Type 2 Diabetes Medications: Balancing Cost and Value

Appropriate medication therapy for type 2 diabetes is important for success in value-based care. A1c control, medication adherence and medication costs are metrics that many payers evaluate. However, managing these medications can be challenging, especially when insurance coverage and cost can vary significantly from patient to patient. After optimizing metformin, most patients will require a second-line agent for glycemic control. Dipeptidyl peptidase-4 inhibitors (DPP4i), glucagon-like peptide-1 receptor agonists (GLP-1 RA), and sodium-glucose co-transporter 2 inhibitors (SGLT2i) are commonly used after metformin. These medications are all high cost, so it is important to choose a medication that provides high value if using any of these classes. The table below can assist with selecting patient-specific, high-value medications to optimize value-for-dollar spending for both patients and payers.

Lower-Cost Options

Some patients have significant affordability concerns that drive the selection of second-line agents and limit the use of DPP4i, GLP-1 RA or SGLT2i medications. The following table provides an overview of the most affordable second-line agents.

Another option is to consider a combination product. While these often have higher cash prices, for some patients with insurance it results in fewer copays and overall savings compared to single-agent preparations. Patients can contact their insurance company to see if a combination product is more cost-effective for their plan. There are numerous combination products available, and it can be difficult to determine what medication classes are included. The chart below provides an overview of which classes have combination products available.

Additional Resources

The American Diabetes Association 2022 Standards of Medical Care in Diabetes has a section devoted to medication therapy, which provides more detailed information. Consider bookmarking these pages to have a quick reference guide:

Table comparing medication classes on efficacy, weight effects, cardiovascular/renal benefits, cost and dosing information.
Flowchart for selecting medications based on patient-specific needs (cardiovascular/renal concerns, hypoglycemia risk, weight effects, cost).
Flowchart for adding and adjusting injectable therapies, specifically insulin and GLP-1 RA.

References:

American Diabetes Association Professional Practice Committee; 9. Pharmacologic Approaches to Glycemic Treatment: Standards of Medical Care in Diabetes—2022. Diabetes Care 1 January 2022; 45 (Supplement_1): S125–S143. https://doi.org/10.2337/dc22-S009
Clinical Resource, Drugs for Type 2 Diabetes. Pharmacist’s Letter/Prescriber’s Letter. December 2020.
Clinical Resource, Comparison of Insulins. Pharmacist’s Letter/Prescriber’s Letter. September 2021. [370901]

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