Article Impact Level: HIGH Data Quality: STRONG Summary of Annals of Internal Medicine, ANNALS-24-01449. https://doi.org/10.7326/ANNALS-24-01449 Dr. Anil N. Makam et al.
Points
- This study evaluated how widely available SGLT2 inhibitors and GLP-1 receptor agonists are in Medicaid plans compared to DPP4 inhibitors, focusing on their inclusion without restrictions like prior authorization.
- As of March 2024, 80 percent of state Medicaid fee-for-service plans offered SGLT2 inhibitors without restrictions, while only 60 percent offered the same access to GLP-1 receptor agonists.
- Among Medicaid managed care plans, 67 percent allowed unrestricted access to SGLT2 inhibitors and 48 percent allowed unrestricted access to GLP-1 receptor agonists, showing lower availability compared to fee-for-service plans.
- Access varied widely by state, with some having nearly complete access and others offering none, leaving many enrollees with restricted availability to these cardioprotective treatments.
- The findings emphasize that gaps remain in Medicaid coverage for GLP-1 receptor agonists despite some improvements, calling for policy adjustments to enhance equitable access to these vital medications.
Summary
This study aimed to assess the unrestricted availability of sodium-glucose cotransporter-2 inhibitors (SGLT2is) and glucagon-like peptide-1 receptor agonists (GLP-1 RAs) in Medicaid, comparing this with the availability of dipeptidyl peptidase-4 inhibitors (DPP4is) as a benchmark. The data came from 50 state Medicaid fee-for-service (FFS) plans and 273 managed care organization (MCO) plans as of March 2024. Unrestricted availability was defined as having at least one medication from each class on the preferred drug list without requiring prior authorization or step therapy.
Results showed that, among FFS plans, 80% had unrestricted availability of SGLT2is, and 60% had unrestricted availability of GLP-1 RAs. In comparison, 67% of MCO plans provided unrestricted access to SGLT2is, while only 48% provided unrestricted access to GLP-1 RAs. The study found considerable variability in availability across states, with the proportion of enrollees with access to SGLT2is ranging from 24% to 100%, and for GLP-1 RAs, it ranged from 0% to 99%. Notably, 25% of MCO enrollees had restricted access to SGLT2is, 40% had restricted access to GLP-1 RAs, and only 22% had restricted access to DPP4is.
The study concluded that many Medicaid enrollees have limited access to cardioprotective medications, particularly GLP-1 RAs, with substantial state-to-state variation. While availability has increased from 2020 to 2024, especially in FFS plans, access to GLP-1 RAs in MCOs has plateaued at less than 60%. These findings suggest that expanding formulary coverage in Medicaid programs could help increase access to these essential medications while managing pharmaceutical costs.
Link to the article: https://www.acpjournals.org/doi/10.7326/ANNALS-24-01449
References Makam, A. N., Bailey, L., Anderson, N., Bellitti, K., Skinner, S., & Nguyen, O. K. (2025). Availability of cardioprotective medications for type 2 diabetes in the medicaid program. Annals of Internal Medicine, ANNALS-24-01449. https://doi.org/10.7326/ANNALS-24-01449
