OBJECTIVE
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.
There is 1 project in this series.
ACTIVE PROJECTS IN THIS SERIES (1)
Audit of Diabetes Drugs Under Medicare Part D
TIMELINE
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March 15, 2024Series Number SRS-A-26-010 Assigned
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March 15, 2024Project Announced
Audit of Diabetes Drugs Under Medicare Part D - WA-24-0035
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Today1 Project In-Progress
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Est FY2026Estimated Fiscal Year for Series Completion