医疗补助中的GLP-1激动剂：利用、生长和管理

1 January 20242 GLP-1 agonists in Medicaid:Utilization, growth, and management2January 2024$-$0.50$1.00$1.50$2.00$2.50$3.00$3.50$4.00$4.50201720182019202020212022Q1 2023 - Q32023Gross Medicaid Spend (in billions)TRULICITYVICTOZAOZEMPICWEGOVYSAXENDARYBELSUSBYETTAMOUNJAROBYDUREON BCISEThe active ingredients in some GLP-1 agonists indicated for type 2 diabetes are the same active ingredient approved for chronic weightmanagement, although dosing may differ between products. For example, Wegovy® (semaglutide), approved for chronic weightmanagement, shares the same active ingredient as Ozempic® (semaglutide) and Rybelsus® (semaglutide), which are approved for thetreatment of type 2 diabetes.RECENT GROWTH AND MARKET DEMANDWhile the first approval of GLP-1 agonists dates back to 2005, there has been a significant increase in utilization and demand for drugsin the GLP-1 therapeutic class in the last few years. Novo Nordisk®, the manufacturer of Ozempic and Wegovy, projects 2023 full-yearsales of these products to grow between 32% and 38% year-over-year, despite availability issues during the year.iiThis recent growthcan be attributed to published outcomes of this drug class, success stories, growing popularity on social media, and the explosion oftelehealth and digital health companies offering prescriptions for GLP-1s as part of a comprehensive weight loss program.iiiBased on our analysis of State Drug Utilization Data,3Medicaid has observed growth in GLP-1 agonist utilization and spend. Figure 2illustrates the year-over-year Medicaid spend on GLP-1 agonists by drug. GLP-1 agonists represented nearly $4.1 billion (4.6%) ingross Medicaid spend in 2022 and reached $4.0 billion (6.7%) through the third quarter of 2023.FIGURE 2: GROSS MEDICAID SPEND BY YEAR FOR GLP-1 AGONISTS* (IN BILLIONS)iv* Data from 2023 includes data through Q3 and likely does not have complete runout. Zepbound is not included because it was not available during the time period studied.Notably, between 2019 and 2022, Trulicity (dulaglutide) and Ozempic, indicated for the treatment of type 2 diabetes, observed a 278%and 405% increase in prescription volume per 1,000 Medicaid enrollees, respectively. Saxenda® (liraglutide), indicated for chronicweight management, observed a 543% increase in prescription volume per 1,000 during the same time period, which may be partiallydriven by states expanding coverage of weight loss products and changes in clinical practice guidelines.v,viA summary of Medicaidscript volume per 1,000 enrollees for select GLP-1 agonists can be found in Figure 3.3Includes data from all state Medicaid programs for covered outpatient drugs. GLP-1 agonists in Medicaid:Utilization, growth, and managementDRIVERS OF GLP-1 AGONIST UTILIZATION GROWTHMedicaid has experienced continued growth in GLP-1 agonist utilization, driven by robust demand for drugs to treat type 2 diabetes andobesity and overweight diagnoses, the expansion of coverage for GLP-1 agonists for chronic weight management, expanded uses, newproduct approvals, and potential off-label utilization.Off-label UtilizationAs public interest in GLP-1 agonists grows, off-label utilization has become a concern for state Medicaid agencies and managed careorganizations. States lacking utilization management for drugs in the GLP-1 agonist therapeutic class may encounter increasedchallenges with off-label utilization. For example, formulations indicated specifically for type 2 diabetes (i.e., Ozempic) may beprescribed off-label for chronic weight management. Although not specific to Medicaid, an analysis examining the proportion ofOzempic utilizers with a diagnosis of type 2 diabetes from 2018 to 2021 found that those with a diabetes or prediabetes diagnosisdecreased from 92% to 77% over the same time period. Additionally, the percentage of new Ozempic utilizers with an obesitydiagnosis, but no evidence of a diabetes or prediabetes diagnosis, increased from 4% to 13% over the same time period.viiiPayershave indicated that they are monitoring off-label utilization to manage this trend. For instance, Anthem Blue Cross Blue Shield’s SpecialInvestigations Unit proactively addressed instances where prescribers across multiple states were prescribing Ozempic to patientswithout sufficient evidence of diabetes by sending educational letters.PipelineGLP-1 agonist Medicaid utilization may continue to grow as new GLP-1 agonists are approved and currently available therapies areapproved for expanded indications. For example:Studies are underway for new GLP-1 agonists, such as subcutaneously administered retatrutide and orally administered orforglipronwith some Phase III clinical trials anticipated to be completed in early 2024. 3January 2024ixx GLP-1 agonists in Medicaid:Utilization, growth, and management4January 2024GLP-1 agonists approved by the U.S. Food and Drug Administration (FDA) are also being studied for a wide range of expandedindications, such as Alzheimer’s disease, heart failure