Who gets Ozempic? People with private insurance and many health plans, research shows

The demand for popular drugs that treat diabetes, obesity and heart disease has increased in the last few years. New research from the University of Southern California showed a 442% increase in semaglutide prescriptions between January 2021 and December 2023. Semaglutide is an active ingredient in the diabetes drugs Ozempic, Rybelsus and Wegovy, the prevention of heart disease and weight loss drugs.

As the number of prescriptions for these drugs continues to increase, patients have great difficulty getting their insurers to pay for these prescriptions that can cost $10,000 a year. In fact, patients covered by Medicaid and Medicare represent a small percentage of those who have Ozempic and Wegovy prescriptions filled.

A USC study published this month in the JAMA Health Forum sheds light on the inequities Medicaid and Medicare face when trying to access these anti-obesity and diabetes drugs.

“If only some patients are getting these drugs — mostly those with private insurance, generous health plans — then there is a large portion of the US population that is not getting 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 government-sponsored Medicare and Medicaid often do not cover these drugs for weight loss, leaving them out of reach for many people who want them. Some insurers have set requirements such as prior authorization or step therapy, which mandates that people try the least expensive drugs first.

For those with coverage, private insurance patients represent 90% of prescriptions for Wegovy in December 2023, according to data from IQVIA’s National Prescription Audit Payer Trak. Patients with Medicare Part D plans represent 1.2% of prescription refills at the same time.

Less than 1% of prescription refills go to cash payers, the study found.

Medicare, the federal health program for adults age 65 and older, is prohibited by law from covering drugs for more than 2 in 5 Americans who are obese but otherwise undiagnosed. serious harm. Ozempic is the only FDA approved drug to control blood sugar levels and treat Type 2 diabetes – it is not yet approved for weight loss.

The health policy organization KFF estimates that 1 in 4 obese Medicare enrollees could qualify for Wegovy to reduce the risk of heart disease or stroke.

Federal spending on weight loss drugs is increasing

The 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 number did not include discounts or additional discounts negotiated by pharmacy benefit managers.

Government use of these drugs is likely to grow, experts say. If just 1 in 10 eligible adults could take Wegovy to prevent a heart attack or stroke, KFF estimated it would cost Medicare’s Part D prescription drug costs as much as $3 billion a year. .

These weight-loss drugs can cost patients $1,350 a month, but research suggests they only cost $22 to make, USA TODAY previously reported.

Contributor: Ken Alltucker, Karen Weintraub, USA TODAY

This article appeared in USA TODAY: Ozempic, weight-loss drug distributed disproportionately, study shows