Studies from University of California San Francisco (UCSF) Provide New Data on Type 2 Diabetes (Availability of Cardioprotective Medications for Type 2 Diabetes In the Medicaid Program): Nutritional and Metabolic Diseases and Conditions – Type 2 Diabetes

2025 MAY 21 (NewsRx) -- By a News Reporter-Staff News Editor at Insurance Daily News -- Fresh data on Nutritional and Metabolic Diseases and Conditions - Type 2 Diabetes are presented in a new report. According to news reporting originating in San Francisco, California, by NewsRx journalists, research stated, “Sodium-glucose cotransporter-2 inhibitors (SGLT2is) and glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are the only type 2 diabetes medications that reduce cardiovascular disease and death, yet their availability in Medicaid is unclear. To assess the unrestricted availability of SGLT2is and GLP-1 RAs, using dipeptidyl peptidase-4 inhibitors (DPP4is) as a benchmark.”

Financial support for this research came from University of California, San Francisco, Action Research Center for Health Equity.

The news reporters obtained a quote from the research from the University of California San Francisco (UCSF), “National cross-sectional study using publicly available data. All 50 state Medicaid fee-for-service (FFS) plans and 273 nonelderly adult managed care organization (MCO) plans with comprehensive coverage in March 2024. Medicaid plans and enrollees with diabetes in those plans as of March 2024. Unrestricted availability was defined as having at least 1 medication in each class listed on the preferred drug list without prior authorization or step therapy. Of 50 FFS plans (including Washington, DC, and excluding 1 state, which had 5 MCO plans), 40 (80%) had unrestricted availability of SGLT2is, 30 (60%) of GLP-1 RAs, 41 (82%) of either, 29 (58%) of both, and 42 (84%) of DPP4is. Among 273 MCO plans (39 states; median, 6 plans [range, 2 to 24 plans]), 182 (67%) had availability of SGLT2is, 131 (48%) of GLP-1 RAs, 184 (67%) of either, 129 (47%) of both, and 204 (75%) of DPP4is. The proportion of MCO enrollees with availability varied markedly among states (SGLT2i range, 24% to 100%; GLP-1 RA range, 0% to 99%; DPP4i range, 41% to 100%). Primarily because of more MCO restrictions, 1.7 million enrollees (lower to upper bound, 1.33 million to 2.17 million enrollees; 25%) had restricted SGLT2i availability, 2.72 million (lower to upper bound, 2.12 million to 3.45 million; 40%) had restricted GLP-1 RA availability, and 1.5 million (lower to upper bound, 1.17 million to 1.90 million; 22%) had restricted DPP4i availability. Availability increased from 2020 to 2024, especially in FFS, but MCO GLP-1 RA availability has plateaued at below 60% since 2022. Tirzepatide was almost entirely restricted. Diabetes enrollment was estimated using plan size and state and national prevalence data. The appropriateness of prior authorization restrictions was unknown. Many Medicaid enrollees have restricted access to cardioprotective medications, particularly in MCO plans for GLP-1 RA medications, with substantial state variation.”

According to the news reporters, the research concluded: “Formulary coverage is a potential lever to increase availability of these medications while balancing pharmaceutical costs.”

This research has been peer-reviewed.

For more information on this research see: Availability of Cardioprotective Medications for Type 2 Diabetes In the Medicaid Program. Annals of Internal Medicine, 2025. Annals of Internal Medicine can be contacted at: Amer Coll Physicians, Independence Mall West 6TH And Race St, Philadelphia, Pa 19106-1572, United States.

Our news correspondents report that additional information may be obtained by contacting Anil N. Makam, University of California San Francisco (UCSF) San Francisco Gen Hosp, Division of Hospital Medicine, San Francisco, CA, United States. Additional authors for this research include Oanh Kieu Nguyen, Logan Bailey, Nigel Anderson, Kathy Bellitti and Sasha Skinner.

The direct object identifier (DOI) for that additional information is: https://doi.org/10.7326/ANNALS-24-01449. This DOI is a link to an online electronic document that is either free or for purchase, and can be your direct source for a journal article and its citation.

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