Canagliflozin Hemihydrate

Medicare Part D spending on leading diabetes medications has reached unprecedented levels, with expenditure skyrocketing from $7.7 billion in 2019 to $35.8 billion in 2023 — translating to a 364% increase over the five-year period, according to newly released data.Auditors from the US Department of Health and Human Services' Office of Inspector General (OIG) identified and analysed Medicare Part D data for 10 widely prescribed type 2 diabetes medications, comprising seven GLP-1s and three SGLT-2 inhibitors, across the US and five overseas territories between January 2019 and December 2023. The analysis looked at utilisation metrics and spending patterns, drawing comparisons with metformin as a baseline therapy. GLP-1s lead uptickDuring the audit period, Medicare Part D expenditure for selected drugs totalled $92.8 billion, with six medications exhibiting substantial spending increases, led by GLP-1 products. Spending on Novo Nordisk's Rybelsus (semaglutide) jumped from $366,000 in 2019 to approximately $1.7 billion by 2023 — a 2182% increase — whereas Ozempic (semaglutide) expenditures increased nearly 16-fold from $552 million to $9.2 billion over the same period, with the number of beneficiaries receiving the medication rising by 929%. Meanwhile, Eli Lilly's Mounjaro (tirzepatide) showed 1541% spending growth in just its second year of coverage.The OIG noted that given a number of the medicines are commonly used off-label for other conditions, notably obesity, their increased use warrants "further inquiry to determine whether…the associated drugs were utilised for medically accepted indications." Meanwhile, TD Cowen analyst Rick Weissenstein suggested that "the data brief may provide ammunition for HHS Secretary Robert Kennedy Jr. and others who see the surge in GLP-1 use as a symptom of 'overmedication' more generally in the US."In contrast, use and spending on Novo's Victoza (liraglutide), Johnson & Johnson's Invokana (canagliflozin), as well as AstraZeneca's Byetta (exenatide) and Bydureon (exenatide extended-release), declined from 2019 to 2023, likely due to the introduction of newer alternatives. In addition, metformin expenditure decreased by 5% from $661 million in 2019 to $628 million in 2023.Spending growth outpaces enrolmentAccording to the analysis, the growth of the selected medications significantly outpaced the 12% increase in Medicare Part D enrolment during the same timeframe, raising concerns about the long-term financial sustainability of the programme. The report suggests that even if spending grows at the minimum observed annual rate of 42% during the five-year period, it could exceed $102 billion for the 10 drugs in 2026. “This substantial increase could have a financial impact on the Medicare programme,” the auditors noted in the report, adding that these findings “may be beneficial to CMS and other policymakers when developing future programme guidance related to these drugs.”Both Ozempic and Rybelsus made it on to the expanded list of medicines selected for the second round of Medicare price negotiations, drawn up by the outgoing Biden administration last month.

The use of a subset of common diabetes drugs skyrocketed in the US Medicare program over a five-year period ending in 2023, according to a new report from the HHS inspector general. The report looked at two widely used classes of diabetes drugs: GLP-1s like Novo Nordisk’s Ozempic, and SGLT-2 drugs including Johnson & Johnson’s Invokana. It found huge growth in the GLP-1 class, with the number of Medicare patients on Ozempic and Rybelsus, another GLP-1 from Novo, rising more than 900% each over that period. The analysis also looked at spending on the products — but with some limitations. Upfront Part D spending on the drugs in 2023 totaled $35.8 billion, with Novo Nordisk’s flagship product Ozempic accounting for more than a quarter of that. But the total is based on list prices and doesn’t include the significant rebates paid by drugmakers, which if included would likely slash the reported amounts. While the number of prescribers of these drugs has grown considerably, who is prescribing the drugs has changed, too. “The prescribers of the diabetes drugs came from a broad range of specialties, primarily internal medicine and endocrinologists, but also including dentists, optometrists, chiropractors, and acupuncturists,” the report found. The agency inspector general projected that if the rate of utilization and spending continues at a similar pace, then annual spending on the same 10 drugs could eclipse $100 billion by 2026, based on list prices and not including rebates. Analysts at TD Cowen said in an investor note Tuesday that the auditing of the drugs was a “minor fundamental risk to GLP-1 uptake.” If anything, they said, it may throw more cold water on an already sluggish effort to expand Medicare’s coverage to include some patients with obesity. “Probably the greatest concern for Novo and Lilly should come in the signal that this report sends as it relates to the government’s cost concerns and its broader stance toward GLP-1s,” the note said.