For the treatment of type 2 diabetes in China, patient access to premium-priced agents is impeded as not all patients can afford these drugs, Burlington, Mass.-based Decision Resources Group has found. The National Reimbursement Drug List was last updated in 2009, and several antidiabetic drug classes (e.g. DPP-IV inhibitors and GLP-1 receptor agonist) are not covered, as they were only approved for use in China after 2009.

Coverage of DPP-IV inhibitors and GLP-1 receptor agonists is very limited. Up to 43% of surveyed physicians indicate the lack of reimbursement for these drug classes is a major factor that limits their prescription. The high cost of GLP-1 receptor agonists would account for more than 50% of the average disposable income of urban residents, should they pay for these therapies out-of-pocket.

The Emerging Markets Physician & Payer Forum report also found there is a low drug-treatment rate. Only 73% of patients diagnosed with type 2 diabetes are treated with prescription drugs, according to surveyed physicians. This percentage is low compared to other Asian markets such as South Korea and Taiwan.

The Medicine Rate is a policy designed to control the prescribing of reimbursed high-cost therapies in public hospitals. Physicians’ prescription records also are reviewed regularly by the Ministry of Human Resources and Social Security. Payers believe these have a negative impact on the prescription of expensive agents.

According to the report, there are at least 15 generic applications for DPP-IV inhibitors or GLP-1 analogues currently pending approval by the China FDA. Up to 72% of surveyed physicians express interest in prescribing these generics when they become available in the Chinese market.

Michael Yeung, M.Sc., Decision Resources Group analyst, said, “Many drugs that are marketed in the West, such as SGLT-2 inhibitors and long-acting release GLP-1 analogues, are yet to launch in China. Therefore, this untapped section of the market presents a large opportunity for multinational pharmaceutical companies. However, competition among branded noninsulin antidiabetic agents will intensify in the next few years when these new agents become available.”

Yeung said, “Surveyed physicians indicated a strong preference for metformin as first-line treatment and sulfonylureas and alpha glucosidase inhibitors as second-line treatments. The use of premium-priced treatments—such as DPP-IV inhibitors, SGLT-2 inhibitors and GLP-1 analogues—are expected to increase considerably in the third or later lines of therapy by the end of 2017.”