OBJECTIVES:

Obesity is universally recognized as the fastest-growing public health challenge. This study examined trends in utilization, pricing, and spending of all the available AOMs for the US Medicaid population.

METHODS:

Using national summary files for outpatient drug utilization and expenditure, we extracted data on AOMs from the Centers for Medicare & Medicaid Services for the period between 1999 to 2021. We conducted a retrospective drug utilization study to examine the annual trends of the number of prescriptions, reimbursement expenditures, and the prices of AOMs. The study drugs included (Xenical® - Alli® - Qsymia® - Contrave®, and Saxenda®). Data were analyzed annually and categorized by total prescriptions (utilization), total reimbursement (spending), and cost per prescription as the proxy for each drug's price.

RESULTS:

The total number of prescriptions for AOMs increased rapidly after the FDA approved Qsymia medication in 2012. The number of prescriptions peaked in 2017 then it started to decrease. In 2020, we found a dramatic drop in the number of prescriptions for all studied medications, followed by an increasing trend in 2021. Noticeably, the reimbursements for Qsymia-Contrave-Saxenda medications started taking a gradual up-rising trend after they were introduced to the market. The annual per-prescription spending on AOMs by Medicaid for the Xenical dramatically increased in 2010 and dropped in 2014 after introducing Qsymia and Contrave to the market; then, it continued the uprising trend. Qsymia and Contrave prices remain sustained over the study period except for 2020, when the cost increased for all studied medications. Saxenda's price dropped in 2018 before it took the rising trend.

CONCLUSIONS:

Medicaid spending has dramatically increased since the new AOMs hit the market in 2012. The benefits that these treatments provide may make the cost justifiable. Future cohort studies with longitudinal data are needed to further explore and examine AOMs cost-effectiveness and clinical outcomes.