KFF June 12, 2024
For Drugs Used to Treat Diabetes, Plans Almost Always Require Prior Authorization or Other Utilization Management
Affordable Care Act (ACA) Marketplace plans rarely cover GLP-1 drugs approved solely for obesity treatment, according to a new KFF analysis of 2024 federal plan data. Wegovy, a drug that is approved for weight loss, is covered by just 1% of Marketplace prescription drug plans, compared to 82% of Marketplace prescription drug plans for Ozempic, which contains the same active ingredient as Wegovy (semaglutide) but is approved only for diabetes.
When GLP-1 drugs are covered for diabetes treatment, almost all plans use at least one utilization management strategy to control costs, such as prior authorization or quantity limits. Of the few Marketplace plans that...
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