Lack of Medicare Coverage for GLP-1 Drugs Tied to Lower Prescription Rates: Study

Ozempic_iStock, imyskin

Pictured: A patient preparing to take their GLP-1 injection/iStock, imyskin

Medicare policy prohibiting the coverage of GLP-1 receptor agonists for obesity may be driving lower prescription and initiation rates of these therapies in adults aged 65 to 69 years, according to a study preprint from the University of Pennsylvania and healthcare data firm Truveta Research.

Using de-identified health record data from Truveta, the study—published Thursday on the preprint server medRxiv—found nearly 414,000 adults between 60 to 69 years of age who were overweight or obese but without type 2 diabetes and were eligible for GLP-1 RA treatment. However, of these seniors, fewer than 1%--or just over 1,200—were actually prescribed these anti-obesity medications.

Prescription rates were even lower among Medicare-aged patients. In the subgroup of patients aged 65 to 69 years, only 0.24% of eligible patients were prescribed GLP-1 treatments, compared to 0.37% in counterparts who were 60 to 64 years old. The absolute difference of 0.13% was statistically significant, with a p-value less than 0.01, according to the study.

Medicare-aged patients also saw a lower rate of dispensing, with 15.2% filling their prescriptions within 60 days, as opposed to 22.7% in the younger age group.

“These findings suggest that Medicare-aged adults face unique gaps in access, occurring at both the medication prescribing and filling stages,” the researchers wrote, adding that this effect could likely be driven by “a lack of coverage.”

Offering Medicare coverage of GLP-1 receptor agonist anti-obesity medications “has the potential to increase prescribing and initiation substantially,” the researchers argue, while acknowledging that more research needs to be done “to understand tradeoffs between increased prescribing costs and potential reductions” in major adverse cardiovascular events and improvements in quality of life.

The Truveta study comes one week after the Centers for Medicare and Medicaid Services announced that it will cover Novo Nordisk’s weight-loss treatment Wegovy (semaglutide) for its use in reducing the risk of heart attack, stroke and other related cardiovascular problems in patients with pre-existing heart conditions.

However, Medicare will still not cover Wegovy when used for weight loss.

Medicare’s decision to expand its coverage for Wegovy follows an analysis by the Congressional Budget Office (CBO), which predicted that the Department of Health and Human Services will negotiate the prices for semaglutide under the Inflation Reduction Act “within the next few years.”

However, at its current monthly cost of around $1,000 to $1,300, Medicare still cannot sustainably cover GLP-1 treatments, though the negotiations are likely to bring prices down, according to the CBO’s analysis. Generic competition and next-generation weight-loss medications will also likely lower the costs of current anti-obesity drugs, the CBO contends.

The FDA last month expanded Wegovy’s label, allowing the use of the GLP-1 RA in conjunction with diet and exercise to cut cardiovascular risks.

Tristan Manalac is an independent science writer based in Metro Manila, Philippines. Reach out to him on LinkedIn or email him at tristan@tristanmanalac.com or tristan.manalac@biospace.com.

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