Top 10 diabetes drugs by 2016 sales

To say there’s a lot going on in the U.S. diabetes space right now would be an understatement. The formulary exclusions and payer pressure that have taken a toll on so many medications are continuing in full force, and thanks to new and forthcoming biosimilars, that likely won’t change anytime soon.

Value-based pricing has arrived on the diabetes scene, too, shaking payer relationships up even further. And price hikes, which some drugmakers have relied on for their long off-patent drugs, are no longer OK as far as the public and many lawmakers are concerned. All three of the diabetes giants—Novo Nordisk, Sanofi and Eli Lilly—have taken steps to allay the price-increase controversy, with Novo and Sanofi each pledging caps on their hikes, but all three are facing legal difficulties for their historical insulin pricing, too.

Then there’s the cardiovascular outcomes data that’s taken the arena by storm. These days, it’s no longer enough to show that your diabetes fighter doesn’t increase heart risks; to compete at the top of its game, a drug has to show it can pare down cardiovascular risks—or face potential upstaging by a rival that can.

And while diabetes is growing in prevalence, it’s still unclear just how well newer classes such as SGLT2 can keep up their growth acts.

With all of those factors in mind, it’ll be no surprise if 2016’s list of top 10 U.S. diabetes sellers sees something of a shake-up in the near future—and in fact, it’ll be pretty surprising if it doesn’t.