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Alarming Rate of Unfilled Prescriptions for Diabetes and Obesity Drugs Highlights Access Crisis
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A important 40% of orders for glucagon-like peptide-1 receptor agonists (GLP-1RAs) went unfilled between January 2018 and September 2022,revealing a critical access gap for these increasingly popular medications,according to a new study published in JAMA Health Forum. Patients are facing considerable barriers, including soaring costs, insurance complications, and concerns about potential racial bias in prescribing practices.
Rising Costs and Insurance Hurdles Limit Access
The study, conducted by researchers at the University of Colorado Health (UCHealth) system, underscores the financial burden these drugs place on patients. uninsured individuals faced an average retail price exceeding $900 per month in 2024 for a single prescription fill. Even those with insurance encountered significant out-of-pocket costs, averaging $71.90 per 30-day supply.
Researchers linked UCHealth electronic health record data with claims data from the Colorado All-Payer Claims Database, analyzing 6,094 patients who had at least one GLP-1 RA order during the study period. The analysis revealed disparities in access based on insurance coverage and medical condition. Patients diagnosed with both diabetes and obesity experienced the lowest out-of-pocket expenses, at $70.32, while those with obesity alone faced costs nearly double, reaching $134.04.
“Out-of-pocket costs for patients with obesity alone were nearly 2 times those for patients with diabetes,” the study authors wrote, attributing this disparity to less comprehensive insurance coverage for obesity treatment.
Racial Disparities in GLP-1RA Access
The study also revealed troubling differences in fill rates based on race and ethnicity. Compared to non-Hispanic White patients, who had a fill rate of 60.9%, non-Hispanic Black and Hispanic patients experienced lower rates of 55.3% and 58.4%,respectively. This suggests systemic barriers may be disproportionately impacting minority communities.
These findings are notably concerning given the higher prevalence of diabetes and obesity within these groups. The lack of access to GLP-1RAs could exacerbate existing health inequities and widen disparities in chronic disease management.
Impact of Drug Indication on access
The reason for the GLP-1 RA prescription also played a significant role in access. Fill rates were highest for patients diagnosed with both diabetes and obesity (64.6%), while those prescribed the medication for obesity alone had the lowest fill rate, at just 37.2%. Patients with a diabetes diagnosis alone had a fill rate of 47.5%.
The study considered a range of GLP-1 RA medications approved during the study period, including exenatide, lixisenatide, liraglutide, dulaglutide, semaglutide, and oral semaglutide. The authors noted that the choice of medication and individual patient cost thresholds likely contributed to the variations observed.
