Objectives:

This study aims to highlight the substantial economic burden of Antidiabetics on Medicare Part D.

Methods:

We analyzed the de-identified data from Medicare Drug Spending Dashboard and utilization dataset from 2015 to 2019. We identified 10 classes of common antidiabetic medications and described the Medicare Part D total spending, utilization, and relative annual changes on those medications. Furthermore, we described the spending by manufacturers and compared the spending on generic and brand antidiabetics during this time frame.

Results:

Medicare Part D total spending on antidiabetics was $124 billion with 56% growth from 2015 to 2019. Approximately, 95% of this spending was on single-agent medications. While insulin remained the largest source of total spending on antidiabetics every year, non-insulin antidiabetics, such as Dipeptidyl peptidase 4 inhibitors (DPP4i), glucagon-like peptide-1 (GLP-1) receptor agonists, and sodium glucose co-transporter inhibitors (SGLT2i) respectively accounted for 12%, 17% and 6% of spending. Medicare Part D antidiabetics utilization increased from 83.2 million prescriptions in 2015 to 90.9 million prescriptions in 2019. While utilization of older agents such as metformin and sulfonylureas remained relatively constant over the study period, numbers of prescriptions for newer combination agents such as SGLT2i- DPP4i (1147% growth) and SGLT2i-metformin (457%) increased significantly over the same time frame. Most of Medicare Part D total spending on antidiabetics was on brand medications (96%) and the top 4 highest spending was on antidiabetics manufactured by Novo Nordisk, Sanofi-Aventis, Eli Lilly and Company, and Merck Sharp & Dohme Corp.

Conclusions:

Between 2015 and 2019, on average, $25 billion per year was spent by Medicare Part D on antidiabetics. Physicians’ adoption of newer brand antidiabetics, in part, plays a role in Medicare Part D spending. Physicians should work to ensure appropriate guideline-recommended treatment for patients with diabetes.