Emerging Markets Physician and Payer Forum

June 2013

The Market Landscape for Type 2 Diabetes in Latin America: Physician and Payer Insights on Access Levers and Barriers for Current and Emerging Noninsulin Antidiabetic Agents

Report Authors
Andreia Ribeiro, Ph.D.
  • Pages:167
  • Tables:67
  • Figures:140
  • Citations:2
  • Drugs:20
  • Interviews:10

Introduction:

The prevalence of T2D in Latin America (LATAM) is high, and set to increase. In the past six years, several new oral and injectable noninsulin drugs have launched in Brazil, Mexico and Argentina, including DPP-IV inhibitors and GLP-1 analogues.

- GLP-1 analogues combine superior glucose-lowering and weight-loss capabilities, and are particularly useful for the significant proportion of T2D patients who are obese. Two GLP-1 analogues, Eli Lilly’s Byetta and Novo Nordisk’s Victoza, are currently marketed in Brazil and Mexico. In Argentina, Bristol-Myers Squibb/AstraZeneca’s Bydureon is already available, and we expect this brand to launch in Brazil and Mexico later in 2013. Further GLP-1 analogues (such as Sanofi-Aventis’ Lyxumia [lixisenatide]) will likely enter the LATAM market by 2015.

- DPP-IV inhibitors are associated with very low risk of hypoglycemia and excellent tolerability making them suitable for widespread use for T2D. Numerous DPP-IV inhibitors are currently launched in the countries under study including Merck’s Januvia and Janumet, Novartis’ Galvus and Galvus Met, Bristol-Myers Squibb’s Onglyza and Kombiglyze XR, and Boehringer Ingelheim’s Tradjenta. Further DPP-IV inhibitor FDCs (such as Takeda’s Liovel [alogliptin/pioglitazone] and Merck’s JuviSync [sitagliptin/simvastatin]) are in late-stage development and will also enter the LATAM market by the end of 2015.

- SGLT-2 inhibitors are set to become available in Brazil, Mexico, and Argentina. Bristol-Myers Squibb/AstraZeneca’s Forxiga (dapagliflozin), Johnson & Johnson’s canagliflozin and Boehringer Ingelheim/Eli Lilly’s empagliflozin will soon compete in the increasingly crowded T2D markets in LATAM. Unique market access hurdles and levers in Brazil, Mexico and Argentina will determine the extent to which these brands achieve penetration in each of these countries.

Our report covers the prescribing and coverage/reimbursement environment for these drug classes in Brazil, Mexico and Argentina, and compares attitudes of physicians and payers to assess how the T2D market access landscape will evolve in the next 2-3 years as the novel SGLT-2 inhibitors expand the treatment armamentarium for T2D.

Questions Answered in This Report:

  *   Understand the Impact of Pricing and the Access/Reimbursement Environment on Use of Current Noninsulin Antidiabetic Agents. How do coverage/reimbursement status, and resulting restrictions impact prescribing of these agents in Brazil, Mexico and Argentina?  How does the impact of payer policies vary between drug classes, and between private and public patients? How do access/reimbursement constraints rank against other hurdles for DPP-IV inhibitors and GLP-1 analogues in Brazil, Mexico and Argentina? Which of these agents is included in drug formularies of government-sponsored and/or social security programs? How does formulary listing affect prescribing in each market? How do the real limitations of state/province or hospital budgets impact supply and access? What procedures must patients and providing institutions follow in order to receive drugs listed, and not listed, in the drug formularies? In several discount scenarios, how much power would price discounts have to shift prescribing? How will access to currently marketed and emerging agents shift by the end of 2015?

  *   Understand Physician and Payer Perspectives on Emerging Noninsulin Antidiabetic Agents. What are the market access hurdles emerging agents will need to overcome in Brazil, Mexico and Argentina?  How do payers and prescribers perceive the emerging brands? To what extent do these brands address unmet clinical needs? How will payer policies in Brazil, Mexico and Argentina impact uptake of emerging brands over currently approved drugs?  How will inclusion in government-issued T2D treatment guidelines and/or reimbursement/ coverage guidelines impact uptake of emerging therapies for public and private patients? How do payers’ attitudes towards the emerging SGLT-2 inhibitors differ between Brazil, Mexico and Argentina? How do clinicians expect to be able to prescribe them? What clinical and commercial factors would be most likely to convince payers to grant emerging SGLT-2 inhibitors formulary coverage or advantaged positioning? Among the DPP-IV inhibitors, GLP-1 analogues and SGLT-2 inhibitors available by 2015, which drug class has the strongest probability for inclusion in the drug formularies?

Scope:

This Emerging Markets Physician & Payer Forum report explores the market access hurdles and levers that affect T2D market dynamics in Brazil, Mexico, and Argentina. The report is based on a survey of 152 prescribers (primary care physicians and endocrinologists) and interviews with 10 payers. Interviewed payers have an influence at a national or regional level and include the following:

- Brazil: Director of purchase and supply, and hospital relations at UNIMED; General coordinator of Strategic Programs Management at ANVISA (National Health Surveillance Agency); Endocrinologist and Professor at a major private Catholic University; Consultant at ANVISA and at several private HMOs; Coordinator of official SBD guidelines and position statements, and diabetes programs in Brazil’s public network.

- Mexico: Endocrinologist and Chief of the Department of Nutrition, Obesity and Metabolic Alterations at a prestigious private Mexican hospital; Medical Director at ISSSTE and Member of the Council of Chronic Disease Programs; Head of Diet-related Disorders Department at an IMSS-affiliated hospital.

- Argentina: Special programs director at a private HMO; General Coordinator of the Diabetes Program at the second largest union Obra Social in Argentina; Purchase manager for the High Cost Programs at PAMI (social health insurance fund for retired workers).

This Emerging Markets Physician & Payer Forum report also leverages key findings on the Brazilian and Mexican T2D markets derived from the research published in our 2012 Emerging Markets Physician & Payer Forum reports Physician and Payer Perspectives on Injectable Antidiabetics in Brazil and Mexico, and Oral Therapies for Type 2 Diabetes: Physician and Payer Perspectives on Market Dynamics in Brazil and Mexico.


Search Reports

Mentioned in this report:

  • - Amylin
  • - AstraZeneca
  • - Bristol-Myers Squibb
  • - Boehringer Ingelheim
  • - Eli Lilly
  • - GlaxoSmithKline
  • - Johnson & Johnson
  • - Merck & Co.
  • - Novartis
  • - Novo Nordisk
  • - Sanofi
  • - Takeda
  • - Zealand Pharma
Decision Resources Group brands include: