TOPLINE:
The less U.S. patients pay out of pocket for drugs that often have high copays, such as sodium-glucose cotransporter 2 (SGLT2) inhibitors or glucagon-like peptide-1 (GLP-1) agonists, the more adherent they are.
METHODOLOGY:
- Review of 90,041 U.S. adults who started a GLP-1 agonist (n = 39,149) or SGLT2 inhibitor (n = 50,892) in 2014-2020.
- Participants had type 2 diabetes, heart failure, or both.
- Data are from Clinformatics Data Mart, including both commercial and Medicare health insurance plans.
- Primary outcome: 12-month adherence to prescribed GLP-1 agonist or SGLT2 inhibitor.
TAKEAWAYS:
- U.S. adults with a lower drug copay had significantly higher odds of 12-month adherence to GLP-1 agonists and SGLT2 inhibitors, compared with those with a higher copay.
- These differences persisted after controlling for patient demographic, clinical, and socioeconomic covariates.
- After full adjustment, patients with a high copay (≥ $50/month) were, after 12 months, 53% less likely to adhere to an SGLT2 inhibitor and 32% less likely to adhere to a GLP-1 agonist, compared with patients with a low copay (< $10/month) for these agents.
IN PRACTICE:
“Lowering high out-of-pocket prescription costs may be key to improving adherence to guideline-recommended therapies and advancing overall quality of care in patients with type 2 diabetes and heart failure,” say the authors.
STUDY DETAILS:
The study was led by Utibe R. Essien, MD, from the University of California, Los Angeles, and Balvindar Singh, MD, PhD, from the University of Pittsburgh, and included several authors from other U.S. centers.
LIMITATIONS:
Study could not exclude residual confounding.
Generalizability uncertain for those without health insurance or with public insurance.
Study did not have information on patient preferences associated with medication use, including specific reasons for poor adherence.
Possible misclassifications of type 2 diabetes and heart failure diagnoses or medical comorbidities.
Study could not assess how copayments influenced initial prescription receipt or abandonment at the pharmacy, nor other factors including possible price inflation.
DISCLOSURES:
The study received no commercial funding. One author (not a lead author) is an advisor to several drug companies, including ones that market SGLT2 inhibitors or GLP-1 agonists.
A version of this article first appeared on Medscape.com.