Many Medicaid enrollees have restricted access to SGLT2 inhibitors, GLP-1 receptor agonists

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% of 50 FFS plans had unrestricted availability of SGLT2is, 60% had unrestricted availability of GLP-1 RAs, 82% had unrestricted availability of either, 58% had unrestricted availability of both, and 84% had unrestricted availability of DPP4is. Overall, 67% of MCO plans had availability of SGLT2is, 48% had availability of GLP-1 RAs, 67% had availability of either, 47% had availability of both, and 75% had availability of DPP4is. There was marked variation observed among states in the proportion of MCO enrollees with availability (SGLT2i range, 24 to 100%; GLP-1 RA range, 0 to 99%; DPP4i range, 41 to 100%). Restricted availability was seen in 25%, 40%, and 22% 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% 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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