Many Medicaid Enrollees Have Restricted Access to SGLT2 Inhibitors, GLP-1 Receptor Agonists
By Elana Gotkine HealthDay Reporter
WEDNESDAY, April 30, 2025 -- Many Medicaid enrollees with type 2 diabetes have restricted access to cardioprotective medications, including sodium-glucose cotransporter-2 inhibitors (SGLT2is) and glucagon-like peptide-1 receptor agonists (GLP-1 RAs), according to a study published online April 22 in the Annals of Internal Medicine.
Using dipeptidyl peptidase-4 inhibitors (DPP4is) as a benchmark, Anil N. Makam, M.D., from UCSF at San Francisco General Hospital, and colleagues examined the unrestricted availability of SGLT2is and GLP-1 RAs. All 50 state Medicaid fee-for-service (FFS) plans and 273 nonelderly adult managed care organization (MCO) plans with comprehensive coverage in March 2024 were included in the study.
The researchers found that 80 percent of 50 FFS plans had unrestricted availability of SGLT2is, 60 percent had unrestricted availability of GLP-1 RAs, 82 percent had unrestricted availability of either, 58 percent had unrestricted availability of both, and 84 percent had unrestricted availability of DPP4is. Overall, 67 percent of MCO plans had availability of SGLT2is, 48 percent had availability of GLP-1 RAs, 67 percent had availability of either, 47 percent had availability of both, and 75 percent had availability of DPP4is. There was marked variation observed among states in the proportion of MCO enrollees with availability (SGLT2i range, 24 to 100 percent; GLP-1 RA range, 0 to 99 percent; DPP4i range, 41 to 100 percent). Restricted availability was seen in 25, 40, and 22 percent of enrollees for SGLT2is, GLP-1 RAs, and DPP4is, respectively, mainly due to more MCO restrictions. From 2020 to 2024, availability increased, especially in FFS; GLP-1 RA availability in MCOs plateaued at less than 60 percent since 2022. Tirzepatide was almost totally restricted.
"Formulary plan coverage is a potential lever to mitigate health inequities for low-income Medicaid enrollees with diabetes," the authors write.
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Posted April 2025
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