The Next Logical Question

The Next Logical Question

Way back in the day, way before the days of way cool whiz bang glucose monitors, before they communicated with the cloud and came in pretty colors Diabetic Investor conducted a non-scientific experiment. We visited 5 local pharmacies told the pharmacist that we were a newly diagnosed patient looking for meter. After the pharmacist provided a recommendation we noted that a friend was using a different meter and asked was it any different from what my friend was using. Almost universally each pharmacist stated that it really didn’t matter which meter was used, that they all did basically the same thing the same way.

Each pharmacist then asked who provided my health insurance so they could then determine which system carried the least out of pocket cost. This was our first inkling that meters were becoming a commodity and that price mattered more than performance.

While the major drug companies here at the conference would beg to differ, we have reached that same point with diabetes drugs. Like it or not the diabetes drug market has also become a commodity market where price trumps performance. That we now live in a world where most of these drugs do the same thing the same way with the differences in performance being miniscule.

Here in steamy NOLA we have been conducting another non-scientific experiment asking each physician we meet to describe the factors that influence their prescribing patterns. Like the pharmacists of years ago, what the patient’s insurance pays for is THE main factor. Which drugs come with the lowest co-pay and least amount of hassle, i.e. no additional forms to file out, no letters to write, etc.

We asked specifically if data made a difference and just like the pharmacist these physicians noted that only in rare occasions as most drugs in the same class do the same thing the same way.

In a somewhat ominous sign for Lilly (NYSE: LLY) and good news for Johnson and Johnson (NYSE: JNJ) and AstraZeneca (NYSE: AZN), we asked specifically about the EMPA-REG data. Universally the physicians were aware of the data and we’re truly impressed. However, every one believed this was a class effect that all SGLT2’s will show cardiovascular benefits. Therefore, as impressive as this data is it won’t likely impact prescribing patterns as much as formulary position.

One conversation was particularly interesting as some Lilly employees happen to join one of these discussions and acknowledged that they also believe this to be a class effect. This is one of the benefits of having some of these discussions over drinks and not wearing a badge that identifies you as a member of the press. Note we did introduce our self as the publisher of Diabetic Investor but never did the Lilly folk state their comments were off the record. As we have said many times best information at these conferences comes off the show floor.

Yet here is some good news for Lilly and some bad news for our wine drinking friends in France. When asked about whether or not they would have any issues prescribing Basaglar, the company’s  biosimilar version of Lantus, not one noted any issues. Again the general belief was that’s its just as good as Lantus, they like the fact its made by Lilly and off course if it’s cheaper for the patient that would help. Asked if they would switch a patient currently on Lantus and doing well to Basaglar the answers were again the same, while they would not prefer to do this they would if the patients coverage dictated such a change.

As we stated before we arrived here in NOLA there would likely be some vigorous debate over some study or series of studies. That the researchers here and the physicians in attendance would debate the finer points, the small differences between drugs. Yet in the real world this avalanche of data plays a minor role and it’s payors who hold the keys to the prescribing kingdom. This isn’t what any drug company wants to here but it just happens to be a pesky fact.