November 12, 2016

Use Lantus – Be Ready to Change in 2017

Sometimes I’m amazed at how oblivious some people in this world can be. Actually, I should say it really doesn’t amaze me given this is the world of diabetes, which is full of clueless opinions. I mention this after some conversations on the nature of the insulin market. Yes, people are beginning to wake up to the fact (yes, those damn pesky facts again), that insulins have become a commodity. This is particularly true with long-acting insulins, of which there are now 5, one being a biosimilar.

Lilly has the biosimilar, Basaglar,which is winning the war that counts: formulary position. Lantus, the current leader, isn’t just losing the war, it’s losing by a mile. Starting next year, when formulary changes go into full effect, Basaglar will become the long-acting insulin of choice. Not because it’s any better than Lantus — it isn’t. It’s the same as Lantus, only cheaper — which is exactly the point.

Still, many seem to believe there will be pushback from physicians. Why would they switch any patient from Lantus to Basaglar, especially when Lantus works so well? First, as much as I hate to state the obvious, it really won’t be left up to the physician. It will be the payor and formulary position that wins, not the opinion of the physician. Think about the discussion a physician would have with a Lantus-using patient after these formulary changes take place.

“Mr./Ms. Patient, you know I would like to keep you on Lantus. It’s been a great drug that has worked very well for you. Now I could keep you on Lantus, but there is a slight problem: your insurance company no longer covers Lantus. You can stay on Lantus, but I must warn you that it’s going to cost you where it hurts most: in your wallet. Your alternative is to go on this new insulin called Basaglar, which is basically the same as Lantus and is covered by your insurance.

Now I know what you’re thinking: should you trust this new insulin, is it really the same as Lantus? Let me assure you that you have nothing to worry about, for two reasons. First, according to all the studies I have read, Basaglar works just as well as Lantus. Second, Basaglar is not made by some no-name company you have never heard of; it’s made by Eli Lilly, a company with a long and distinguished history in diabetes.

Now I want to say that I am not happy about the changes made by your insurance company, although I am not surprised by their decision. So, the choice, as always, is up to you. You can stay on Lantus and pay more — likely a lot more. Or you can switch to Basaglar and pay what you were paying before. You tell me.

This type of discussion is about to happen in physician offices in 2017; likely sooner, as we’re pretty sure insurance companies have been informing patients about the upcoming changes in formulary. Changes which they will support so that the patient feels comfortable switching from a drug that works very well to one they have never heard of. In the end, patients will accept these changes, as at the end of the day this isn’t about whether Basaglar is as good as Lantus: this is about money. While there may be some who will pay a premium for Lantus, the majority will not.

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