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Considering Medication Costs

Dec 23, 2017

A 47-year-old patient returns for a follow-up visit. He currently takes metformin 2000 mg daily, but is not achieving his glycemic target of A1C <7 %. His current A1C is 8.0%. You would like to add a second medication to his regimen, however, he voices concern that he is no longer covered by any health insurance and is worried about how to pay for his medications. Taking his concern into consideration, what drug would you add to metformin?


Answer: C. Sulfonylurea

Educational Critique: A 2-drug combination is the appropriate next management step for this patient. When the cost of medications is the major concern, metformin + sulfonylurea is the lowest cost combination. Relative costs of antihyperglycemic medications are as follows. Low Cost: metformin, sulfonylureas. Moderate Cost: a-glucosidase inhibitors. High Cost: meglitinides, thiazolidinediones, SGLT2 Inhibitors, DPP-4 inhibitors, bile acid sequestrants, dopamine-2 agonists, GLP-1 agonist, amylin mimetics,. Variable: insulin. The best response would be to choose the best treatment individualized for that patient and contact the drug company to see what program might be available for your patient to lower their cost. -- Arc Med Science