by Demand for popular prescription drugs to treat diabetes, obesity, and heart disease has exploded in recent years. New research from the University of Southern California showed a 442% increase in semaglutide prescriptions between January 2021 and December 2023. Semaglutide is the active ingredient in the diabetes drugs Ozempic, Rybelsus, and Wegovy, a heart disease prevention and weight loss drug.
As the list of medical uses for these drugs continues to grow, patients are finding it increasingly difficult to get their insurers to cover these prescriptions, which can cost more than $10,000 a year. In fact, Medicaid and Medicare patients represent only a small portion of those who have filled their Ozempic and Wegovy prescriptions.
The USC study published this month in JAMA Health Forum highlights the disparities Medicaid and Medicare recipients face when trying to access these blockbuster obesity and diabetes drugs.
“If only certain patient populations have access to these drugs — those who primarily have private insurance, more generous health plans — then a huge percentage of the American population does 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:
Privately insured patients are more likely to have their prescriptions filled
Many private insurers and state-funded Medicare and Medicaid programs typically don’t cover these weight-loss drugs, leaving them out of reach for a significant number of people who need them. Some insurers have imposed requirements such as prior authorization or step therapy, which require people to try less expensive drugs first.
For those with coverage, patients with private insurance accounted for 90% of prescriptions dispensed for Wegovy as of December 2023, according to IQVIA’s National Prescription Audit Payer Trak data. Patients with Medicare Part D plans accounted for 1.2% of prescriptions dispensed during the same period.
According to the study, less than 1% of prescriptions were issued to people paying in cash.
The law prohibits Medicare, the federal health program for adults 65 and older, from covering medications for the more than 2 in 5 Americans who are obese but don’t have serious risk factors. Ozempic is FDA-approved only to manage blood sugar and treat people with type 2 diabetes — it’s not yet approved for weight loss.
The health policy nonprofit KFF estimates that one in four Medicare enrollees who are obese may be eligible for Wegovy to reduce their risk of heart attack or stroke.
Federal spending on weight-loss drugs is rising
A KFF analysis found that Medicare spending on three drugs — Novo Nordisk’s Ozempic and Rybelsus and Eli Lilly’s Mounjaro — rose from $57 million in 2018 to $5.7 billion in 2022. That figure doesn’t include rebates or other discounts negotiated by pharmacy benefit managers.
Federal spending on these drugs is likely to increase, experts say. If just 1 in 10 eligible adults took Wegovy to prevent a heart attack or stroke, KFF estimated it would cost Medicare Part D prescription drug coverage nearly $3 billion a year.
These weight-loss drugs can cost patients about $1,350 a month, but research suggests they cost just $22 to make, USA TODAY previously reported.
Contributions: Ken Alltucker, Karen Weintraub, USA TODAY
