Demand for popular prescription drugs used to treat diabetes, obesity and heart disease has skyrocketed in recent years. New research from the University of Southern California showed a 442% increase in prescriptions for semaglutide between January 2021 and December 2023. Semaglutide is the active ingredient in the diabetes drugs Ozempic, Rybelsus and Wegovy, a drug used to prevent heart disease and promote weight loss.
As the list of medical uses for these drugs continues to grow, it’s becoming increasingly difficult for patients to get their insurance companies to cover these prescriptions, which can cost over $10,000 a year. In fact, patients covered by Medicaid and Medicare make up only a small portion of those who have filled their Ozempic and Wegovy prescriptions.
The USC study, published this month in JAMA Health Forum, sheds light on the inequities Medicaid and Medicare beneficiaries face as they try to gain access to these blockbuster obesity and diabetes drugs.
“If only certain groups of patients have access to these drugs – especially those with private health insurance and more generous health insurance plans – then there is a huge percentage of the U.S. population that 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 people have prescriptions redeemed more often
Many private health insurance plans and the government-funded Medicare and Medicaid programs typically do not cover the cost of these weight-loss drugs, making them unaffordable for many people who want them. Some health insurance plans have implemented requirements such as prior authorization or step therapy, which requires patients to try less expensive drugs first.
According to data from IQVIA’s National Prescription Audit Payer Trak, patients with private health insurance accounted for 90% of prescription redemptions for Wegovy in December 2023. Patients with Medicare Part D plans accounted for 1.2% of prescription redemptions during the same period.
According to the study, less than 1% of prescriptions were filled by people who paid in cash.
Medicare, the government health program for adults ages 65 and older, is legally barred from covering drugs for more than two in five Americans who are obese but otherwise have no serious risk factors. Ozempic is approved by the FDA only to regulate blood sugar levels and treat type 2 diabetes – it is not yet approved for weight loss.
The nonprofit health policy organization KFF estimates that one in four overweight Medicare beneficiaries could be eligible for Wegovy to reduce their risk of heart attack or stroke.
Federal spending on weight loss drugs is rising sharply
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 does not include rebates or other discounts negotiated by pharmacy benefit managers.
Government spending on these drugs is likely to rise, experts say. If just one in 10 eligible adults took Wegovy to prevent heart attacks or strokes, it would add nearly $3 billion a year to Medicare Part D drug coverage, according to KFF estimates.
These weight-loss drugs can cost patients around $1,350 a month, but research suggests they cost as little as $22 to produce, USA TODAY previously reported.
Contributors: Ken Alltucker, Karen Weintraub, USA TODAY
