What is the least expensive DPP-4 (Dipeptidyl Peptidase-4) inhibitor for diabetes management covered through a pharmacy for a Medicare patient with a Blue Cross supplement?

Alogliptin is the Least Expensive DPP-4 Inhibitor for Medicare Patients with Blue Cross Supplement

Based on the most recent data, alogliptin is the least expensive DPP-4 inhibitor available for Medicare patients with Blue Cross supplement, costing $234 AWP/$161 NADAC per month for the maximum daily dose of 25 mg. 1

Cost Comparison of DPP-4 Inhibitors

The American Diabetes Association's cost data shows significant price differences among DPP-4 inhibitors:

• Alogliptin (25 mg): $234 AWP/$161 NADAC per month 1
• Saxagliptin (5 mg): $524 AWP/$466 NADAC per month 1
• Linagliptin (5 mg): $630 AWP/$504 NADAC per month 1
• Sitagliptin (100 mg): $657 AWP/$525 NADAC per month 1

This represents a potential annual savings of approximately $2,900 when choosing alogliptin over the most expensive option (sitagliptin) 1. The 2022 American Diabetes Association guidelines also confirm alogliptin as the lowest-cost DPP-4 inhibitor option 2.

Clinical Efficacy Considerations

• All DPP-4 inhibitors work through the same mechanism - preventing inactivation of GLP-1, which increases insulin secretion and reduces glucagon secretion 3
• Clinical studies show similar efficacy across the DPP-4 inhibitor class, with HbA1c reductions of approximately 0.6-1.1% 4
• All DPP-4 inhibitors are administered once daily, making them equally convenient from a dosing perspective 3

Medicare Coverage Considerations

• For Medicare patients with a Blue Cross supplement, out-of-pocket costs will depend on:

  • Which phase of coverage the patient is in (deductible, initial coverage, coverage gap, or catastrophic coverage) 2
  • The specific Blue Cross supplement plan's formulary tier placement of each medication 2
  • Whether the patient qualifies for Low-Income Subsidy (LIS) programs 2

• Since alogliptin has the lowest base price, it is most likely to have the lowest out-of-pocket cost regardless of coverage phase 1

Clinical Application Algorithm

1. Verify that the patient has tried metformin first, as it remains the first-line therapy due to its low cost ($2-4 per month) and established cardiovascular benefits 1

2. If a DPP-4 inhibitor is clinically appropriate as add-on therapy, choose alogliptin as the most cost-effective option 1

3. Check the specific Blue Cross supplement plan's formulary to confirm tier placement and any prior authorization requirements for alogliptin

4. If alogliptin is not on formulary or requires prior authorization that cannot be obtained, consider saxagliptin as the next most affordable option 1

Important Caveats

• Prices may vary between pharmacy networks, so it's worth checking if Green Tree Pharmacy has any special pricing agreements for specific DPP-4 inhibitors 2

• The listed prices (AWP and NADAC) do not account for discounts, rebates, or other price adjustments that may affect the actual cost incurred by the patient 2

• All DPP-4 inhibitors have similar safety profiles with low risk of hypoglycemia and neutral effects on body weight 4

• For patients with established cardiovascular disease, consider that sitagliptin has been specifically studied in the TECOS cardiovascular safety trial and demonstrated cardiovascular safety 5