SARAH: And welcome back to the Qi Hub video series. Today we are joined by Dr. Sarah Atkins. Thank you so much for being here.

DR. ADKINS: Thank you. It is so nice to be here today.

SARAH: Oh, fantastic. So, Dr. Atkins is a pharmacist and has been around pharmacy for over 30 years ,which means she's old. And today we are gonna talk about medications for type two diabetes. So not just um, all the medications,  but you know, some medications for type two.

DR. ADKINS: Just call me Sarah. And we are not just talking about type two medications in the normal sense. We're gonna talk about some nuances that you may not know. 

SARAH: Oh, nuances. Alright, fantastic. So, uh, Sarah also wanted us to tell you that um, she's focused today on section nine of the ADA standards of care, which is the section on pharmacologic approach. And we're focused mainly on just the uh, type two section. So, and I understand that we are also starting with SGLT twos. So tell me more about SGLT twos. 

DR. ADKINS: SGLT twos. Let's start with SGLT twos. That's a great place to begin. Okay. So, um, as Sarah said, we are starting with the section nine of the ADA, if you want to look at those. Let's, when we talk about SGLT twos, I think it is important to talk about the entire class of medications. There are actually five drugs in this class of medications and the use of these is clinically dependent on the disease states that the patient currently has. So when we look at approval of these medications, the, the one we see the most is a generic name called empagliflozin, which is branded as Jardiance. That particular drug is approved for cardiovascular type two diabetes and kidney protection. So that medication has gone through several, uh, FDA approvals to get to that point. There are other drugs in this class that I think should also be discussed because they might be a less expensive option. Um, for patients who may not be able to pay. So as far as the other medications go, we have a drug called dapagliflozin. Which has a brand name of Farxiga. We have canagliflozin, which has a brand name of Invokana. We have ertugliflozin, which has a brand name of Steglatro. Okay. And you have a drug called bexagliflozin. What's interesting about that last one is it is only approved for type two diabetes. Um, but it may be a less expensive option for that type two diabetes.

SARAH: Interesting. 

DR. ADKINS: So I encourage you looking these and knowing what their approvals are for and we are going to give you a quick handout just so you can look at it, just to look what those approvals are for, to help pick clinically which drug might be most appropriate.

SARAH: Okay. That is awesome. Okay, that's super cool. Like clinical information for us. So I understand also Sarah, that um, these medications could be quite expensive, these SGLT twos. 

DR. ADKINS: That is a fantastic question. So we are going to talk about cost. This is a prohibitive, prohibitive piece of um, not using SGLT twos, which is really sad 'cause it's a really amazing class of medications. So when I think about cost of these drugs, cost reflects, we talked about what they were approved for, right? So type two diabetes, cardiovascular improvements, and kidney protection because it has all three of those approvals through the FDA that actually makes the drug more costly. So, or empagliflozin, which is the brand name of Jardiance, is the more expensive of the medications in the class because it was approved for those. I think what's important also is understanding the formulary that is used for the patient's insurance. And if they have Medicaid, really, um, the world is your oyster at that point. So you can pick Jardiance and it will be covered on the plan which is an excellent medication. It's a great choice, but if there's cost prohibitive problems, check out the formulary for that patient's information. And also when you check out the formulary, look at what the drugs were approved for, see if maybe you can get a generic product. Actually dapagliflozin is now available in a generic, which I think is a really fantastic, option. Um, so the generic for Farxiga. Um, the cost plus option is pretty cool and dapagliflozin is still kind of pricey on there. It's around $300, but cash price is $700. So the cost plus model might be fantastic. 

SARAH: Cost plus. Well, you tell me. I don't understand what the cost plus model is. So you tell me more about that cost plus model and tell me, so dapagliflozin is on there, that's fantastic. Um, cash price is interesting. So tell me more about that. 

DR. ADKINS: Yeah, the cost plus model, sorry about that. So cost plus is important and I, I want to mention it here. I don't know if it's been mentioned a lot, but the cost plus model option is available online. It is a model of pharmacy sales or drug sales that is not related to insurance. So it is a way for patients to actually pay cash for a medication. And so what we would recommend is, you can look it up online, is the cost plus drugs online and you can look at a cash price on there and see what it compares to a regular insurance cost. It's, it's a pretty cool option and I think one that we don't talk about enough, um, as an option for some patients, um, in lieu of their insurance coverage. 

SARAH: Oh, that's fantastic. Okay. Awesome. Awesome. Sarah, thank you so much for all this information on SGLT twos today. We really appreciated learning about them and their clinical information and cost information. And, um, thank you for being here and maybe we get to join you again someday. 

DR. ADKINS: Thank you so much for having me. I enjoyed this so much, um, such a challenge and it feels so nice to be on this side of the table. 

SARAH: Well, we appreciate that you feel that way and we all hope that you have a wonderful rest of your day. And join us again for another QI Hub video.