Diabetes, Obesity Drugs at Center of Latest CMS Medicare Part D Negotiation List

The US Department of Health and Human Services (HHS) announcement of the next 15 drugs covered under the Medicare Part D price negotiations offers a glimpse into the current state of health among the aging US population.

With 20% of the list boasting indications for type 2 diabetes or obesity, headlined by the GLP-1 receptor agonist semaglutide (Ozempic, Rybelsus, Wegovy), the list is a reflection of the growing obesity, metabolic illness crises gripping the US. Even beyond the inclusion in the list, which is composed based on Medicare Part D spending, statistics from recent studies further illustrate the burden these conditions have placed on the US public.

According to a recent study leveraging data from the nationally representative NHANES survey, nearly 140 million individuals—more than half of all US adults—could be considered eligible for semaglutide. However, other recent data from the same medical journal also suggests that in 2023, for the first time in more than a decade, the US saw a decrease in obesity prevalence, with investigators pointing to notable decreases in prevalence in the South, which had the highest observed per capita GLP-1 RA dispensing rate.

“I’m thrilled about semaglutide being in this list because we did not have a GLP one agent in the original list of 10. We did have SGLT2 inhibitors, but not GLP-1 agents," said Diana Isaacs, PharmD, Co-Director of Endocrine Disorders in Pregnancy and the Director of Education and Training in Diabetes Technology at the Cleveland Clinic, in an interview. "I think this is really huge in terms of helping people to access these medications in the future, especially now that it's being used for type 2 diabetes and for obesity.”

The inclusion of agents for type 2 diabetes is not unique to the 2025 iteration of the CMS Medicare Part D drug price negotiation list, as insulin aspart products and a pair of SGLT2 inhibitors in dapagliflozin and empagliflozin were included on the first list of 10 agents announced in August 2023.

However, as Isaacs notes in her interview with The Educated Patient, some of the other agents included on the list with indications for type 2 diabetes are no longer considered first-line options for management by many major organizations, including the American Diabetes Association. These agents, linagliptin (Tradjenta) and sitagliptin/metformin (Janumet; Janumet XR) are members of the DPP-4 inhibitor class, with the latter being a combination agent with metformin. Similarly, a DPP-4 inhibitor, sitagliptin (Januvia), was also included among the first list of agents up for Medicare Part D price negotiation.

“I am a little surprised that there are two agents that have DPP-4 inhibitors. So even in the first list, we had sitagliptin, and now we've got the Janumet, a combination of sitagliptin/metformin, then we also have Linagliptin,” explained Isaacs. “We were using these drugs a lot in the past. Now, that we have GLP-1 agents that have shown such improved outcomes and also the cardiovascular benefits, these have fallen out of favor.”