For Treatment of Type 2 Diabetes, Complete Lack of Coverage of GLP-1 Analogues by Government-Sponsored Programs in Brazil, and Limited Coverage in Mexico, Substantially Restricts Prescribing of These Agents in the Public Setting
Decision Resources, one of the world’s leading research and advisory firms for pharmaceutical and healthcare issues, finds that coverage of injectable type 2 diabetes therapies by public programs for pharmaceutical assistance in Brazil is limited to regular and NPH (neutral protamine Hagedorn) insulin and does not include any insulin analogues or Glucagon-like peptide 1 (GLP-1) analogues. In Mexico, although coverage of insulin analogues is moderate, most public programs do not provide coverage for GLP-1 analogues. As a result, GLP-1 analogue prescribing is uncommon in the public setting in both countries, particularly Brazil, where surveyed clinicians report that just 1 percent of publically-funded patients currently receive a GLP-1 analogue. Brazilian payers add that the current off–label use of GLP-1 analogues for weight loss is a barrier to public coverage of these agents.
Decision Resources’ new Emerging Markets Physician & Payer Forum report entitled also finds that interviewed payers cite patient difficulty in paying for GLP-1 analogues as the major reason limiting uptake of these drugs in Brazil and Mexico and the same applies for insulin analogues in Brazil.
According to interviewed Brazilian payers, insulin analogue manufacturers do not currently provide discounts through patient assistance programs, and although some GLP-1 analogue manufacturers offer discounts of up to 50 percent on their drugs through such programs, the substantial outstanding cost means treatment remains inaccessible to most public patients. In Mexico, as GLP-1 analogues are not available at hospitals subscribed to most public-sponsored programs, patients covered by these programs do not have access to GLP-1 analogues unless they pay out-of-pocket for them at a private pharmacy. Among the insulin analogues, although Sanofi’s Lantus and Eli Lilly’s Humalog are covered by all public-sponsored healthcare programs in Mexico and are available free of charge to type 2 diabetes patients, payers from IMSS (Mexico’s Institute of Social Security) indicate that the availability of these agents is usually restricted to secondary and tertiary care institutions.
“As the type 2 diabetes injectables market becomes increasingly crowded, marketers must showcase the key efficacy advantages and innovative qualities that their novel agents offer in order to overcome cost-related barriers to public coverage, and they must educate clinicians accordingly in order to optimize uptake,” said Decision Resources Analyst Andreia Ribeiro, Ph.D. “Interviewed payers identify clinical differentiation between agents as a major formulary-inclusion driver, but they seek assurance of a highly favorable cost-benefit ratio, and are somewhat skeptical regarding the degree of innovation of emerging agents. Furthermore, while most surveyed clinicians in Brazil and Mexico perceive a need for additional GLP-1 analogues, the volume of near-term emerging agents is such that this market is expected to triple in both countries by the end of 2015. Marketers must ensure that prescribers are fully aware of the distinct advantages their novel agent offers in order to allow prescribing to be targeted accordingly.”
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