Effects of Ozempic Reimbursement Policy Changes on Ozempic Utilization and Glycemic Control in Type 2 Diabetes
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Abstract
In November 2024, Denmark tightened its reimbursement policy for glucagon-like peptide-1 receptor agonists (GLP-1RAs) for type 2 diabetes (T2D), such as semaglutide (Ozempic), because of rising use and escalating costs. Previously, reimbursement for GLP-1RAs was broadly available to patients with T2D who were inadequately controlled on standard antihyperglycemic therapy or unable to use other antihyperglycemic drugs. Under the new policy, reimbursement is restricted to two groups with T2D: (1) patients who cannot use sodium-glucose co-transporter 2 inhibitors (SGLT2is) due to intolerance or severe renal impairment, and who either have cardiovascular or kidney disease (regardless of glycemic control) or have multiple cardiovascular risk factors with inadequate glycemic control on metformin; and (2) patients who have not achieved adequate glycemic control despite treatment with all relevant oral antihyperglycemic drugs, including SGLT2is. Consequently, many Danish patients with T2D were required to discontinue GLP-1RA treatment and switch to other drugs, raising questions about how these changes might have affected diabetes care. GLP-1RAs and SGLT2is are both effective antihyperglycemic drugs that reduce cardiovascular events and mortality; however, their profiles differ in clinically meaningful ways. GLP-1RAs appear to be more effective in reducing stroke, whereas SGLT2is seem superior in preventing heart-failure hospitalizations and slowing kidney-disease progression, although large head-to-head trials are lacking. At T2D-indicated doses, GLP-1RAs provide greater HbA1c reductions and slightly more weight loss than SGLT2is. While SGLT2is are recommended alternatives to GLP-1RAs, the sudden restriction of GLP-1RA access may have adversely affected short-term glycemic control, even if such changes do not necessarily translate into long-term trends. Following this reimbursement policy change, it is important to understand how patients adjusted their treatments and if reimbursement-related treatment switches led to changes in glycemic control. Given that Ozempic accounted for the majority of GLP-1RA use for T2D in Denmark during the study period, this study focuses on patients treated with Ozempic. Specifically, we will address two complementary questions to evaluate the impact of the policy on Ozempic. First, we will assess the number of Ozempic-treated patients who changed their treatment and compare these patients with those who did not, with respect to baseline patient characteristics and prior treatment patterns. Among patients who changed treatment, we will describe the therapies they switched to. For patients who continued treatment with Ozempic, we will assess whether continuation was consistent with the reimbursement policy. Second, we will evaluate the impact on glycemic control by analyzing within-person HbA1c changes, with and without Ozempic treatment. Together, these analyses will provide insight into the implementation of the reimbursement policy and its short-term consequences.