The demand for standard pharmaceuticals that deal with diabetes, weight problems and coronary heart illness has skyrocketed over the previous few years. New analysis from the University of Southern California confirmed a 442% improve in prescriptions for semaglutide between January 2021 and December 2023. Semaglutide is the energetic ingredient in diabetes medication Ozempic, Rybelsus and Wegovy, a coronary heart illness prevention and weight-loss drug.
Because the listing of medical makes use of for these medication continues to develop, sufferers are experiencing extra issue getting their insurers to cowl these prescriptions that may value over $10,000 a 12 months. In truth, sufferers coated by Medicaid and Medicare symbolize a small share of those that’ve had their Ozempic and Wegovy prescriptions crammed.
The USC study published this month in JAMA Health Forum sheds gentle on the disparities Medicaid and Medicare holders face when attempting to entry these blockbuster anti-obesity and diabetes medication.
“If solely sure affected person populations get entry to those drugs — these primarily with non-public insurance coverage, extra beneficiant well being plans — then there’s an enormous proportion of the U.S. inhabitants that is not gaining access to these drugs,” lead author Christopher Scannell told Axios.
Here is what it’s essential to learn about affected person entry to Ozempic, Rybelsus and Wegovy:
Privately insured sufferers extra prone to have their prescriptions crammed
Many non-public insurers and government-funded Medicare and Medicaid usually do not cowl these medication for weight reduction, leaving them out of attain for vital numbers of people that need them. Some insurers have imposed necessities akin to prior authorization or step remedy, which mandates that individuals attempt cheaper medication first.
For many who are coated, sufferers with non-public insurance coverage represented 90% of prescription fills for Wegovy in December of 2023, according to data from IQVIA’s National Prescription Audit Payer Trak. Sufferers with Medicare Half D plans represented 1.2% of prescription fills throughout that very same time interval.
Lower than 1% of prescription fills went to individuals paying in money, the study found.
Medicare, the federal health program for adults 65 and older, is prohibited by law from overlaying medication for the greater than 2 in 5 People who’re overweight however in any other case wouldn’t have severe threat elements. Ozempic is only FDA permitted to handle blood sugar ranges and deal with these with Kind 2 diabetes – it isn’t but permitted for weight reduction.
The nonprofit well being coverage group KFF estimates that 1 in 4 Medicare enrollees who’re overweight could also be eligible for Wegovy to cut back their threat of coronary heart assault or stroke.
Federal spending on weight-loss medication surges
A KFF analysis discovered Medicare spending on three medication − Novo Nordisk’s Ozempic and Rybelsus and Eli Lilly’s Mounjaro − surged from $57 million in 2018 to $5.7 billion in 2022. That determine didn’t embrace rebates or different reductions negotiated by pharmacy profit managers.
Federal spending on these medication is prone to develop, consultants say. If simply 1 in 10 eligible adults take Wegovy to forestall coronary heart assault or stroke, KFF estimated it might cost Medicare’s Part D prescription drug coverage almost $3 billion every year.
These weight reduction medication can value sufferers round $1,350 a month, however analysis suggests they value simply $22 to make, USA TODAY previously reported.
Contributing: Ken Alltucker, Karen Weintraub, USA TODAY
