United States: Recently, the demand for famous prescription drugs that are used for their benefits – control diabetes, obesity, as well as heart disease, among others, has been up significantly in the past few years.
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Semaglutide is an active substance in diabetes products such as Ozempic, Rybelsus, and Wegovy; it is also a weight-control and cardiovascular disease prevention medication.
With the discoveries made and an ever-increasing list of approvals for the medical use of these drugs, patients are finding it increasingly difficult to get their insurance to cover these pills, some of which cost more than USD 10,000 per year, as USA Today reported.
Surprisingly, individuals with Medicaid and Medicare with Ozempic and Wegovy prescriptions are less than those with other insurance types prescribed the products.
A recent USC study in the JAMA Health Forum this month helps elucidate the difficulties those covered by Medicaid or Medicare face when attempting to obtain these blockbuster drugs for weight loss and diabetes.
According to the lead author of the study, Christopher Scannell, “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,” as the USA Today reported.
Access to Ozempic, Rybelsus, and Wegovy
Most private insurance plans, Medicare and Medicaid, do not cover these drugs for weight loss, making them unavailable to thousands of people who wish to use them.
They attempted to set conditions like prior authorization or step therapy, wherein a patient has to use cheaper drugs before a certain brand.
Data from IQVIA’s National Prescription Audit Payer Trak indicates that 90 percent of insured patients with private insurance filled prescriptions for Wegovy in December 2023.
Thus, the Medicare Part D plans encompassed 1.2 percent of prescription fills during that period.
Medicare, the federal health program, is not allowed by law to cover drugs for the over 40 percent of the population that is obese but does not face any other major risk factors for diseases through Medicare, the federal health program for all Americans 65 and older, according to USA Today reports.
Moreover, Ozempic is the only FDA-approved medicine to regulate blood sugar levels, as well as treat those with Type 2 diabetes, which is yet to be approved for its weight loss benefits.