Adherence to GLP-1 receptor agonists and SGLT2 inhibitors by out-of-pocket spending among Medicare beneficiaries with diabetes.

IF 5.4 2区医学 Q1 ENDOCRINOLOGY & METABOLISM

Diabetes, Obesity & Metabolism Pub Date : 2025-07-16 DOI:10.1111/dom.16619

Nicklas S Klepser, Ellerie S Weber, Lihua Li, Kirsten E Fleischmann, Umesh Masharani, Meyeon Park, Wendy B Max, Joseph Yeboah, M G Myriam Hunink, Bart S Ferket

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引用次数: 0

Abstract

Aims: To assess associations between out-of-pocket (OOP) expenditures and adherence to glucagon-like peptide-1 receptor agonists (GLP-1RAs) and sodium-glucose cotransporter-2 inhibitors (SGLT2i) among low-income Medicare beneficiaries with diabetes.

Materials and methods: We analysed Medicare Current Beneficiary Survey two-year longitudinal data (2016-2021) on beneficiaries with diabetes using GLP-1RAs (N = 168; weighted = 2 187 500) or SGLT2i (N = 139; weighted = 1 741 910) in year one (baseline). Among these, N = 97 (weighted = 1 117 637) GLP-1RA and N = 73 (weighted = 785 301) SGLT2i users had an income below 200% of the Federal Poverty Level (low-income). Survey-weighted generalized Poisson regression assessed the association between baseline cumulative OOP drug expenses and year two adherence, defined as proportion of days covered (PDC). We repeated analyses in participants with higher income and using dual (Medicare/Medicaid) enrolment as a proxy for full coverage in low income.

Results: Year-two PDC was 65.2% (95% CI: 57.9%-72.6%) for low-income GLP-1RA users and 65.4% (95% CI: 58.3%-72.5%) for low-income SGLT2i users. We did not observe a significant association between OOP costs (mean: $253; range: $0-$4699) and adherence in low-income GLP-1RA users. For low-income SGLT2i users, higher OOP costs (mean: $204; $0-$2649) were associated with lower adherence: adjusted adherence ratio 0.959 (95% CI: 0.932-0.987) per $100 increase. Dual Medicare-Medicaid coverage was associated with increased adherence: adjusted adherence ratio 1.580 (95% CI: 1.061-2.352). For high-income GLP-1RA users, higher OOP expenditures were associated with increased adherence in the highest income range.

Conclusions: OOP costs for GLP-1RAs and SGLT2i are substantial, potentially posing a particular burden for low-income Medicare beneficiaries. Policy changes may reduce this burden, although adherence improvements appear limited to beneficiaries using SGLT2i.

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GLP-1受体激动剂和SGLT2抑制剂在医疗保险受益人糖尿病患者中的自付支出依从性

目的：评估自费（OOP）支出与患有糖尿病的低收入医疗保险受益人坚持使用胰高血糖素样肽-1受体激动剂（GLP-1RAs）和钠-葡萄糖共转运蛋白-2抑制剂（SGLT2i）之间的关系。材料和方法：我们使用GLP-1RAs分析了医疗保险当前受益人调查（2016-2021）对糖尿病受益人的两年纵向数据(N = 168；加权= 2 187 500)或SGLT2i (N = 139；加权= 1 741 910)在第一年（基线）。其中，N = 97（加权= 1 117 637）名GLP-1RA使用者和N = 73（加权= 785 301）名SGLT2i使用者的收入低于联邦贫困水平（低收入）的200%。调查加权广义泊松回归评估了基线累积OOP药物费用与第二年依从性之间的关系，其定义为覆盖天数（PDC）的比例。我们在高收入的参与者中重复分析，并使用双重（医疗保险/医疗补助）登记作为低收入完全覆盖的代理。结果：低收入GLP-1RA使用者的第二年PDC为65.2% (95% CI: 57.9%-72.6%)，低收入SGLT2i使用者的第二年PDC为65.4% （95% CI: 58.3%-72.5%）。我们没有观察到OOP成本(平均：253美元；范围：$0-$4699)和低收入GLP-1RA使用者的依从性。对于低收入的SGLT2i用户，更高的OOP成本(平均：204美元；$0-$2649)与较低的依从性相关：每增加$100调整的依从性比为0.959 （95% CI: 0.932-0.987）。双重医疗-医疗补助覆盖与增加的依从性相关：调整后的依从比为1.580 （95% CI: 1.061-2.352）。对于高收入的GLP-1RA使用者，在最高收入范围内，较高的OOP支出与增加的依从性相关。结论：GLP-1RAs和SGLT2i的OOP成本是巨大的，可能给低收入医疗保险受益人带来特别的负担。政策变化可能会减轻这种负担，尽管依从性的改善似乎仅限于使用SGLT2i的受益人。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Diabetes, Obesity & Metabolism 医学-内分泌学与代谢

CiteScore

10.90

自引率

6.90%

发文量

319

审稿时长

3-8 weeks

期刊介绍： Diabetes, Obesity and Metabolism is primarily a journal of clinical and experimental pharmacology and therapeutics covering the interrelated areas of diabetes, obesity and metabolism. The journal prioritises high-quality original research that reports on the effects of new or existing therapies, including dietary, exercise and lifestyle (non-pharmacological) interventions, in any aspect of metabolic and endocrine disease, either in humans or animal and cellular systems. ‘Metabolism’ may relate to lipids, bone and drug metabolism, or broader aspects of endocrine dysfunction. Preclinical pharmacology, pharmacokinetic studies, meta-analyses and those addressing drug safety and tolerability are also highly suitable for publication in this journal. Original research may be published as a main paper or as a research letter.