Medicaid Gross Spending on 10 Selected Diabetes and 2 Selected Weight Loss Drugs Totaled More Than $9 Billion in 2023, an Increase of 540 Percent From 2019

There has been a substantial increase in the use of certain diabetes and weight loss drugs in recent years. Certain diabetes drugs initially approved by the Food and Drug Administration (FDA) to help control blood sugar levels for individuals with type 2 diabetes are known to be highly effective weight loss agents. Similar drugs were later approved by FDA specifically for weight loss. Most State Medicaid agencies cover the diabetes drugs to treat diabetes in Medicaid enrollees, but most States do not cover the weight loss drugs or the diabetes drugs if prescribed for weight loss.

This data brief presents information about trends in national Medicaid gross spending on and utilization of 10 selected diabetes and 2 selected weight loss drugs. For this data brief, we have identified that Medicaid gross spending on these 12 selected drugs increased by 540 percent from 2019 to 2023, totaling $9.4 billion in 2023. During this same time period, utilization of the 12 drugs increased by 350 percent, totaling 11 million claims in 2023. We estimated that Medicaid gross spending on the 12 selected drugs accounted for approximately 9 percent of Medicaid spending on covered outpatient prescription drugs in 2023. We also estimated that Medicaid gross spending on the 12 selected drugs could potentially amount to over $29 billion in 2026.

This substantial increase could have a financial impact on the Medicaid program. Information in this data brief may be beneficial to the Centers for Medicare & Medicaid Services (CMS) and State Medicaid agencies when developing future program guidance related to these drugs.

Because this data brief contains no recommendations, CMS did not provide written comments on our draft data brief but did furnish technical comments, which we addressed as appropriate.

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