Payer's Perceptions of Glucagon Kits Aimed at Reducing Administration Complexity During Severe Hypoglycemic Events.

Abstract

Severe hypoglycemic events (SHE) contribute to health care utilization for insulin-dependent diabetics, and may drive expenditures by health care payers. Rescue treatment for SHE includes glucagon kits, which are administered by caregivers and difficult to use. Consequently, there are high rates of unsuccessful administration, leading to increased health care service use. A new kit under development aims to ease the burden of administration by reducing the complexity. The new device aims to increase successful use and lower rates of health care service utilization. This study aimed to understand payers’ receptivity to this value proposition. Seven medical directors from US payers were interviewed, representing commercial, Medicare, Medicaid and other covered lives. The interview was designed to understand plans’ focus on diabetes and hypoglycemia, coverage/reimbursement of current kits, and impressions of characteristics of the new kit. The prevention of SHE is not a concern for insurers; the risk of SHE is largely a type 1 problem, representing a small subset of their overall diabetic population. While payers are confident in current kits’ effectiveness, they are not focused on managing access to such a low-volume treatment. Current kits are covered by insurers without restrictions, and contracting is not prevalent due to low volume. Payers believe the new kit will be an improvement over current kits, but do not believe it will reduce the cost of SHE. Payers feel that the new kit will be an improvement over currently available kits, but are skeptical that the ease of use will translate into lower health care service use. Additionally, SHE is not a major cost driver among their diabetic population; therefore, SHE is not a high-priority condition. Consequently, for optimal market access and reimbursement, the new kit must demonstrate significant reductions in high-cost health care utilization (e. g., ED, hospitalizations) to justify a premium price without coverage restrictions.