- Among nearly 10,000 GLP-1 receptor agonist prescriptions given at a single health system, 60% were filled.
- Fill rates varied by patient race and ethnicity, as well as indication.
- Researchers suggested that low fill rates indicate barriers to treatment and possible insurance coverage gaps.
Nearly half of patients prescribed a GLP-1 receptor agonist were not filling the order, with certain factors playing a role, according to a cohort study.
Among nearly 10,000 GLP-1 receptor agonist prescriptions given at a single health system, 60.1% were filled, reported Ameet Sarpatwari, PhD, of Harvard Pilgrim Health Care Institute in Boston, and colleagues.
Black and Hispanic patients were less likely to fill their orders than white patients (fill rate 55.3% and 58.4% vs 60.9%, P=0.006 and P=0.045, respectively), and patients with both diabetes and obesity were more likely to fill their orders than those with diabetes only or obesity only (64.6% vs 47.5% vs 37.2%; P<0.001).
"Prescribing of [GLP-1 receptor agonists] for diabetes and obesity has soared, yet patients report barriers accessing these medications," Sarpatwari and team wrote in a research letter in JAMA Health Forum.
"Although very concerning, it is not surprising that 40% of orders went unfilled. Prior literature has shown that primary non-adherence is high," Sarpatwari told MedPage Today. "Discussion of barriers to prescription fills and possible solutions should be standard practice."
All patients in the cohort had continuous enrollment in Medicare or commercial insurance for 12 months prior and 3 months after the order. With insurance, the average out-of-pocket cost was $71.90 for filled orders. In comparison, the average non-insurance retail price of GLP-1 receptor agonists in 2023 was over $900 per month.
Out-of-pocket costs significantly varied among patients. For a 30-day supply, out-of-pocket costs averaged $41.15 for Black patients and $63.69 for Hispanic patients compared with $78.37 for white patients (P<0.001 and P=0.006, respectively).
Out-of-pocket costs for GLP-1 medications are especially concerning for patients in racial and ethnic minority groups, Sarpatwari and co-authors noted, since these groups have a higher prevalence of diabetes and obesity, and may face racial disparities in GLP-1 agent receipt.
Out-of-pocket costs were also significantly lower for patients with diabetes and obesity, averaging $70.32 per order, compared with $134.04 for orders for patients with obesity alone (P<0.001).
"Out-of-pocket differences across groups may stem from differences in insurance coverage, use of different GLP-1 RAs [receptor agonists], or different cost thresholds for forgoing GLP-1 RAs," the authors wrote. "Out-of-pocket costs for patients with obesity alone were nearly 2 times those for patients with diabetes, likely reflecting less comprehensive insurance coverage for this indication."
Sarpatwari and colleagues urged policymakers to explore options to improve equitable access to these medications.
"Attention must foremost focus on making sure that patient out-of-pocket costs are affordable," Sarpatwari told MedPage Today.
For this study, Sarpatwari's group linked medication orders and patient characteristics from the University of Colorado Health system electronic health record to eligibility, medical, and pharmacy claims from the Colorado All-Payer Claims Database. They included patients with one or more of 15 common chronic conditions who had an order for a GLP-1 agent between January 2018 and September 2022.
Mean patient age was 60.9, and 53.7% were women. Most were white (72.3%); 19.4% were Hispanic, 5.8% were Black, and 2.5% were Asian.
The researchers determined if GLP-1 orders were filled within 90 days. Out-of-pocket costs were adjusted for inflation to 2023 dollars. Outcomes were adjusted for age, sex, insurance type, geography, median household income by zip code, and order type (initial or refill).
The authors emphasized that these data were only reflective of a single healthcare system. Other limitations to the study included a lack of data on reasons for nonadherence, and it was unknown if GLP-1 agents were purchased with cash instead of insurance.
"The study period preceded widespread use of GLP-1 RAs that are highly effective for obesity, and conclusions regarding results for obesity should be viewed with caution," they noted.
Disclosures
The study was funded by the National Institute on Minority Health and Health Disparities.
Sarpatwari reported no disclosures.
Co-authors reported grants from the National Institute on Aging and the Agency for Healthcare Research and Quality.
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