Utilization of GLP-1RA and SGLT2i Medication Classes in Medicaid: Results from an Academic Health System

Introduction and Objective: Limited data exists on utilization patterns of GLP-1RA and SGLT2i among the Medicaid population. Further, a 2022 single-formulary policy designed to improve access to medications among California Medicaid patients remains unstudied. The purpose of this project is 1) to compare utilization of GLP-1RA and SGLT2i use between Medicaid and other insurance types and 2) to assess the impact of the 2022 California single-formulary policy on GLP-1RA and SGLT2i utilization among Medicaid patients. Methods: We analyzed EHR data from the University of California health system from 2020 to 2025. We included adults with type 2 diabetes. We used cluster-robust, propensity-score weighted linear probability models to assess adjusted differences in utilization of GLP-1RA and SGLT2i by insurance type, and a difference-in-differences design to assess changes in Medicaid utilization following implementation of California’s single-formulary policy. Results: The cohort included 63,152 unique patients and 153,051 person-years. Medicaid was associated with lower adjusted probability of GLP-1RA use compared to commercial insurance (+2.9 percentage points (pp); 95% CI: 1.7 to 4.1; P<.001) and Medicare coverage (+1.9 pp; 95% CI: 0.4 to 3.3; P=.01). Insurance type was not associated with (SGLT2i) use. The single-formulary policy was associated with a slower rate of increase for GLP-1RA (-2.8%, p<0.01) but higher rate of increase (3.2%, p<0.01) for SGLT2i compared to non-Medicaid insurance types. Conclusion: Medicaid patients are less likely to receive GLP-1RA medications than commercially insured and Medicare patients. The California single formulary policy was associated with increased rate of prescribing of SGLT2i over time for Medicaid patients but decreased relative prescribing of GLP-1RA. These results suggest continued barriers to GLP-1RA use for Medicaid patients. Further research is needed to delineate whether provider factors or patient acceptance of the drugs explain the disparities in care. Disclosure: H.A. Torres: None. Y. Jiang: None. Funding: NIH-NIDDK (U24DK1132746), NIH/National Center for Advancing Translational Sciences (UL1TR001881)