospitalizations due to dangerously low or high blood glucose levels.
This is the conclusion of a new study by researchers at Harvard Medical School that could change the way diabetics are treated and change the fate of drug manufacturers.
For years, even as insulin prices had risen sharply, doctors have continued to administer to patients some of the newer, mostly expensive versions. But more and more senior researchers are questioning whether drugs such as Sanofi's Lantus, Levemir and Novolog from Novo Nordisk A / S, and Humalog from Eli Lilly & Co. are really needed for many patients.
The findings, published Tuesday in the Journal of the American Medical Association, suggest that it is prudent to replace most patients with type 2 diabetes with newer and more expensive drugs, particularly if the cost is a problem.
"Simply put, it means that pbading a large number of type 2 diabetic patients, or most of them, from badog insulin to human insulin is probably safe and effective and that It could also be very economical, "said Jing Luo, a researcher at Harvard Medical School. and internist who is the main author of the study.
The replacement of insulin was carried out by CareMore Health, a physician-led healthcare delivery branch of Anthem Inc., which treats patients under private Medicare and Medicaid regimes in multiple states. It has community care centers located within five to five miles of the patient's place of residence.
The healthcare organization has consistently provided the most expensive insulin-based medicines to Medicare patients without any co-payments. But as drug prices skyrocketed, he reconsidered his approach in 2014. He decided to mbadively transfer patients to older, less expensive insulin medications. Co-payments on new drugs were increased for some patients after the change, while patients who received older insulin-based drugs had no copayment, according to the study.
"There has never been a large-scale effort like ours to migrate an entire population of badog insulin to human insulin," said Sachin Jain, president and CEO of CareMore Health and co-author of the study. "We did this with some apprehension." But it worked well, he said.
The monthly insulin expenditures of the health system dropped from $ 3.4 million at the end of 2014 to $ 1.4 million at the end of 2016, according to the results of the Journal of the American Medical Association. Although blood sugar levels have risen slightly on average, this small difference may not be clinically important, the study concluded.
More importantly, many patients have saved money. Before the transition, 80.4% of insulin patients had reached the Medicare coverage gap, said donut hole, said Harvard's Luo. In 2016, after the change of patients, only 52.7% of patients had enough expenses to place them in the coverage gap, said Luo.
In an email, Sanofi said that the study was not able to detect the rates of episodes of minor hypoglycemia or nocturnal hypoglycemia that could put life into jeopardy. danger.
"This, among other limitations, prevents drawing conclusions," spokeswoman Ashleigh Koss said in an email. About 85 percent of people who use Sanofi insulins pay less than $ 50 a month out of pocket, she said.
Eli Lilly, who makes both new insulin-like products and older human insulins, said the choice of treatment should be between the patient and his doctor.
"Analogues and human insulin have revolutionized the way diabetes is treated and continue to have a place in the current treatment regimen," spokesman Gregory Kueterman said in an e-mail.
While older human insulins are an important option, "insulin badogues continue to play a vital role in the overall management of diabetes," said Ken Inchausti of Novo Nordisk, in a statement. Novo's human insulin is available in many pharmacies for $ 25 a bottle, he said.
In an editorial accompanying the study at JAMA, Kasia Lipska, a professor at the Yale School of Medicine, said the new insulin-based products "do not offer any major benefits "although they can modestly reduce the episodes of nocturnal hypoglycemia.
"These findings should prompt physicians and patients to reconsider the type of insulin that is best suited," she wrote.
In total, 14,635 members of the CareMore plan took insulin during the study period, according to the study. The vast majority suffered from type 2 diabetes, in which the body still produces insulin but withstands its effects.
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