Comparison of Medicare Tirzepatide Prescribing and Cardiovascular Deaths by State

Abstract

Purpose: Tirzepatide (Mounjaro) is a new antidiabetic drug effective in lowering A1C. The American Diabetes Association guideline does not have Mounjaro under the medications with cardiovascular (CV) benefits; however, a study conducted in 2023 highlighted the potential CV benefits of Mounjaro.1 According to the Centers for Disease Control and Prevention (CDC), roughly 919,032 people in the United States died from cardiovascular disease in 2023. Diabetes is linked to a higher risk of heart disease and cardiovascular (CV) death. This study aims to analyze the correlation between Mounjaro prescriptions and prevention of CV death rates among the 50 states.

Methods: This study was a retrospective, evaluative study utilizing state prescription data from the 2023 Medicare Provider Utilization and Payment Data: Part D Prescriber Data. The data contained Mounjaro claims and beneficiaries for all 50 states from 2023 and CV death rates per 1,000 Medicare Beneficiaries ages 65 and older for each state during that year from the CDC. The raw data for Mounjaro claims were adjusted for population by dividing claims by the total beneficiaries for all medications then multiplied by 1000 and analyzed per 1000 beneficiaries in each state.

Results: Based on the 2023 data, the top 10 states with the highest CV deaths include Oklahoma, Mississippi, Alabama, Arkansas, Louisiana, Tennessee, West Virginia, Michigan, Kentucky, and Missouri. The states with the highest Mounjaro prescription rates include Alabama, Louisiana, Oklahoma, Arkansas, Georgia, Kentucky, Indiana, Texas, West Virginia, and South Carolina. Of the top 10 states with the highest CV deaths, there were six states–Alabama, Louisiana, Oklahoma, Arkansas, Kentucky, West Virginia–that were among the top 10 states that had the highest Mounjaro prescribing rate. The top 10 states that had the lowest CV deaths were Minnesota, Hawaii, Colorado, Massachusetts, Connecticut, Alaska, Washington, California, Florida, and Oregon, none of which were among the top 10 states with the highest Mounjaro prescribing rates.

Conclusion: There was no correlation between Mounjaro prescription rates and prevention of CV death rates in 2023. However, there was a possible correlation between Mounjaro prescription rates and states with the highest CV death rates. The major limitations of this study was the data was collected from only 2023 and Medicare Part D data. Further studies with larger sample sizes, broader ranges of age groups, and data across multiple years are needed to assess if there are long-term benefits in preventing cardiovascular deaths, especially in the states with the highest death rates.