Limited Access to SGLT2 Inhibitors and GLP-1 Receptor Agonists Among Medicaid Enrollees

A recent study reveals that many Medicaid enrollees with type 2 diabetes face restricted access to vital cardioprotective medications, notably sodium-glucose cotransporter-2 inhibitors (SGLT2 inhibitors) and glucagon-like peptide-1 receptor agonists (GLP-1 RAs). Published online on April 22 in the Annals of Internal Medicine, the research highlights significant disparities in medication availability across different Medicaid plans. The study assessed coverage by examining all 50 state Medicaid fee-for-service (FFS) plans and 273 managed care organization (MCO) plans for nonelderly adults as of March 2024.

Findings show that while 80% of FFS plans provide unrestricted access to SGLT2 inhibitors, only 60% offer unrestricted access to GLP-1 RAs. Overall, 82% of plans offered either medication without restrictions, but only 58% allowed unrestricted access to both. Coverage of dipeptidyl peptidase-4 inhibitors (DPP-4is), another class of diabetes medication, was higher, with 84% of plans providing unrestricted access. Among MCO plans, 67% had availability of SGLT2 inhibitors, and 48% offered GLP-1 RAs without restrictions, with considerable variability among states—ranging from 24% to 100% for SGLT2 inhibitors and 0% to 99% for GLP-1 RAs.

The study also notes that restricted medication access often results from specific MCO restrictions, and overall availability has improved from 2020 to 2024, especially within FFS plans. However, since 2022, GLP-1 RA coverage in MCO plans has plateaued below 60%. Notably, the medication tirzepatide remains nearly entirely restricted.

According to the authors, formulary plan coverage is a critical lever for addressing health inequities, especially for low-income Medicaid populations dealing with diabetes. Enhancing formulary access could significantly improve health outcomes and reduce disparities.

This research underscores the need for policy changes to improve access to these essential medications, which are proven to lower cardiovascular risks and aid in diabetes management.

Source: https://medicalxpress.com/news/2025-04-medicaid-enrollees-restricted-access-sglt2.html