New research presented at AMCP Nexus 2023 demonstrated a method to detect and prevent duplicate therapy with a glucagon-like peptide-1 agonist (GLP-1) and dipeptidyl peptidase-4 inhibitor (DPP-4). The researchers said the approach can help correct inadvertent duplicate therapy, which can help control costs.
GLP-1 and DPP-4 medications are common therapies for diabetes and weight loss. However, they have overlapping mechanisms of action, both exerting antidiabetic effects via the incretin pathway. TheAmerican Association of Clinical Endocrinology has advised clinicians that combination of incretin-based therapies is not recommended, according to the lead author, Nicholas J. Friedlander, PharmD, a clinical programs pharmacist with Prime Therapeutics, a pharmacy benefit management company based in Eagan, Minn.
“Diabetes management commonly involves use of multiple drugs, which when mechanistically similar may result in duplicate therapy and increased costs,” he said. “Combination therapy is less than the sum of parts.”
His project sought to develop and integrate a tool that would detect this type of duplicate therapy and alert pharmacists filling the prescriptions. They reviewed six months of pharmacy claims to identify members utilizing both GLP-1 and DPP-4 medications. In a database of 16 million commercially insured members, the researchers identified 7,471 unique patients who received duplicate therapy from July 2022 through April 2023.
Of those patients, the researchers used 6,773 cases for the research project. They loaded case-specific information into a pharmacist-facing web application. Pharmacists could then confirm duplicate therapy and contact other health care professionals (e.g., prescribers, other pharmacists) to discuss whether duplicate therapy was appropriate.
At the time the researchers submitted their data, pharmacists had successfully intervened on 196 cases, discontinuing one of the two therapies. That led to an annualized program savings of $1,142,462. An additional 283 cases were still actively in progress, with a potential annual savings of $1,375,619. Another 180 cases were deemed unsuccessful, usually because of provider nonresponse. Dr. Friedlander said his group hopes this novel approach can be used more broadly to help facilitate pharmacist-to-provider or pharmacist-to-pharmacist outreach about duplicate therapy in order to optimize therapy and reduce costs.
Friedlander NJ, Gleason PP, Champaloux SW. Identification and Management of Duplicate Therapy Involving Incretin-Targeting Therapies for Diabetes and Weight Loss. Poster E26. Presented at AMCP Nexus 2023; Oct. 16‒19, 2023; Orlando, Fla.