Prevalence of Obesity and Related Conditions and GLP-1 Use in Medicare Fee-for-Service Beneficiaries.
Only 6.2% of Medicare beneficiaries with Part D are using GLP-1 RAs, highlighting a gap between eligibility and actual treatment uptake.
Where it sits
this study against the rest of the albiglutide corpusSummary and findings
This study estimated the prevalence of GLP-1 receptor agonist (RA) use among Medicare fee-for-service beneficiaries. Among 16,474,786 beneficiaries with Part D, 6.2% were using GLP-1 RAs. The study highlights the potential for broader access to anti-obesity medications if additional conditions are covered by Medicare.
Abstract
<h4>Aims</h4>This study estimated the number and percentage of Medicare fee-for-service (FFS) beneficiaries who use GLP-1 RAs, are currently eligible or could become eligible if ongoing-trial indications receive approval and coverage.<h4>Materials and methods</h4>This retrospective cohort study used Medicare enrolment and claims data, representing 100% of Medicare FFS beneficiaries. The study period was 1 January 2023 through 31 December 2024. Patients aged ≥ 18 years at the beginning of the study period who were alive and continuously enrolled in Medicare FFS Parts A, B and D for all 24 months were included.<h4>Results</h4>Among Medicare FFS beneficiaries with Part D (n = 16 474 786), 6.2% had GLP-1 RAs. Overall, 35.1% had a currently covered GLP-1 indication (Type 2 diabetes, established cardiovascular disease with overweight/obesity, obstructive sleep apnoea with obesity or metabolic dysfunction-associated steatohepatitis). Among beneficiaries with a condition currently covered by Medicare, only 16.5% had a claim for a GLP-1 RA. In total, 76.9% had ≥ 1 currently covered or potential future indication. An estimated 1.2 million (7.0%) had obesity alone and were ineligible under current policy. If Medicare covered heart failure with preserved ejection fraction, chronic kidney disease, psoriasis and/or knee osteoarthritis, 35% of these currently ineligible beneficiaries (n = 407 085) could gain access.<h4>Conclusions</h4>Coverage via secondary conditions may broaden potential access to anti-obesity medications for Medicare FFS patients, but eligibility alone may not translate into actual treatment uptake unless affordability and other barriers are addressed. Further studies should quantify net benefits and costs of AOMs in Medicare FFS.
Background
This paper addresses the prevalence of obesity and related conditions among Medicare beneficiaries and the use of GLP-1 receptor agonists (RAs) in this population. Prior knowledge indicated that GLP-1 RAs are effective for managing obesity and related metabolic conditions, but their uptake in specific populations like Medicare beneficiaries was unclear. Understanding the current usage patterns and potential eligibility for treatment is critical for addressing obesity in older adults.
Methods
This retrospective cohort study utilized Medicare enrolment and claims data, representing 100% of Medicare fee-for-service beneficiaries. The study included patients aged ≥ 18 years who were alive and continuously enrolled in Medicare FFS Parts A, B, and D for all 24 months from January 1, 2023, to December 31, 2024. Primary outcome measures included the percentage of beneficiaries using GLP-1 RAs and those eligible for treatment based on current Medicare coverage.
Results
Among the 16,474,786 Medicare FFS beneficiaries with Part D, 6.2% were reported to be using GLP-1 RAs. Of these beneficiaries, 35.1% had a currently covered indication for GLP-1 RA use. Notably, only 16.5% of those with a covered condition had a claim for a GLP-1 RA. Additionally, 76.9% of beneficiaries had at least one currently covered or potential future indication for treatment. An estimated 1.2 million beneficiaries had obesity alone and were ineligible under current policy, with 35% of these (n=407,085) potentially gaining access if additional conditions were covered.
Interpretation
The findings indicate that while a small percentage of Medicare beneficiaries are using GLP-1 RAs, a significant number are eligible based on current or potential future indications. However, the low percentage of those with a covered condition who actually had a claim for GLP-1 RA suggests barriers to treatment uptake. This study's reliance on claims data may limit the understanding of actual patient experiences and outcomes, which are crucial for evaluating the effectiveness of these medications in practice.
Key findings
- 6.2% of Medicare FFS beneficiaries with Part D (n=16,474,786) had GLP-1 RAs.
- 35.1% had a currently covered GLP-1 indication.
- Only 16.5% of beneficiaries with a covered condition had a claim for a GLP-1 RA.
- 76.9% had ≥ 1 currently covered or potential future indication.
- 1.2 million (7.0%) had obesity alone and were ineligible under current policy.
- 35% of currently ineligible beneficiaries (n=407,085) could gain access if additional conditions were covered.
Limitations
- Relies on claims data, which may not reflect actual treatment uptake.
- Does not assess patient outcomes or experiences with GLP-1 RAs.
- Short study period may not capture long-term trends in treatment.
- Potential confounding factors not addressed in the analysis.