Medicare spending on diabetes drugs surged in 5 years: IG
Add Axios as your preferred source to
see more of our stories on Google.
Illustration: Shoshana Gordon/Axios
Medicare spending on 10 diabetes drugs, including popular GLP-1s, more than quadrupled over a five-year period and could reach $102 billion next year, an analysis by Health and Human Services' inspector general found.
Why it matters: Medicare doesn't cover the drugs for weight loss, but the watchdog report noted a surge in utilization raises questions about whether the program paid drug claims for unauthorized uses.
- The findings also come as the Trump administration weighs the fate of a Biden administration proposal that would require Medicare and Medicaid to cover GLP-1s for weight loss.
By the numbers: Medicare Part D spending on the 10 drugs studied rose from $7.7 billion in 2019 to $35.8 billion in 2023, for an overall increase of 364%.
- The number of Part D enrollees increased just 12% over that time, from 44.9 million to 50.5 million.
- The biggest spikes in usage were for Rybelsus, Novo Nordisk's once-daily GLP-1 tablet, and for the company's weekly injectable Ozempic, whose spending about doubled every year under review.
- While Eli Lilly's Mounjaro wasn't covered by Medicare Part D until mid-2022, program spending on it increased 1,541% the following year.
Between the lines: Prescribers of the diabetes drugs came from a broad range of specialties, mostly internal medicine and endocrinologists, but also including dentists, optometrists, chiropractors and acupuncturists, the IG found.
- The analysis found spending on metformin, an older first-line oral drug for Type 2 diabetes that's available as a generic, decreased 5% over the five years studied, to $623 million. Some GLP-1s are increasingly replacing metformin as the standard of care for diabetics and prediabetics.
- The IG didn't conduct medical reviews to determine whether the drugs were prescribed according to their drugs' accepted use or review potential health benefits or long-term cost savings from their use.
What we're watching: Use of the GLP-1s is expected to keep rising as the FDA approves more medically accepted uses for the drugs. The analysis predicts Part D spending for the 10 selected drugs could top $102 billion in 2026, based on the trends observed.
- New competitors to the popular anti-obesity and anti-diabetes drugs are heading toward commercialization.
- The increase in prescriptions, and the prescribers who work in a broad range of specialties, point to the need for further audits into whether claims are being paid in accordance with Medicare requirements, the IG said.
