RD208 - Medicaid Expenditures for Diabetic and Weight Loss Drugs – March 21, 2024


Executive Summary:

Weight loss Medications: Glucagon-Like Peptide 1 (GLP1) medications are utilized more often for weight loss than non GLP1 medications. Utilization of GLP1 medications for weight loss have increased in the last quarter for Fee For Service (FFS) members and most Managed Care Organizations (MCOs), except for United Health Care. All MCO and FFS share the same criteria.

Diabetes Medications: GLP1utilization for Diabetes has increase on average 2,000 claims for all MCOs except HealthKeepers, utilization in FFS doubled which is likely a factor of fluctuations of the FFS population during redeterminations.

Utilization of Wegovy was impacted by manufacturer shortage. Stricter guidelines to prevent off label use of Ozempic became effective in Q4. Mounjaro was approved for weight loss under the name of Zepbound in Q4, which is non-preferred on the PDL and only available if there was a trial and failure of preferred products. Utilization for weight loss will be added to this report in Q4.