Table. Coverage and Out-of-Pocket Costs for Diabetes Drugs Under Medicare Part D in 2019.
| Drug classa | Plan coverage, % | Total cost, $ (SD) | Out-of-pocket cost, $ | ||
|---|---|---|---|---|---|
| 30 db | Annual | 30 d (SD) | Projected annual | ||
| Metformin | 100 | 5 (3) | 63 (35) | 2 (2) | 63c |
| Traditional second-line drugs | |||||
| Sulfonylureas | |||||
| Glipizide | 100 | 3 (1) | 31 (17) | 2 (2) | 31 |
| Glimepiride | 100 | 7 (3) | 80 (38) | 2 (2) | 80 |
| Glyburide | 29 | 8 (4) | 101 (52) | 6 (7) | 101 |
| TZDsa | |||||
| Pioglitazone | 100 | 11 (9) | 136 (113) | 4 (4) | 136 |
| Novel second-line drugs | |||||
| SGLT2is | |||||
| Empagliflozin | 99 | 497 (41) | 5967 (486) | 51 (24) | 1298 |
| Dapagliflozin | 69 | 498 (47) | 5971 (565) | 87 (71) | 1615 |
| Canagliflozin | 51 | 510 (18) | 6118 (214) | 86 (75) | 1565 |
| GLP-1RAs | |||||
| Exenatide weekly | 95 | 723 (54) | 8681 (646) | 103 (108) | 2102 |
| Exenatide | 77 | 735 (47) | 8822 (562) | 214 (127) | 2520 |
| Dulaglutide | 90 | 742 (49) | 8903 (582) | 96 (97) | 2108 |
| Semaglutide | 73 | 808 (39) | 9690 (467) | 68 (53) | 2071 |
| Liraglutide | 89 | 935 (52) | 11 225 (627) | 68 (60) | 2230 |
| DPP-4is | |||||
| Saxagliptin | 39 | 434 (14) | 5202 (165) | 112 (61) | 1639 |
| Linagliptin | 90 | 441 (38) | 5288 (452) | 58 (40) | 1250 |
| Sitagliptin | 94 | 455 (38) | 5461 (454) | 50 (21) | 1236 |
| Drug regimens of metformin, ACEi, and statin, plus | |||||
| Traditional second-line drugs | |||||
| Sulfonylureas | 100 | 21 | 250 | 7 | 250c |
| TZDs | 100 | 30 | 355 | 9 | 355c |
| Novel second-line drugs | |||||
| SGLT2is | 100 | 514 | 6164 | 56 | 1381 |
| GLP-1RAs | 100 | 735 | 8820 | 65 | 1981 |
| DPP-4is | 100 | 455 | 5454 | 53 | 1231 |
Abbreviations: ACEi, angiotensin-converting enzyme inhibitor; DPP-4is, dipeptidyl peptidase-4 inhibitors; GLP-1RAs, glucagon-like peptide-1 receptor agonists; SGLT2is, sodium-glucose cotransporter-2 inhibitors; TZDs, thiazolidinediones.
a
Extended release formulations and drugs covered by less than 20% of plans are not presented: rosiglitazone (19% of plans), alogliptin (14%), ertugliflozin (7%), and lixisenatide (1%).
b
30-Day costs are reported during the initial coverage phase.
c
For patients taking metformin, sulfonylureas, or TZDs, alone or in combination with lisinopril and atorvastatin, projected annual costs were low enough to fall entirely within the $415 deductible phase, in which patients pay 100% of drug costs.