Cost Keeps Many Who Need Them From Getting New Weight-Loss Meds

Key Takeaways

• People on Medicare and Medicaid are less likely to get a semaglutide prescription, new research shows

• Most prescription fills for the weight-loss and diabetes drugs go to people with private insurance

• Hurdles in the public insurance programs likely cause these disparities

WEDNESDAY, Aug. 7, 2024 (HealthDay news) -- Medicare and Medicaid patients are less likely to get cutting-edge weight-loss drugs than people with private insurance are, a new study finds.

Medicaid accounted for less than 10% of semaglutide ( Ozempic , Wegovy) prescription fills in 2023, researchers found.

Similarly, Medicare Part D accounted for less than 29% of Ozempic fills and a little more than 1% of Wegovy fills.

“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 U.S. population that isn’t getting access to these medications. And that brings up a very significant equity issue,” said lead researcher Dr. Christopher Scannell , a postdoctoral researcher at the University of Southern California's (USC) Center for Health Policy & Economics.

For the study, researchers reviewed a pharmaceutical database that captures about 92% of prescriptions filled and dispensed at retail pharmacies in the United States.

Ozempic is a once-weekly semaglutide injection approved for use in treating type 2 diabetes in 2017. A higher-dose version called Wegovy was approved in 2021 specifically for weight loss.

Ozempic costs about $1,000 a month, while Wegovy is $1,350 a month, researchers noted.

Prescription fills for semaglutide drugs skyrocketed by more than 400% between 2021 and 2023, reaching 2.6 million by December 2023, researchers found.

However, most of those prescriptions went to people with private insurance.

Access to semaglutide through Medicaid is a state-level decision, researchers noted. A state’s budget -- or its politics -- might lead some programs to not cover the pricey medications.

Meanwhile, Medicare Part D doesn’t cover semaglutide to treat obesity unless a patient also has another health problem like heart disease, the researchers added.

“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,” Scannell said in a USC news release. “It’s like saying ‘You have to be sick enough, then we’ll cover that medication for you.’”

Diabetics are getting the short end of the stick as a result of the semaglutide craze, Scannell added.

“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,” Scannell said. “It’s the reason why I’ve been able to get some of my patients off insulin.”

This lack of coverage for semaglutide could worsen health disparities for American minorities and the poor, the researchers noted.

The new study was published Aug. 2 in the journal JAMA Health Forum .

“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 researcher Dima Quato , an associate professor with the University of Southern California’s School of Pharmacy & Pharmaceutical Sciences.

More information

The National Institutes of Health has more about semaglutide .

SOURCE: University of Southern California, news release, Aug. 2, 2024

What This Means For You

People on Medicaid or Medicare might have a harder time obtaining a prescription for semaglutide.