S2567 Insurance Coverage for GLP-1 Receptor Antagonists for the Treatment of Metabolic Dysfunction-Associated Steatohepatitis (MASH): Analysis of the Top US Insurers

Introduction: Several randomized clinical trials have shown glucagon-like peptide-1 receptors agonists (GLP-1 RAs) to reverse steatohepatitis and prevent progression of fibrosis in patients with MASH. However, current limitations in insurance coverage restrict access to a GLP-1 RAS, a potentially disease-altering therapy. In this study, we analyzed GLP-1 RA coverage for MASH among top U.S. insurers and compared it to coverage for obesity and diabetes, major determinates of metabolic disease. Methods: We reviewed current coverage policies of the top 25 U.S. health insurance providers according to National Association of Insurance Commissioner. We analyzed coverage of GLP-1 RAs the following diagnoses: MASH, Type II diabetes (defined as a hemoglobin a1C ≥6.5%, fasting glucose ≥126 mg/dL or 2-hour plasma glucose ≥200 mg/L during a 75 g oral glucose tolerance test), BMI ≥30, and BMI >27 with at least 1 weight related comorbidity. Data was obtained through the coverage policies available on insurance providers’ official websites as well as formularies provided by pharmacy benefit managers. Results: Six (24%) insurers denied coverage of GLP-1 RAs for MASH, while the remaining 19 (76%) insurers had no standardized policy regarding the coverage of GLP-1 for MASH. By comparison, 15 (60%) insurers and 13 insurers (52%), had plans that provided coverage for BMI ≥30 and BMI ≥27 with at least 1 weight-related comorbidity, respectively. All 25 insurers had plans providing coverage for diabetes, with varying requirements for prior. Conclusion: None of the top 25 health insurance providers in the US offer coverage of GLP-1 receptor agonists for the treatment of metabolic dysfunction-associated steatohepatitis (MASH). By contrast, many of these providers include plans that cover GLP-1 receptor agonists for the treatment of diabetes and obesity, principal drivers of metabolic disease. GLP-1 receptor agonists have demonstrated histologic reversal of MASH. MASH is increasingly prevalent in the U.S. and addressing insurance barriers is essential to improving access to care. This study advocates for coverage of GLP-1 receptor agonists that aligns with the current evidence.