Medicare Reduces Diabetes Test Supplies Reimbursement
CMS plan to reduce reimbursement for diabetes test strips by 72% by July 1st, 2013. The reimbursement to pharmacies for 100 test strips will be reduced to $22.47. Currently 100 name brand test strips cost pharmacies in the area of $54.00. It is expected that less pharmacies will opt
to bill Medicare B for these supplies due to less than cost reimbursement.
Helpful notes about diabetes med changes from Marty Irons, VT Pharmacist and CDE.
GLP-Receptors
Eli Lilly expects to submit its GLP-1 receptor agonist, dulaglutide, to the FDA later this year. This agent
is a once weekly injectible agent.
TZD
The FDA has announced that it will review the cardiac safety of the rosiglitazone (Avandia). The June two day review will look at the
study that caused the FDA to put restrictions on Avandia. Approximately on 3,300 patients still use rosiglitazone. It is not available in community pharmaciesin the US.
DuetAct (pioglitazone + glimepiride) is now available generically.
SGLT-2 Inhibitors
Canagliflozin (Invokana) is the first Sodium Glucose Transporter 2 Inhibitor approved in the USA. It is marketed as both 100mg and 300mg tablets. Canagliflozin is the first of several SGLT2 inhibitors under development. "These drugs reduce the reabsorption of glucose through inhibition of renal sodium glucose co-transporter (SGLT). SGLT type 2 is responsible for mediating about 90% of renal glucose absorption in the S1 segment of the proximal convluted tubule”. They do not cause hypoglycemia if used alone and do not require functioning beta cells to work.
DPP-IV
The FDA approved alogliptin (Nesina) on January 25th. It will join several other agents already on the market. Does are 6.25mg, 12.5mg and
25mg. A fixed dose combo with metformin will be marketed as Kazano while a fixed dose combination with pioglitazone (Actos) will be marketed as Oseni.
GLP-1 Agents; Study shows higher rates of pancreatitis
A retrospective study showed that patients using sitagliptin or exenatide were at double the risk for developing pancreatitis according to an article published in JAMA. However both the ADA and AACE criticized the study stating the risk of pancreatitis was low overall, the benefits outweighed the risks, and that more “robust” studies need to be conducted before treatment protocols are changed.
Insulin; FDA Application Denied
The FDA denied the approval of Novo’s new long acting insulin, degludec/ Tresiba. The agency is requesting more cardiovascular data from studies before the drug is approved. It will be at least 2014 before it is resubmitted for approval. Novo is also developing a degludec + insulin aspart Novolog. This agent would be marketed as Ryzodeg.