Limited Access to Cardioprotective Medications for Medicaid Enrollees with Diabetes

Recent research has revealed that a significant number of Medicaid enrollees living with type 2 diabetes face considerable restrictions in accessing essential cardioprotective medications, specifically sodium-glucose cotransporter-2 inhibitors (SGLT2is) and glucagon-like peptide-1 receptor agonists (GLP-1 RAs). The findings, published in the Annals of Internal Medicine, highlight the disparities in medication availability among different Medicaid plans.

The study conducted by a team from UCSF at San Francisco General Hospital assessed the availability of these medications across all 50 state Medicaid fee-for-service (FFS) plans and a selection of 273 managed care organization (MCO) plans as of March 2024. The researchers used dipeptidyl peptidase-4 inhibitors (DPP4is) as a benchmark to measure the unrestricted availability of SGLT2is and GLP-1 RAs.

Results indicated that while 80% of FFS plans offered unrestricted access to SGLT2 inhibitors, only 60% provided the same for GLP-1 receptor agonists. A total of 82% of these plans had unrestricted access to either medication, and 58% allowed access to both. Comparatively, 84% of FFS plans offered unrestricted access to DPP4 inhibitors. In the case of MCO plans, 67% had access to SGLT2is, while only 48% provided access to GLP-1 RAs. Furthermore, 67% of MCO plans allowed access to either medication, and 47% provided access to both. The availability of DPP4 inhibitors in MCO plans was higher, with 75% having unrestricted access.

Marked variations were observed across states, particularly concerning the proportion of enrollees with access to these medications. For instance, the availability of SGLT2 inhibitors among MCO enrollees ranged from as low as 24% to as high as 100%, while GLP-1 receptor agonists varied from 0% to 99%. Additionally, 25% of enrollees faced restrictions for SGLT2is, 40% for GLP-1 RAs, and 22% for DPP4is, primarily due to the constraints imposed by MCOs. Notably, access to GLP-1 RAs in MCOs has plateaued at under 60% since 2022, despite a general increase in availability from 2020 to 2024.

The research suggests that formulary plan coverage may serve as a critical tool to address health disparities faced by low-income Medicaid enrollees with diabetes, emphasizing the need for policy changes to improve access to these vital medications.

For more detailed information, refer to the study titled Availability of Cardioprotective Medications for Type 2 Diabetes in the Medicaid Program published in the Annals of Internal Medicine.