Ozempic, weight reduction medication being distributed inconsistently, examine exhibits
The demand for widespread pharmaceuticals that deal with diabetes, weight problems and coronary heart illness has skyrocketed over the previous few years. New analysis from the College of Southern California confirmed a 442% enhance in prescriptions for semaglutide between January 2021 and December 2023. Semaglutide is the lively ingredient in diabetes medication Ozempic, Rybelsus and Wegovy, a coronary heart illness prevention and weight-loss drug.
Because the record 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 price over $10,000 a yr. In truth, sufferers coated by Medicaid and Medicare characterize a small share of those that’ve had their Ozempic and Wegovy prescriptions crammed.
The USC examine revealed this month in JAMA Well being Discussion board sheds gentle on the disparities Medicaid and Medicare holders face when making an attempt to entry these blockbuster anti-obesity and diabetes medication.
“If solely sure affected person populations get entry to those medicines — these primarily with personal insurance coverage, extra beneficiant well being plans — then there’s an enormous proportion of the U.S. inhabitants that is not having access to these medicines,” lead writer Christopher Scannell advised Axios.
Here is what you might want to learn about affected person entry to Ozempic, Rybelsus and Wegovy:
Privately insured sufferers extra more likely to have their prescriptions crammed
Many personal insurers and government-funded Medicare and Medicaid sometimes 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 reminiscent of prior authorization or step remedy, which mandates that folks strive inexpensive medication first.
For individuals who are coated, sufferers with personal insurance coverage represented 90% of prescription fills for Wegovy in December of 2023, based on information from IQVIA’s Nationwide 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 folks paying in money, the examine discovered.
Medicare, the federal well being program for adults 65 and older, is prohibited by regulation from overlaying medication for the greater than 2 in 5 Individuals who’re overweight however in any other case should not have severe danger components. Ozempic is simply FDA authorised to handle blood sugar ranges and deal with these with Sort 2 diabetes – it is not but authorised 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 danger of coronary heart assault or stroke.
Federal spending on weight-loss medication surges
A KFF evaluation 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 embody rebates or different reductions negotiated by pharmacy profit managers.
Federal spending on these medication is more likely to develop, consultants say. If simply 1 in 10 eligible adults take Wegovy to forestall coronary heart assault or stroke, KFF estimated it might price Medicare’s Half D prescription drug protection almost $3 billion every year.
These weight reduction medication can price sufferers round $1,350 a month, however analysis suggests they price simply $22 to make, USA TODAY beforehand reported.
Contributing: Ken Alltucker, Karen Weintraub, USA TODAY
