Monday , October 23 2017
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Prescription Coverage: Sodium Glucose Cotransporter 2-Inhibitors

Recently, I was chatting electronically with Irl B. Hirsch, MD, Diabetes Treatment and Teaching Chair at the University of Washington School of Medicine. I asked him if he had been using Invokana with his patients, and he sent me back this message: “No, not yet, and not likely to anytime soon due to lack of (prescription) coverage in this part of the country. Will be interesting to see if the experience of others matches the clinical trials.”

See more SGLT-2 Resources

This got me thinking that even though we have a lot of prescribers ready to use the Sodium Glucose Cotransporter 2 (SGLT2)-inhibitors, there is probably an insurance coverage barrier to many of them making that choice. With this in mind, I headed into the pharmacy to see what I could find out.

The cash price for 1 month of Invokana is $315.72. And then I started running claims for different prescription plans to see what the actual coverage was:

  • RXE United and other discount cards are approximately $268.
  • PSN Commercial calls it non-formulary and charges a $100 co-pay.
  • AARP-United Health will allow the first fill with a $95 co-pay then a prior authorization is needed.
  • Paid/Medco calls it non-formulary and charges an $85 co-pay.
  • Humana Part D requires prior authorization before the first fill and no partial fill is available until the prior authorization is approved.
  • WIN, or WHP Health Initiative (can include WellCare) requires prior authorization before the first fill and no partial fill is available until the prior authorization is approved.
  • Catalyst Commercial calls it non-formulary and charges a $131.00 co-pay.
  • Blue Cross Medicare calls it non-formulary and will not pay at all for it. They advise the Pharmacist to call the physician to change drugs.
  • NMH Optimum Health Care Part D calls it non-formulary and will not pay at all for it.
  • Express Scripts for Tri Care or the Department of Defense has it for a $17 co-pay with no prior authorization required.

In addition, many of our patients are now being seen by Accountable Care Organization (ACO) practices and each of these have their own formularies and for the most part are not currently covering this class of drugs.

NOTE: What many prescribers may not know is that Janssen offers co-pay assistance to make Invokana affordable for patientsHere’s the link to find out more: http://www.invokanahcp.com/patient-assistance/carepath-medication-cost-support

David Joffe, BSPharm, CDE, Editor-in-chief, Diabetes In Control