Presentation (CTI)

OBJECTIVES: Semaglutide, a glucagon-like peptide-1 receptor agonist (GLP-1RA), is widely used in the management of type 2 diabetes mellitus (T2DM). Following loss of exclusivity (LoE) in T2DM in Canada, the introduction of lower-cost generic semaglutide may have substantial implications for healthcare expenditure and treatment uptake. We developed a budget impact (BI) model to evaluate the potential impact of semaglutide LoE on costs and treatment utilisation in T2DM from a Canadian payer perspective.
METHODS: The BI of subcutaneous injectable branded semaglutide LoE was assessed over five years in the GLP-1RA-treated T2DM population. This target population was assumed to increase linearly over time, reflecting expected continued uptake of GLP-1RA therapies. In a ‘world without generic semaglutide,’ patients were allocated between branded semaglutide and tirzepatide based on forecasted market shares. Tirzepatide market share was assumed to increase in line with uptake seen in the UK following payer reimbursement in T2DM, with corresponding reductions in branded semaglutide share. Patients received the standard recommended dose for both treatments. The BI of semaglutide LoE was assessed by assuming that people anticipated to receive branded semaglutide would instead receive generic semaglutide at a 50% reduced price, with no change to market shares. A scenario was conducted where semaglutide LoE was also assumed to result in a reduction in tirzepatide market share based on sodium-glucose cotransporter 2 inhibitor treatments market share data following LoE in T2DM in the UK.
RESULTS: In the base case analysis, the five-year cumulative BI to the Canadian payer was a $7.4 billion saving. In the scenario this increased to a $9.5 billion saving.
CONCLUSIONS: Semaglutide LoE is projected to significantly reduce healthcare expenditure in T2DM in Canada, demonstrating how availability of generic alternatives can translate into meaningful cost savings at the healthcare system level. Further savings may arise from greater generic uptake over other newer branded therapies.