The surge in demand for semaglutide-based medications—such as Ozempic, Rybelsus, and Wegovy—has highlighted significant disparities in access to these high-cost drugs. A recent study from the University of Southern California reveals that private insurance holders are far more likely to secure prescriptions for these treatments compared to those with Medicaid or Medicare.
Key Findings:
Prescription Increase: There was a staggering 442% increase in semaglutide prescriptions from January 2021 to December 2023. Semaglutide, a key ingredient in Ozempic and Wegovy, is used for diabetes management and weight loss.
Coverage Disparities: The study published in JAMA Health Forum indicates that access to these drugs is predominantly restricted to those with private insurance. For instance, in December 2023, 90% of Wegovy prescriptions were filled for privately insured patients. In contrast, Medicare Part D recipients accounted for only 1.2% of fills.
Insurance Challenges: Many private insurers and government-funded Medicare and Medicaid programs often exclude coverage for weight loss purposes. Moreover, those with these insurance plans may face additional barriers such as prior authorization or step therapy requirements, which mandate trying less costly alternatives first.
Medicare Restrictions: Medicare is prohibited by law from covering drugs for patients with obesity who do not have serious co-morbidities. This restriction limits access to weight loss medications for a significant portion of the population. For example, despite the high prevalence of obesity among Medicare enrollees, only a fraction are covered for these treatments.
Cost and Spending: The financial burden of these drugs is substantial, with monthly costs around $1,350 for patients, despite the low production cost of approximately $22 per dose. Federal spending on these medications has soared, from $57 million in 2018 to $5.7 billion in 2022. Future costs are expected to increase, potentially reaching nearly $3 billion annually for Medicare if a significant portion of eligible adults use Wegovy for heart attack or stroke prevention.
Conclusion: The USC study underscores a critical issue in the healthcare system—disparities in access to expensive, yet potentially life-changing medications. As demand for these drugs grows, it highlights the need for broader and more equitable coverage options to ensure that all patients who could benefit from them have access.
