Availability of Cardioprotective Medications for Type 2 Diabetes in the Medicaid Program
Authors' conclusion
Many Medicaid enrollees have restricted access to cardioprotective medications, particularly in MCO plans for GLP-1 RA medications, with substantial state variation. Formulary coverage is a potential lever to increase availability of these medications while balancing pharmaceutical costs.
Study context
- Population
- Medicaid plans and enrollees with diabetes in those plans, March 202450 fee-for-service (FFS) and 273 managed care organization (MCO) plans
- Participants
- 50 vs 273
- Exposure
- Unrestricted availability of SGLT2i and GLP-1 RA vs DPP-4i (benchmark) in Medicaid FFS and MCO plans
- FFSn = 50
- MCOn = 273
- Outcome
- Unrestricted availability: ≥1 medication in each class on the preferred drug list without prior authorization or step therapy
- Follow-up
- March 2024
Methodological detailsnational, publicly available data, Diabetes enrollment estimated using plan size and state and national prevalence data
- National
- Publicly available data
- Diabetes enrollment estimated using plan size and state and national prevalence data
Main finding
As reported in the abstract
Unrestricted availability by drug class
- FFS plans with SGLT2i availability
- 40 (80%)
- FFS plans with GLP-1 RA availability
- 30 (60%)
- FFS plans with either
- 41 (82%)
- FFS plans with both
- 29 (58%)
- FFS plans with DPP-4i availability
- 42 (84%)
- MCO plans with SGLT2i availability
- 182 (67%)
- MCO plans with GLP-1 RA availability
- 131 (48%)
- MCO plans with either
- 184 (67%)
- MCO plans with both
- 129 (47%)
- MCO plans with DPP-4i availability
- 204 (75%)
Observational data: associations, not effects.
Further findings
Proportion of MCO enrollees with availability across states
- SGLT2i range
- 24% to 100%
- GLP-1 RA range
- 0% to 99%
- DPP-4i range
- 41% to 100%
Enrollees with restricted availability
- Restricted SGLT2i (lower to upper bound 1.33 million to 2.17 million)
- 1.7 million (25%)
- Restricted GLP-1 RA (lower to upper bound 2.12 million to 3.45 million)
- 2.72 million (40%)
- Restricted DPP-4i (lower to upper bound 1.17 million to 1.90 million)
- 1.5 million (22%)
- Primarily because of more MCO restrictions
Trends 2020–2024
- Availability increased from 2020 to 2024, especially in FFS; MCO GLP-1 RA availability plateaued below 60% since 2022
- Tirzepatide was almost entirely restricted
Original publication
Availability of Cardioprotective Medications for Type 2 Diabetes in the Medicaid Program. Ann Intern Med. Published 22 April 2025. doi:10.
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