John A. Johnson, MD, MBA: If you check the current standards or guidelines, which would be [those from] the American Diabetes Association and the American Association of Clinical Endocrinologists, both advocate, initially, for starting with a single agent—whether it’s metformin, which is a biguanide—and then, subsequently, adding on other agents.
What we know in the United States is that diabetes is a progressive disease. So the longer you live with the condition, the more likely you will require more than one medication—unless you significantly change your diet and activity level.
Patients, or the public, tend to associate the number of medications (particularly the number of pills) with worsening of their disease or condition. So, what a lot of pharmaceutical companies have done, and WellCare supports this, is combine medications such that it’s 2 medications in 1 pill.
With combination therapy, to the patient it’s 1 pill; but it’s actually 2 medications. In the last 25 years, we’ve seen an expansion in the number of oral antidiabetic agents. Insulin, as you know, was developed in 1921. About 35 years later, sulfonylureas came on the market. But then, if you fast-forward to 1994 or 1995, the biguanides—[including] metformin, which I referenced—became available. Then, within the last 25 years, you see this expansion of another 10 agents in [various] classes. So, as our knowledge about diabetes, and how to treat and manage diabetes becomes more refined, more agents have become available. These are basically tools in the provider’s belt that help him manage a diabetic.
At WellCare, we try to ensure that all of these tools (medications)—the low-cost affordable options—are available on our preferred drug list. We work with the provider community to make the oral antidiabetic medications and insulin available on our preferred drug list so that providers and our members have access to those medications.
But, again, there is a myth that the number of medications you have, or that you’re on, portends worsening of your disease. And so, it’s about education and awareness and reassuring our members and patients that the number of medications is not meant to be punitive, but rather supportive— to help. Again, not all medications work for every patient. The drug cocktail is very patient-centered—very individualized such that it has to take into account other comorbidities and conditions you may have that may not allow you to take one agent over another.
AI in Health Care: Closing the Revenue Cycle Gap
April 1st 2025This commentary explores the current state, challenges, and potential of artificial intelligence (AI) in health care revenue cycle management, emphasizing collaboration, data standardization, and targeted implementation to enhance adoption.
Read More
Managed Care Reflections: A Q&A With Hoangmai H. Pham, MD, MPH
April 1st 2025To mark the 30th anniversary of The American Journal of Managed Care® (AJMC®), each issue in 2025 will include a special feature: reflections from a thought leader on what has changed—and what has not—over the past 3 decades and what’s next for managed care. The April issue features a conversation with Hoangmai H. Pham, MD, MPH, a member of AJMC’s editorial board and the president and CEO of the Institute for Exceptional Care (IEC).
Read More
Bridging Care Gaps With a Systemwide Value-Based Care Strategy
March 29th 2025Mapping care management needs by defining patient populations and then stratifying them according to risk and their needs can help to spur the transformation of a siloed health care system into an integrated system that is able to better provide holistic, value-based care despite the many transitions that continue among hospital, primary, specialty, and community care environments.
Read More