Demand for popular prescription drugs to treat diabetes, obesity and heart disease has skyrocketed in recent years.University of Southern California There was a 442% increase in semaglutide prescriptions between January 2021 and December 2023. Semaglutide is the active ingredient in a diabetes treatment. Ozempic, Rubelsus and WegoviHeart disease prevention and weight loss drug.
As the medical uses for these drugs expand, it is becoming increasingly difficult for patients to get insurance companies to cover the cost of these prescription drugs, which can cost more than $10,000 a year. In fact, patients on Medicaid or Medicare make up only a small fraction of those who fill prescriptions for Ozempic or Wegovy.
The USC study was published in JAMA Health Forum this month. It reveals the disparities Medicaid and Medicare enrollees face when trying to access these blockbuster anti-obesity and diabetes drugs.
“If these drugs are only available to certain patient populations, primarily those with private or more generous health insurance, then a significant portion of the U.S. population will not have access to these drugs.” lead author Christopher Scannell told Axios..
Here’s what you need to know about patient access to Ozempic, Rybelsus, and Wegovy.
Patients with private insurance are more likely to have their prescriptions filled.
Many private insurers and the government-funded Medicare and Medicaid programs typically don’t cover these weight-loss drugs, leaving many who want them out of reach, and some insurers impose requirements such as prior authorization or stepped-treatment, requiring people to try less expensive drugs first.
Among covered patients, those with private insurance accounted for 90% of Wegovy’s prescription dispensing in December 2023. According to data from IQVIA’s National Prescription Audit Payer Trak. During the same period, patients enrolled in Medicare Part D plans accounted for 1.2% of prescription fillings.
Fewer than 1% of prescriptions paid for with cash were paid. This was revealed through research.
Medicare, the federal health care program for adults 65 and older, Law It would ban drug coverage for more than two in five Americans who are obese but have no other significant risk factors. Ozempic is FDA-only It is approved to manage blood sugar levels and treat type 2 diabetes, but not yet for weight loss.
KFF, a nonprofit health policy group, 1 in 4 people on Medicare People who are obese may be eligible to receive Wegovy to reduce their risk of heart attack and stroke.
Federal spending on weight-loss drugs soars
KFF analysis The study found that Medicare spending on three drugs — Novo Nordisk’s Ozempic and Ryvelsus and Eli Lilly’s Maunjaro — has soared to $5.7 billion in 2022 from $57 million in 2018. That figure doesn’t include rebates and other discounts negotiated by pharmacy benefit managers.
Federal spending on these drugs could increase, experts say. If just one in 10 eligible adults took Wegovy to prevent heart attacks and strokes, KFF said. Estimation Medicare Part D prescription drug coverage will cost about $3 billion each year.
These weight loss drugs cost patients about $1,350 per month, but studies suggest they cost just $22 to manufacture, USA Today previously reported.
Contributors: Ken Altucker and Karen Weintraub, USA TODAY
