The number of anti-diabetics listed in the Ministry of Health Medicine Formulary (MoHMF) and the proposal to change prescribing category for usage in primary care facilities has increased each year causing difficulty in monitoring effectiveness, safety and rational use of the treatment and budget management. This study aimed to describe the reassessment and selection strategy of Dipeptidyl Peptidase-4 Inhibitors (DPP4-i), a class of anti-diabetic medicines in the MoHMF.

A literature review on the comparative effectiveness and safety of all available DPP4-i in MoHMF were conducted. Comparative treatment cost and utilization of DPP4-i were analyzed. Approved MoHMF indications were listed and compared against approved Drug Control Authority (Malaysia) indications. Information on clinical guidelines recommendations and listing or reimbursement status in non-Ministry of Health Malaysia (MoHM) public institutions and other countries were obtained. All findings were presented to MoHM drug expert committee for DPP4-i selection strategy. The final recommendation based on consensus among drug expert committee and Pharmaceutical Services Program were presented to the MoHMF Panel.

The MoHMF Panel acknowledged that the efficacy and safety profile of all DPP4-i were equivalent across therapeutic group as supported by strong evidence, hence, their selection can be made via cost-minimization strategy. The call for contract tender for single tablet was conducted based on therapeutic group (drug class) to encourage price competition and contracts were awarded to two DPP4-i which offered the lowest treatment costs. Saxagliptin and vildagliptin were awarded as contract items while sitagliptin remained as local purchase item. Prescribing category for all DPP4-i in MoHMF were streamlined accordingly. Linagliptin was disinvested due to sufficient availability of alternatives.

Selection strategy and disinvestment has successfully reduced the number of DPP4-i listed in MoHMF thus allowing more efficient clinical and cost monitoring. Cost minimization through tender by therapeutic group was the first to be done and has efficiently provided an avenue for price competition which results in saving to MoHM.