Dr Jennifer Green Weighs in on CMS Drug Prices, the Future of Combination Therapies

Jennifer Green, MD, an endocrinologist and clinical trialist at Duke University, explained that the CMS-negotiated drug prices under the Inflation Reduction Act (IRA) may not immediately reduce patients' out-of-pocket costs; however, they could eventually lead to better access to expensive medications.

She also emphasized the need for efficient prescribing of treatments for patients with diabetes that address multiple conditions. Looking ahead to 2025, Green is particularly interested in the potential for combination therapies in managing cardio-renal-metabolic diseases.

This transcript has been lightly edited for clarity.

Transcript

CMS recently announced the negotiated drug prices for the first 10 drugs under the IRA. What is your reaction to the announced prices?

I think it's wonderful, but I think it is important to understand that it may not, at this time, change the amounts that our patients need to pay out of pocket for medications.

However, if there is the ability at a higher level to negotiate drug prices, what that may mean is greater availability of newer and more expensive drugs to patients, ultimately. So, I'm very happy to see that, and I hope it continues.

How can we ensure we’re doing a better job of addressing the modifiable factors that can reduce the risk of complications in patients with diabetes?

I think that there are both challenges and opportunities there. We're learning more about interventions that improve outcomes in one of those respects. For example, cardiovascular outcomes are also likely to benefit kidney outcomes and maybe even diabetes management. So, we need to think about efficiency of prescribing so that what we are choosing to treat people with can treat multiple conditions.

We do need each system to figure out how we can best implement those interventions because, right now, for the most part, it's a little bit scatter shot. So, I think more focus on the implementation of guideline-based therapy is going to be very, very important.

What changes in the cardio-renal-metabolic landscape are you keeping an eye on for 2025?

I am very interested in understanding how the guidelines will incorporate newer information about the effects of GLP-1 receptor agonist therapy in patients with type 2 diabetes and chronic kidney disease.

I am very interested to see what the emphasis will be on combination therapy moving forward. For example, will there be recommendations to give both an incretin-based therapy and an SGLT2 [ sodium-glucose cotransporter 2] inhibitor in certain groups of people?

I think a real gray area is the best approach to risk reduction in people who don't have established comorbidities but are at high risk for the same; I think that's an area where there's not a lot of information that we still should be addressing.