A new USC study suggests that publicly insured individuals who are most likely to benefit from new drugs for diabetes and obesity are less likely to get them than those with private insurance.

Prescription fills for the drug best known as Ozempic or Wegovy — semaglutide — increased by more than 400% between January 2021 and December 2023, according to research out Friday in JAMA Health Forum.

Studies show that semaglutide — approved first for Type 2 diabetes, then for weight loss — also improves blood pressure and reduces cardiovascular disease. Those problems plague millions of Americans, but the lion’s share of prescriptions went to people with private insurance.

“Given the proven cardiovascular benefits of Ozempic and Wegovy when used for diabetes or obesity, and the disproportionate burden of diabetes and obesity in Black/Latinx Medicaid and Part D populations, these findings suggest that their lower use in Medicaid and Part D may worsen disparities in diabetes and obesity outcomes,” said senior author Dima Qato, an associate professor at the USC Alfred E. Mann School of Pharmacy and Pharmaceutical Sciences and senior scholar at the USC Leonard D. Schaeffer Center for Health Policy & Economics.

Ozempic, Wegovy and Rybelsus: More than just weight-loss drugs

“I think all the current attention in the media on semaglutide’s anti-obesity effect obscures the fact that the drug is also hugely important for treating diabetes. It’s the reason why I’ve been able to get some of my patients off insulin,” said first author Christopher Scannell, a physician and postdoctoral researcher at the USC Schaeffer Center for Health Policy & Economics.

“If only certain patient populations get access to these medications — those primarily with private insurance, more generous health plans — then there’s a huge percentage of the U.S. population that isn’t getting access to these medications,” he said. “And that brings up a very significant equity issue.”

Ozempic and Wegovy are once-weekly injections; another form of semaglutide, Rybelsus, is a daily pill. Ozempic was approved in 2017, followed by Rybelsus in 2019, to treat Type 2 diabetes. Wegovy, approved in 2021, is a higher-dose version that’s specifically approved for weight loss. Ozempic’s sticker price is about $1,000 per month, while Wegovy is listed around $1,350.

For the study, researchers used data from IQVIA’s National Prescription Audit PayerTrak, which captures 92% of prescriptions filled and dispensed to individuals at retail pharmacies in the United States.

Then, they calculated monthly fills for semaglutide by drug brand (Ozempic, Wegovy and Rybelsus) and by payment method (commercial insurance, Medicaid, Medicare Part D and cash) between January 2021 and December 2023.

Prescription fills reached 2.6 million by December 2023. Ozempic persistently accounted for most of the prescriptions, but prescription fills for Wegovy soared by more than 1,361% between July 2021 and December 2023. Awareness of the drugs’ weight-loss benefits shot up in late 2022 and likely contributed to shortages of Ozempic and Wegovy, first reported by the FDA in March 2022.

• Medicaid accounted for less than 10% of semaglutide fills for all three drug brands in 2023. Access via Medicaid is a state-level decision, Scannell said. Depending on the budget — and politics — of where you live, the drugs may or may not be covered. (Medicaid provides assistance to low-income people, the elderly and some people with disabilities.)
• Medicare Part D accounted for 28.5% and 32.9% of Ozempic and Rybelsus fills, respectively, in 2023; it only accounted for 1.2% of Wegovy fills. Medicare Part D doesn’t cover the drugs for obesity unless a patient also has a comorbidity such as cardiovascular disease as well — the very problem Wegovy or Ozempic can prevent.
• Approximately 1% or less of all semaglutide fills went to people paying cash in 2023.

In the context of treating obesity, Scannell said, “If Medicare is only covering these drugs for patients who have obesity and a comorbidity, it may be forcing patients who only have obesity to develop these additional chronic conditions before they can get access to the medications. It’s like saying, ‘You have to be sick enough, then we’ll cover that medication for you.’”

The researchers said future studies should examine how changes in Medicare Part D and Medicaid coverage restrictions influence disparities in access to these essential medications. In addition, further research could examine individual-level variables such as age, race and ethnicity and whether the drugs were prescribed for obesity or diabetes.

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About this study: In addition to Scannell and Qato, other authors include John Romley and Dana Goldman of USC; and Rebecca Myerson of University of Wisconsin-Madison.

About the USC Leonard D. Schaeffer Center for Health Policy & Economics: A joint enterprise between the USC Price School of Public Policy and the USC Mann School of Pharmacy and Pharmaceutical Sciences, the USC Schaeffer Center is a flagship program of the USC Leonard D. Schaeffer Institute for Public Policy & Government Service.

Contact: Leigh Hopper at lhopper@usc.edu

Women residing in states with the most restrictive abortion policies after the Supreme Court’s reversal of Roe v Wade also experienced declines in the use of birth control pills and emergency contraceptives, according to a new USC study evaluating the impact of the decision.

The findings, which appear today in JAMA Network Open, suggest that the Dobbs v. Jackson Women’s Health Organization case has had even wider ramifications for women’s reproductive health than previously thought.

The analysis found that states that became that most restrictive after Dobbs, implementing a full ban on abortion, saw significant declines in the number of prescriptions filled for birth control pills and emergency contraceptives at retail pharmacies. These reductions weren’t observed in restrictive states whose policies were unchanged after the Dobbs decision.

Many family planning clinics with abortion services closed immediately after the Roe reversal—particularly in the most restrictive states, said lead author Dima M. Qato, the Hygeia Centennial Chair and associate professor at the USC Alfred E. Mann School of Pharmacy and Pharmaceutical Sciences of USC.

“Because 11% of women rely on such clinics for the provision of prescriptions for contraceptives – many of which are filled at outside pharmacies – these closures may have reduced access to oral and emergency contraceptives,” Qato said.

What’s more, the Supreme Court decision may also have contributed to declines in the use of emergency contraceptives due to misunderstandings about their legality. A January 2023 survey by the Kaiser Family Foundation found that half of women in full-ban states believed Plan B was illegal in their state.

This is the first national study to evaluate the impact of the court’s June 24, 2022, Dobbs decision on prescription fills for oral and emergency contraceptives in the United States.

Efforts needed to protect access

Qato led a team which examined changes in the use of prescription birth control pills and emergency contraceptives before and after the Dobbs decision. During the time period analyzed, March 2021 and October 2023, 142.8 million prescriptions for oral contraceptive pills and 904,269 prescriptions for emergency contraceptives were dispensed at U.S. retail pharmacies.

Before Roe’s reversal, trends in monthly prescription rates for oral and emergency contraception were similar between the most restrictive and least restrictive states. Then, while the case was being reviewed, more highly restrictive states saw a spike in emergency contraceptive prescriptions.

After the decision, however, the researchers found that states becoming the most restrictive experienced a 24% total decline in oral contraceptive prescriptions filled. Fills for emergency contraceptives declined by 65% in the most restrictive states compared to less restrictive ones.

“In states such as Texas and Mississippi where women now don’t even have the option to have an abortion, their access to contraception is also becoming more difficult,” said Qato. “More efforts to improve and protect access to oral contraceptives are needed, especially for emergency contraceptives in states where abortion is no longer an option.”

Researchers noted that emergency contraceptive fills post-Dobbs increased the most in Idaho, which, among states with the most restrictive abortion policies, is the only one that allows pharmacists to prescribe emergency contraceptives to women without any age restrictions.

“We saw the greatest declines in birth control pills and emergency contraceptives in states that had closed a larger share of their family planning clinics. In Texas, for example, birth control pill prescriptions declined by 28% and emergency contraceptive fills declined by 48%,” said Rebecca Myerson, a Schaeffer Fellow and assistant professor at UW Madison who worked on the study.

About this study

Data for the study came from three sources: IQVIA National Prescription Audit PayerTrak, to estimate the monthly volume of prescriptions dispensed at pharmacies at the national and state level; the 2021 American Community Survey, to determine the total population of women and girls of reproductive age; and the Guttmacher Institute, to classify each state in terms of changes in policies related to abortion restrictions between June 2022 and October 2023.

In addition to Qato and Myerson, other authors include co-author G. Caleb Alexander, professor of epidemiology and medicine at the Johns Hopkins Bloomberg School of Public Health; UC Berkeley assistant professor Jenny S. Guadamuz, a former postdoctoral research fellow at the Schaeffer Center; and USC Mann research affiliate Andrew Shoostari.

Qato directs USC Mann’s Program on Medicines and Public Health and is a senior fellow at the USC Schaeffer Center for Health Policy & Economics. The Schaeffer Center is a partnership between USC Mann and the USC Sol Price School of Public Policy.

‘More efforts to improve and protect access
to oral contraceptives are needed, especially for
emergency contraceptives in states where
abortion is no longer an option.’

— Dima Qato, USC Mann

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June 24 marks two years since the U.S. Supreme Court’s decision in Dobbs v. Jackson Women’s Health Organization, which overturned Roe v. Wade and effectively ended federal protections for the right to abortion.

USC experts are available to discuss how the landmark ruling has significantly changed reproductive rights and access across the country, and how these critical issues might shape voter behavior and decisions in the upcoming presidential election.

Contact: Nina Raffio, raffio@usc.edu or (213) 442-8464; USC Media Relations, uscnews@usc.edu or (213) 740-2215

Supreme Court blocks abortion pill ban, but experts warn legal battles are ‘far from over’

Last week, the U.S. Supreme Court unanimously rejected an effort to limit access to the abortion pill mifepristone.

“The Supreme Court gave women’s bodies a momentary reprieve from further regulation by the government by dismissing the mifepristone case on the ground that the activist doctors lacked standing. What the public needs to understand is that this is a procedural ruling and not a proclamation that the distribution of mifepristone is lawful or that birth control is protected by the Constitution,” said Aya Gruber, an expert in criminal law and procedure, violence against women and feminist legal theory.

“Plaintiffs with standing may lodge the same challenge that the FDA lacked authority to approve mifepristone. Additionally, pro-life groups are dusting off an 1800s obscenity law, the ‘Comstock Act,’ to argue for a national ban on abortion and ‘abortifacient’ drugs, equipment, and even information. This fight is far from over.”

Gruber is the Harold Medill Heimbaugh professor of law at the USC Gould School of Law.

Contact: agruber@law.usc.edu

How most Americans feel about reproductive rights

“Contrary to common speculation, American women are not the only ones in favor of policies protecting a right to choice, and there is little variation between the sexes in terms of support for abortion rights,” said Jane Junn, an expert on public opinion, political behavior, and polling methods and analysis.

“Indeed, a majority of Americans of all sexes support reproductive freedom, and the most substantial variation is by partisanship, with Republican-affiliated voters more supportive of abortion restriction. Nevertheless, even states with strong Republican majorities such as Kansas have supported policies to protect abortion rights following Dobbs. Having lost the right to choice at the federal level is a rallying point for Democratic Party voters, and will likely enhance turnout among these Americans in 2024.”

Junn is the USC Associates Chair in social sciences and professor of political science and gender and sexuality studies at the USC Dornsife College of Letters, Arts and Sciences.

Contact: junn@usc.edu

State ballot initiatives give voters a say on abortion post-Dobbs

In November, residents in Colorado, Maryland, South Dakota, and Florida will vote on abortion access initiatives, with six other states also advancing similar measures.

“Using referendums has some advantages over the more traditional legislative path. Most important, it allows citizens to overrule their elected representatives if they dislike the state’s policy choice,” wrote John Matsusaka, an expert on direct democracy and a professor of business, law and political science at USC in his 2022 op-ed in POLITICO, “Let the People Decide on Abortion.”

“Opinion surveys on abortion tell us that most Americans favor a compromise policy somewhere in between what the activists on both sides want — legal abortion in the early stages of pregnancy, with increasing prohibitions as the fetus becomes viable,” said Matsusaka, executive director of the Initiative and Referendum Institute at USC, which studies and tracks ballot measures and propositions throughout the country.

“If legislators take abortion policy in an extreme direction, a real risk in this age of hyper-polarized parties, initiatives and referendums let voters steer policy back toward the center.”

Contact: matsusak@marshall.usc.edu

Preserving access to emergency contraception

“The Dobbs decision has not only impacted access to abortion care, forcing many women in restrictive states to travel out-of-state or self-manage an abortion, but has also threatened access to contraception, which is critical to the prevention of pregnancy in states where legal abortion is no longer an option,” said Dima Qato, an expert in health policy, pharmacoepidemiology, drug safety and health disparities.

“Efforts to expand and protect access to emergency contraceptives—the only option safe and effective option to prevent a pregnancy after contraceptive failure, unprotected sexual intercourse or rape–  should be a priority for many federal and state policy and public health officials in the post-Dobbs U.S.”

Qato is the Hygeia Centennial Chair and associate professor at the USC Alfred E. Mann School of Pharmacy and Pharmaceutical Sciences and a senior fellow at  the USC Leonard D. Schaeffer Center for Health Policy and Economics.

Contact: qato@usc.edu

Additional Experts

Annalisa Enrile is an expert on gender equity, human rights, gender-based violence, and global social justice. Enrile is a teaching professor of social work at the USC Suzanne Dworak-Peck School of Social Work. Enrile has previously provided insights into how restrictive abortion policies disproportionately affect vulnerable populations of women, including victims of sex trafficking and domestic violence.

Contact: enrile@usc.edu

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Christian Grose is an expert in American government, political institutions, and the politics of the policymaking process. Grose is an associate professor at the USC Dornsife College of Letters, Arts and Sciences and academic director of the USC Schwarzenegger Institute for State and Global Policy.

Contact: cgrose@usc.edu

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Sofia Gruskin is director of the USC Institute on Inequalities in Global Health with joint appointments at the Keck School of Medicine of USC, USC Gould School of Law, and USC Dornsife Spatial Sciences Institute.

Contact: gruskin@usc.edu

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Brian Nguyen is an associate professor of clinical obstetrics and gynecology at the Keck School of Medicine of USC. Nguyen’s research focuses on men’s access to emergency contraception, disparities in the use of vasectomy, and men’s experiences of unintended pregnancy and abortion.

Contact: nguyenbt@usc.edu

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Mindy Romero is a research assistant professor and the founder and director of the Center for Inclusive Democracy at the USC Price School of Public Policy. She is an expert in political sociology, political behavior, voting rights and civic engagement.

Contact: msromero@usc.edu

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(Photo/iStock)