How Drug Cost Influences Drug Selection

Zachary T. Bloomgarden, MD, MACE: Very few of my patients are sufficiently wealthy and have sufficiently wonderful managed care pharmacy benefit plans [such] that they can take any drug under the sun and I don’t have to worry about it.

For most individuals with diabetes, we have to realize that they’re taking 1 or 2 lipid-lowering drugs, 2 or 3 diabetes drugs, 2 or 3 blood pressure drugs, often a low-dose aspirin, [and] often a proton-pump inhibitor (although we’re learning that these have some undesirable effects). Often, because of the very high prevalence of anxiety and depression, they take psychoactive drugs. So, these are individuals [who] are not just treated with 1 drug, but they take multiple therapeutic agents.

So, cost is, of course, an issue. If you have a drug that costs $500 or $600 a month, and you expect an individual with diabetes to buy 5 or 6 of them, we’re probably going to be outside the range [within which] that individual can afford [treatment]. [Therefore], we always work very hard with managed care. We work very hard with the patient, but we have to realize that there simply are some cheap drugs that turn out to have a lot of side effects. My personal perspective is that sulfonylureas and NPH (neutral protamine Hagedorn) insulin are drugs that should not be used for treatment of type 2 diabetes.