Non-insulin anti-diabetic agents covered by NLPDP with special authorization
Posted by dkwinter

NLPDP Drug Lookup:

 

Thiazolidinedione

  • Repaglinide (GlucoNorm)

 

  • MOA: Nonsulfonylurea hypoglycemic agent which blocks ATP-dependent potassium channels, depolarizing the membrane and facilitating calcium entry through calcium channels. Increased intracellular calcium stimulates insulin release from the pancreatic beta cells. Repaglinide-induced insulin release is glucose-dependent.

 

  • From NLPDP: "For the treatment of type 2 diabetes in patients who are inadequately controlled on a combination of a sulfonylurea and metformin, at maximum dosages, or in whom these agents are contraindicated or not tolerated"
    • ​Currently the only non-injection third-line med covered by NLPDP

 

DPP-4 Inhibitors

  • Linagliptin (Trajenta)
  • Saxagliptin (Onglyza)
  • Sitagliptin (Januvia)

 

  • MOA: DPP-4 Inhibitors inhibits dipeptidyl peptidase 4 (DPP-4) enzyme resulting in prolonged active incretin levels. Incretin hormones (eg, glucagon-like peptide-1 [GLP-1] and glucose-dependent insulinotropic polypeptide [GIP]) regulate glucose homeostasis by increasing insulin synthesis and release from pancreatic beta cells and decreasing glucagon secretion from pancreatic alpha cells. Decreased glucagon secretion results in decreased hepatic glucose production. Under normal physiologic circumstances, incretin hormones are released by the intestine throughout the day and levels are increased in response to a meal; incretin hormones are rapidly inactivated by the DPP-4 enzyme.  --UpToDate

 

  • From NLPDP: "For the treatment of type 2 diabetes as a third drug added to metformin and a sulfonylurea for patients with inadequate glycemic control on metformin and a sulfonylurea AND in whom insulin is not an option"

 

Combined Formulations

  • Dapagliflozin + metformin (Xigduo)
  • Linagliptin + metformin (Jentadueto)*
  • Saxagliptin + metformin (Komboglyze)*
  • Sitagliptin + metformin (Janumet)*
  • Sitagliptin + metformin (Janumet XR)*
  • Empagliflozin + metformin (Synjardy)

 

  • *DPP-4 Inhibitor + metformin. From NLPDP: "For the treatment of type 2 diabetes in patients with inadequate glycemic control on metformin and a sulfonylurea and in whom insulin is not an option AND who are already stabilized on therapy with metformin, a sulfonylurea and a DPP-4 inhibitor, to replace individual components of a DPP-4 inhibitor and metformin in these patients."

 

SLGT2 Inhibitors

  • Canagliflozin (Inovokana)
  • Dapagliflozin (Forxiga)
  • Empagliflozin (Jardiance)

 

  • MOA: By inhibiting sodium-glucose cotransporter 2 (SGLT2) in the proximal renal tubules, SGLT2-inhibitors reduce reabsorption of filtered glucose from the tubular lumen and lowers the renal threshold for glucose (RTG). SGLT2 is the main site of filtered glucose reabsorption; reduction of filtered glucose reabsorption and lowering of RTG result in increased urinary excretion of glucose, thereby reducing plasma glucose concentrations. --UpToDate

 

  • From NLPDP: "For the treatment of type 2 diabetes as a third drug added to metformin and a sulfonylurea for patients with inadequate glycemic control on metformin and a sulfonylurea AND in whom insulin is not an option" -- must be on metformin for 3 months at maximum tolerable dose first

 

GLP-1 Receptor Agonist

  • Semaglutide (Ozempic) [Only SC injection covered. Once weekly injection.]

 

  • MOA: Semaglutide is selective glucagon-like peptide-1 (GLP-1) receptor agonist. Acting on the same receptor as the endogenous hormone incretin, semaglutide increases glucose-dependent insulin secretion, decreases inappropriate glucagon secretion, and slows gastric emptying. Increases first- and second-phase insulin secretion.

 

  • From NLPDP: "For the treatment of type 2 diabetes in combination with metformin and a sulfonylurea, when diet and exercise plus dual therapy with metformin and a sulfonylurea do not achieve adequate glycemic control"