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Will SGLT-2 combos with DPP-4 win insurance coverage?
  • By So Jae-hyeon
  • Published 2018.04.04 15:12
  • Updated 2018.04.04 15:12
  • comments 0

Suppliers of antidiabetic medicines are paying attention to whether SGLT-2 (sodium-glucose cotransporter-2) inhibitors such as Forxiga and Jardiance will win a full insurance coverage when they are used for combination therapies with DPP-4 (dipeptidyl peptidase-4) inhibitors.

The Health Insurance Review and Assessment Service (HIRA) reportedly requested the Korean Diabetes Association to make a financial impact assessment report, regarding possible changes in reimbursement of antidiabetic drugs.

Locally available SGLT-2 (sodium-glucose cotransporter-2) inhibitors include (from left) Forxiga, Jardiance, and Suglat.

The health authorities seek opinions from experts through a financial impact assessment to know how much health insurance cost will occur with changes in reimbursement conditions.

The pharmaceutical community is anticipating for an expansion of insurance coverage for combos of SGLT-2 inhibitors and DPP-4 inhibitors.

In Korea, diabetes treatments are variously combined out of metformin, sulfonylurea, thiazolidine (TZD), GLP-1(glucagon-like peptide-1) analogs, and SGLT-2 inhibitors.

DPP-4 inhibitors account for the largest share in the antidiabetic drug market. According to U-BIST data, DPP-4 inhibitors sold 468.5 billion won ($440.3 million) in 2017, and the sales are growing every year.

DPP-4 inhibitors have become popular as they were effective not only for lowering blood glucose but reducing hypoglycemia risk and weight gain risk.

Popular DPP-4 inhibitors include MSD’s Januvia, Boehringer Ingelheim’s Trajenta, Novartis’ Galvusmet, AstraZeneca’s Onglyza, LG Chem’s Zemiglo, Takeda’s Nesina, Handok’s Tenelia, JW Pharmaceutical’s Guardlet, and Dong-A ST’s Suganon.

SGLT-2 inhibitors also drew as much anticipation as DPP-4 inhibitors because they reduce cardiovascular risks as well as blood sugar and weight.

Locally available SGLT-2 inhibitors include AstraZeneca’s Forxiga, Boehringer Ingelheim and Eli Lilly’s Jardiance, and Astella’s Suglat. Each of them has a different reimbursement condition. Forxiga has insurance benefit only when it is used with metformin, or sulfonylurea, or Januvia, a combo of metformin, sulfonylurea and a DPP-4 inhibitor.

In contrast, Suglat can be reimbursed as a single therapy or when combined with metformin or with TZD-type antidiabetics. Jardiance enjoys insurance benefit in a single use, or as a combo with metformin, a combo with insulin, or a combo of three agents including metformin and sulfonylurea, or a combo of three including metformin and insulin.

While DPP-4 inhibitors enjoy the same criteria for reimbursement, SGLT-2 inhibitors have different criteria. The medical community is complaining that physicians cannot prescribe SGLT-2 inhibitors easily due to different reimbursement criteria.

“It is very confusing for me because different SGLT-2 inhibitors have different standards for reimbursement. We can’t verify all of the combination therapies’ effectiveness through clinical trials,” said a professor of endocrinology and internal medicine at a university hospital.

Under such circumstance, the HIRA recently began to do a financial impact assessment on a possible change in reimbursement conditions for SGLT-2 inhibitors. The move prompted drugmakers to anticipate for an expansion of reimbursement on SGLT-2 inhibitors.

“Many physicians are hoping that reimbursement on the combination of SGLT-2 inhibitors and DPP-4 inhibitors could be broadened. If the combos can benefit a full reimbursement, SGLT-2 inhibitors could become the major player in the antidiabetic drug market,” said a pharmaceutical source. “As the authorities would need to review drug pricing and the scope of combinations in each medicine, it would take some time actually to expand the insurance coverage for the combos.”


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