Publicly insured US individuals who are most likely to benefit from new drugs for diabetes and obesity are less likely to get them than those with private insurance, according to a study by researchers from the University of Southern California. Prescription fills for the drug best known as Ozempic or Wegovy (semaglutide) increased by more than 400% between January 2021 and December 2023, according to research published in JAMA Health Forum.
"I think all the current attention in the media on semaglutide's anti-obesity effect obscures the fact that the drug is also hugely important for treating diabetes. It's the reason why I've been able to get some of my patients off insulin," said first author, Dr Christopher Scannell, a physician and postdoctoral researcher at the Schaeffer Center. "If only certain patient populations get access to these medications, those primarily with private insurance, more generous health plans, then there's a huge percentage of the US population that isn't getting access to these medications. And that brings up a very significant equity issue."
Approved first for type 2 diabetes, then for weight loss, studies show that semaglutide also improves blood pressure and reduces cardiovascular disease—problems that plague millions of Americans. Yet the lion's share of prescriptions went to people with private insurance.
For the study, researchers used data from IQVIA's National Prescription Audit PayerTrak, which captures 92% of prescriptions filled and dispensed to individuals at retail pharmacies in the US. Then, they calculated monthly fills for semaglutide by drug brand (Ozempic, Wegovy, and Rybelsus) and by payment method (commercial insurance, Medicaid, Medicare Part D, and cash) between January 2021 and December 2023.
Prescription fills reached 2.6 million by December 2023. Ozempic persistently accounted for most of the prescriptions, but prescription fills for Wegovy, soared by more than 1,361% between July 2021 and December 2023.
Awareness of the drugs' weight-loss benefits shot up in late 2022 and likely contributed to shortages of Ozempic and Wegovy, first reported by the FDA in March 2022.
Medicaid accounted for less than 10% of semaglutide fills for all three drug brands in 2023. Access via Medicaid is a state-level decision, Scannell said. Depending on the budget, and politics, of where you live, the drugs may or may not be covered (Medicaid provides assistance to low-income people, the elderly and some people with disabilities).
Medicare Part D accounted for 28.5% and 32.9% of Ozempic and Rybelsus fills, respectively, in 2023; it only accounted for 1.2% of Wegovy fills. Medicare Part D doesn't cover the drugs for obesity unless a patient also has a co-morbidity such as cardiovascular disease as well, the very problem Wegovy or Ozempic can prevent. Approximately 1% or less of all semaglutide fills went to people paying cash in 2023.
"Given the proven cardiovascular benefits of Ozempic and Wegovy when used for diabetes or obesity, and the disproportionate burden of diabetes and obesity in Black/Latinx Medicaid and Part D populations, these findings suggest that their lower use in Medicaid and Part D may worsen disparities in diabetes and obesity outcomes," said senior author, Dr Dima Qato, an associate professor at the USC School of Pharmacy and senior scholar at the USC Leonard D Schaeffer Center for Health Policy & Economics.
The researchers said future studies should examine how changes in Medicare Part D and Medicaid coverage restrictions influence disparities in access to these essential medications.
“If Medicare is only covering these drugs for patients who have obesity and a co-morbidity, it may be forcing patients who only have obesity to develop these additional chronic conditions before they can get access to the medications,” added Scannell. “It's like saying 'You have to be sick enough, then we'll cover that medication for you.'"
In addition, further research could examine individual-level variables such as age, race, and ethnicity and whether the drugs were prescribed for obesity or diabetes.
The findings were featured in the research letter, ‘Prescription Fills for Semaglutide Products by Payment Method’, published in JAMA Health Forum. To access this letter, please click here
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