Drug Facts: Combination Medications

A common complaint that I get from patients is that they take a significant number of pills every day. Some people take 3-4 medications for diabetes per day, with many of them being taken twice daily. Optimal diet and exercise can potentially decrease the amount of medications required to manage blood sugars, which is the ultimate goal for most people I talk to. However, there is another way to decrease the number of pills you take per day: combination drugs! These are pills that have multiple medications in one. Many people find this convenient as there is just one medication to pick up at the pharmacy, which also means just one copay.

There are many different combination diabetes drugs on the market. Since metformin is a drug that most people with diabetes are on, about half the combination products on the market are metformin mixed with another medication.

There is potential to save a significant amount of money switching from two separate medications to a combination product. This is especially true when two higher cost medications are combined together. For example, SGLT2 inhibitors and DPP-4s inhibitors are normally higher tier drugs, so you will pay a higher copay for these. If you were to switch to a medication that combined these drugs, like Glyxambi, then you would only have to pay one copay. Depending on your insurance plan, you could end up saving hundreds of dollars or more per year. If you have a high deductible plan, you will most likely save money as well. Trijardy XR actually combines three different drugs together so this could potentially be a huge cost savings. You would also be able to take just 2 pills a day rather than 4.

These combination drugs are, in my opinion, highly underutilized. Most patients are unaware they exist so they don’t ask about them. Combination medications can help with pill burden as well as the financial side of diabetes management, which are two of the biggest concerns for many people with diabetes. Not only can these medications save money for patients, but they can save money for insurance companies as well.

Combination products do have their downsides however. Most people with diabetes don’t stay on the same medication regimen for years and years with zero changes. Sometimes medications need to be increased, while other times they need to be decreased. When multiple medications are in one pill this can get confusing. I’ve seen multiple patients that were not on the optimal dose of metformin because the other medication in the pill needed to be decreased for whatever reason. In cases such as these it may make sense to discontinue the combination pill so the separate medications can have their dose adjusted independently, however this doesn’t always end up happening.

In addition to oral medications, there are also combination products for injectable diabetes medications. These include premixed insulins which combine multiple types of insulin together as well as fixed ratio combinations which combine insulin and GLP-1 receptor agonists together.

If you are interested in seeing if combination medications are a good option for you, talk to your provider, diabetes educator, pharmacist or health insurance company representative.