Glucagon Prescriptions Still Fall Short of Meeting Demand

TOPLINE:

Glucagon prescriptions for severe hypoglycemia in Medicaid initially decreased from 2012 to 2018 but increased between 2019 and 2023 following the introduction of newer products. 

METHODOLOGY:

• Although professional guidelines recommend all patients with diabetes at risk for hypoglycemia, especially those taking insulin or sulfonylureas, have access to glucagon, fill rates remain low.
• Researchers evaluated prescribing and reimbursement trends for glucagon products within Medicaid from 2012 to 2023, focusing on the periods before (2012-2018) and after (2019-2023) the introduction of newer products (eg, intranasal and autoinjector formulations).
• A list of national drug codes (NDCs) for all approved glucagon products was obtained using the Drugs@FDA directory; NDCs for glucagon products not specifically designated for the treatment of severe hypoglycemia were omitted.
• Products were categorized into five groups based on formulation and administration route: Glucagon nasal spray, glucagon unmixed syringe, glucagon prefilled syringe, dasiglucagon autoinjector, and glucagon autoinjector.
• Analysis included data from state Medicaid departments and other parties paying part of Medicare costs, such as other federal coverages, co-pays, and private insurances.

TAKEAWAY:

• Glucagon prescriptions decreased by 28% from 78,505 in 2012 to 56,722 in 2018; however, they increased by 61% from 56,838 in 2019 to 91,732 in 2023 following the introduction of newer glucagon products.
• Between 2019 and 2023, prescriptions for nasal spray formulations increased from 4% to 48%, those for glucagon autoinjectors increased by 18%, and those for unmixed syringes dipped from 96% to 31%; prefilled syringes and dasiglucagon autoinjectors constituted
• The annual total reimbursement increased by 33% from $21,233,811 in 2012 to $28,319,930 in 2018, and further increased by 50% from $28,370,595 in 2019 to $42,650,195 in 2023.

IN PRACTICE:

“Less than 100,000 glucagon prescriptions were dispensed in 2023. The appropriate number of glucagon prescriptions is unknown, but the observed number is likely a fraction of the potential need based on the high-risk population,” the authors wrote.

SOURCE:

The study was led by Noah M. Feder, Center for Pharmaceutical Policy and Prescribing, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania. It was published online in JAMA.

LIMITATIONS:

Findings were limited to Medicaid beneficiaries alone, limiting their generalizability. The Medicaid State Drug Utilization Data lacked diagnosis codes that would have helped determine the clinical appropriateness of each glucagon prescription.

DISCLOSURES:

One author was supported by a grant from the National Institute of Diabetes and Digestive and Kidney Diseases. He reported receiving grants to his university from the Helmsley Charitable Trust and nonfinancial support from few pharmaceutical companies.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.