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Audit of Diabetes Drugs Under Medicare Part D

In 2022, six type 2 diabetes drugs accounted for more than half of all Medicare Part D payments for diabetes drugs. Diabetes drugs are meant to lower blood sugar levels and often result in weight loss. Part D spending for one of these six drugs, Ozempic, more than tripled between 2020 and 2022, with expenditures jumping from $1.5 billion to $4.6 billion. Other diabetes drugs are experiencing similar growth and could overshadow Ozempic. Part D payments for a type 2 diabetes drug, such as Ozempic, for a use that Medicare does not cover as a medically accepted indication is not in compliance with Medicare requirements and presents an opportunity for fraudulent, excessive, or unnecessary Part D payments. Furthermore, drugs that are used for weight loss are specifically excluded from Medicare Part D coverage. We will obtain Part D data for prescribed diabetes drugs and any related Part B service claims. We will determine whether they were billed according to Medicare requirements.

Announced or Revised Agency Title Component Report Number(s) Expected Issue Date (FY)
March 2024 Centers for Medicare and Medicaid Services Audit of Diabetes Drugs Under Medicare Part D Office of Audit Services WA-24-0035 (W-00-24-35910) 2025