Those damn pesky facts

Sometimes it amazes us how stupid some people in this wacky world can be. Actually we should say it really doesn’t amaze us given this is the wacky world of diabetes which is full of clueless opinions. We mention this after some conversations on nature of the insulin market. Yes, people are beginning to wake up to the fact, yes those damn pesky facts again, that insulin’s have become a commodity. This is particularly true with long-acting insulin’s of which there are now 5, one being a biosimilar.

Lilly (NYSE: LLY) has the biosimilar, Basaglar, which is winning the war which counts; formulary position. Lantus, the current leader isn’t just losing the war, it’s losing by mile. Starting next year when formulary changes go into full effect Basaglar will become the long acting insulin of choice. Not because it’s any better than Lantus, it isn’t. It’s the same as Lantus only cheaper which is exactly the point.

Still many seem to believe there will be push back from physicians. That why would they switch any patient from Lantus to Basaglar especially when Lantus works so well.  First as much as we hate to state the obvious it really won’t be left up to the physician. As we keep saying it will be the payor and formulary position that wins not the opinion of the physician. Think about the discussion a physician would have with a Lantus using patient after these formulary changes take place.

“Mr. Patient you know I would like to keep you on Lantus. It’s been a great drug that has worked very well for you. Now I could keep you on Lantus but there is a slight problem your insurance company no longer covers Lantus. You can stay on Lantus but I must warn you that it’s going to cost you where it hurts most in your wallet. Your alternative is to go on this new insulin called Basaglar which is basically the same as Lantus and is covered by your insurance.

Now I know what your thinking should you trust this new insulin, is it really the same as Lantus. Let me assure you that you have nothing to worry about for two reasons. First, according to all the studies I have read Basaglar works just as well as Lantus. Second, Basaglar is not made by some no name company you have never heard of, it’s made by Eli Lilly a company with a long and distinguished history in diabetes.

Now I want say that I am not happy about the changes made by your insurance company, although I am not surprised by their decision. So the choice as always is up to you. You can stay on Lantus and pay more, likely a lot more. Or you can switch to Basaglar and pay what you were paying before. You tell me.”

This type of discussion is about to happen in physician offices in 2017, likely sooner as we’re pretty sure insurance companies have been informing patients about the upcoming changes in formulary. Changes which they will support so that patient feels comfortable switching from a drug that works very well to one they have never heard of. In the end patients will accept these changes as at the end of the day this isn’t about whether Basaglar is good as Lantus, this is about money. While there may be some who will pay a premium for Lantus the majority will not.

As Momma Kliff was fond of saying; “When it comes to health related decisions which are not life threatening, the decision is usually made not based on what is better but what is cheaper.”