Fact Checked

Why is Januvia So Expensive?

Out of 34.2 million Americans that are diagnosed with diabetes, approximately 31 million individuals have type 2 diabetes, while the remainder are diagnosed with type 1 diabetes. While Type 1 diabetes, sometimes called juvenile diabetes, is characterized by not producing enough or any insulin, people with type 2 diabetes experience insulin resistance that causes their bodies to ignore the side effects of the hormone. People with type 2 diabetes are often directed to make healthy lifestyle changes like eating a healthy diet and getting more exercise as the first course of treatment for their condition. However, for many patients, lifestyle changes alone are not enough to control their blood sugar levels, whether it is high or low blood sugar. In these cases, injectable insulin or oral diabetes medications like Januvia, Glucophage, or Glipizide may be prescribed. Januvia is a medication that is designed to help lower blood sugar in adults with type 2 diabetes when combined with diet and exercise. Although it is the most popular drug in its class, it’s also very pricey. Why is Januvia so expensive?

What is Januvia?

Januvia, sometimes referred to by its active ingredient, sitagliptin, is a medication that is designed to be used in conjunction with a healthy diet and exercise to help manage high blood sugar in people with type 2 diabetes. Januvia belongs to a class of drugs called dipeptidyl peptidase-4 (DPP-4) inhibitors, which work by blocking the action of an enzyme called DPP-4, which destroys a hormone in the body called incretin. Incretin influences the amount of insulin produced by the body, as it directs the body to produce more insulin if needed and also minimizes the amount of glucose that the liver produces when it is not needed. Januvia was first approved by the U.S. Food and Drug Administration (FDA) in 2006, which means that approximately six years remain on the original manufacturer’s patent for the brand name drugs medication. 

What is Januvia used to treat?

Januvia is used in conjunction with a healthy diet and exercise to treat type 2 diabetes. More than one out of every ten Americans has diabetes, and about 90 percent of people with diabetes are diagnosed with Type 2 diabetes, also known as Type 2 diabetes mellitus. Unlike type 1 diabetes, which is characterized by the inability to produce the correct amount of insulin, type 2 diabetes is defined by insulin resistance. No matter which type of diabetes a person has, diabetic patients struggle to process the sugar we consume into energy that can be used by the body. In patients without diabetes, the body begins to break down food into glucose shortly after eating. This glucose is then released into the bloodstream, which causes our blood sugar levels to rise. Sensing the rise in blood sugar levels, the body signals the pancreas to release a hormone called insulin, which directs the body to use the sugar in your blood for energy. People with diabetes are unable to use insulin properly, and people with type 2 diabetes do not produce enough insulin for their body’s needs. Without medications like Januvia, used in combination with a healthy diet and exercise, people with Type 2 diabetes have uncontrolled high blood sugar (also known as hyperglycemia), which can cause dangerous health effects. 

Serious conditions and complications associated with high blood glucose include:

  • Nerve damage in the feet and hands (neuropathy)

  • Damage to the blood vessels of the eyes (retinopathy)

  • Increased risk of kidney disease

  • Weight gain

  • Increased risk of heart problems like heart failure and heart attack

Januvia is taken once a day and should be used in conjunction with exercise, a healthy diet, and a healthy lifestyle. Januvia is not suitable for the treatment of type 1 diabetes and should not be taken by people with diabetic ketoacidosis.

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Why is Januvia so expensive?

Januvia is a costly drug that many people with type 2 diabetes cannot afford, but it remains the most popular gliptin medication for the treatment of type 2 diabetes. The high cost of Januvia - approximately 500 dollars for 30 pills at 100 mg strength - is due partially to the fact that the manufacturer, Merck, holds a patent on the medication that is not set to expire until 2026. No generic version of Januvia is currently available, and no generic will be allowed to enter the market without the manufacturer’s permission until 2026. The lack of generic availability, plus the popularity of the drug, combined with the prevalence of type 2 diabetes in the United States, means that there is a high demand for Januvia and the medication can command high prices. The price of Januvia rose 93 percent between 2010 and 2015.

Does insurance cover Januvia?

Unfortunately, most commercial health insurance plans do not cover Januvia at this time so there are no co-pay. This is due in large part to the lack of a generic option that is specific to Januvia, combined with the fact that there are other similar medications on the market in the same diabetes drug class that do have generic alternatives. Many insurance companies and discount cards cover alternative medications to Januvia in hopes that patients will request the generic form of another prescription medication. Insurance coverage of Januvia is likely to change once a generic version of the drug is available, but this is not expected to occur until 2026.

How can I save money on my Januvia prescription?

Although conventional wisdom suggests that choosing the generic drug is the best way to save on prescriptions, it’s not always an option, as in the case of Januvia. However, there are other ways to save on your medication. 

Combine medications

Many patients take Januvia in combination with metformin, a popular generic medication for the treatment of type 2 diabetes. If you take both medications, you can save some money by asking your doctor to transition your prescriptions to Janumet, which is a drug that combines the common side effects of both metformin and Januvia. Although Janumet is still quite costly, ringing in at about 250 dollars for a 30 pill supply, you will not have to pay for both medications, which helps to provide some savings. Additionally, Janumet is available for about half of the cost of Januvia at the moment.

Coupons and Rebates

Because Januvia is a relatively new medication that is still under patent, coupon programs are currently available through the manufacturer, Merck. Januvia’s current coupon program allows eligible patients with private commercial insurance to pay as little as five dollars for their prescriptions for up to twelve qualifying prescriptions, or one year’s worth of medication.   Coupon programs are excellent options for those who qualify, but they often have strict eligibility requirements based around the type of insurance a patient has, the reason they are using the medication, and other qualifying factors. Patients with public insurance, such as Medicare and Medicaid, do not qualify for the Januvia cost savings program. While savings are available on the manufacturer’s website, you might also have some luck talking to your healthcare provider about other discounts or coupon codes that may be available. Drug reps sometimes provide special coupons to doctors in combination with samples of the medication, so it’s possible that you can find an even better deal at your doctor’s office. The manufacturer’s coupons for Januvia can be printed directly from the drug website or can be sent to your mobile device in order to be shown at the pharmacy counter. 

Patient Assistance Programs

Patient assistance programs are programs designed by drug manufacturers that are intended to provide payment assistance and discounted or free medications for people who are unable to afford their medications. Eligible patients are typically low income, do not have any health insurance, or do not have health insurance that sufficiently covers the cost of their medications. Januvia has a patient assistance program that is offered by its manufacturer, Merck. Patient assistance programs often have specific eligibility criteria that include limits on the amount of income earned each year, the type of insurance held, and the underlying health condition being treated by the medication. Merck has residency, insurance, and income eligibility criteria for its Januvia patient assistance program, and an approved application allows patients to receive their medication for free for one year. In general, Medicare and Medicaid recipients are not eligible for these programs, nor are patients who have commercial insurance that offers prescription drug coverage; however, each patient assistance program has different criteria. Patient assistance programs may offer discounted or free medication for a set period of time, such as one year, while others are good for the duration of the prescription, for patients taking the medication on a long-term basis, or for new prescriptions only. Be sure to check the manufacturer’s website to determine if you qualify for patient assistance.

Sources:

https://www.cdc.gov/diabetes/basics/type2.html 

https://www.cdc.gov/diabetes/basics/diabetes.html 

https://www.diabetes.org/resources/statistics/statistics-about-diabetes 

https://www.diabetes.org.uk/guide-to-diabetes/managing-your-diabetes/treating-your-diabetes/tablets-and-medication/dpp-4-inhibitors-gliptins 

https://www.inquirer.com/philly/blogs/healthcare/Just-how-bad-are-drug-price-Increases.html 

https://www.merckhelps.com/

Published August 1st, 2020 by Bridget Reed
Fact Checked by Chris Riley

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