Type of insurance carrier plays a role in persistence with antiobesity medications
Presenter: Hamlet Gasoyan, PhD, Associate Staff, Cleveland Clinic
Gasoyan H, Schulte R, Le P, et al. Association of insurance characteristics and persistence with anti-obesity and GLP-1 RA medications. Presentation at Obesity Week, October 14–17, 2023, Abstract Oral 0-78.
Gasoyan H, Schulte R, Le P, et al. Factors associated with prescription of anti-obesity and GLP-1 RA medications in people with obesity. Presentation at Obesity Week, October 14–17, 2023. Abstract Poster 316.
The type of an obese patient’s insurance may play a role in how long patients stay on antiobesity medications, according to a retrospective cohort study presented at the 2023 Obesity Week by Hamlet Gasoyan, PhD, Associate Staff, Cleveland Clinic.1
Previously, little was known about the association between health insurance characteristics and the consistent use of antiobesity medications and glucagon-like peptide 1 (GLP-1) receptor agonists (which are indicated for diabetes management but also have weight-loss effects). Persistent use of these drugs has been associated with clinically modest but stable long-term weight loss. Patients who continue on these drugs, on average, lose more weight than those who are not persistent, who in turn lose more than those who get no prescription. These changes may persist for 3 to 5 years.2
Dr. Gasoyan and colleagues analyzed electronic health records and prescription data from 9,305 patients who received prescriptions for antiobesity medications or GLP-1 receptor agonists (including semaglutide or liraglutide) between 2015 and 2022. The patients, median age 51 years, had a median body mass index of 38 kg/m2; 58% were female, 71% were white, 18% were Black, and 6.6% were Hispanic. Most (71%) of the patients had diabetes and were privately insured (67%).
Multivariable logistic regression models were used to examine the association between insurance-related factors and persistence with these drugs, defined as a cumulative gap of less than 90 days within the first year. Results were first adjusted for relevant clinical and sociodemographic variables.
Overall, 54% of patients filled a prescription for semaglutide for diabetes management and 26% filled one for liraglutide for diabetes management; as for antiobesity medications, 7.7% of patients filled a prescription for naltrexone-buproprion, 6.9% filled one for for phentermine-topiramate, 2.6% for semaglutide as an antiobesity medication, 2.5% for liraglutide as an antiobesity medication, and 0.4% for orlistat.
Compared with privately insured patients, patients with other insurance were less likely to still be using their medications at 1 year, including those with:
- Medicaid (adjusted odds ratio [OR] 0.71)
- Medicare (adjusted OR 0.72)
- Medicare Advantage plans (adjusted OR 0.64).
Among the privately insured, the odds of persistence varied with the specific insurance carrier.
Black patients had smaller odds of persistence compared with whites (adjusted OR 0.64). Sex and higher Area Deprivation Index quartile were not associated with persistence.
“Health insurance characteristics may act as a barrier to consistent use of antiobesity medication and GLP-1 receptor agonist medications among patients with obesity,” said Dr. Gasoyan.
But these were patients who had been prescribed these medications. In another presentation at Obesity Week, Gasoyan found considerable disparities exist in whether patients receive antiobesity medications or GLP-1 receptor agonists at all, based on sociodemographic and insurance-related factors.3 This retrospective cohort study identified 60,897 patients who attended at least 1 weight-management program or received an initial prescription for GLP-1 receptor agonists (including semaglutide or liraglutide) or antiobesity medications between 2015 and 2022.
The patients, median age 51 years, had a median BMI of 36 kg/m2; 54% were female. Major racial and ethnic groups included white (67%), Black (23%), and Hispanic (6%). More than half (57%) of the patients had private insurance; 48% had diabetes.
Overall, 22% of the patients received a prescription for either antiobesity medications or GLP-1 receptor agonists; 50% of those prescriptions were for semaglutide for diabetes management, 22% for liraglutide for diabetes, 10% for naltrexone-buproprion, 7.7% for phentermine-topiramate, 4.8% for semaglutide as an antiobesity medication, 3.9% for liraglutide as an antiobesity medication, and 1.7% for orlistat.
Groups that were less likely to be prescribed these medications were:
- Black patients (adjusted OR 0.70 vs white patients)
- Men (adjusted OR 0.59 vs women)
- Those with Medicaid (adjusted OR 0.56 vs private insurance)
- Those with Medicare (adjusted OR 0.48)
- Those with Medicare Advantage plans (adjusted OR 0.55)
- Self-paying (adjusted OR 0.62)
- Those with a higher level of Area Deprivation Index (4th quartile adjusted OR 0.84 vs 1st quartile).
References
- Gasoyan H, Schulte R, Le P, et al. Association of insurance characteristics and persistence with anti-obesity and GLP-1 RA medications. Presentation at Obesity Week, October 14–17, 2023, Abstract Oral 0-78.
- Gasoyan H, Schulte R, Le P, et al. Long-term weight change in patients with obesity who receive anti-obesity or GLP1-RA medications. Presentation at Obesity Week, October 14-17, 2023. Abstract Poster 317.
- Gasoyan H, Schulte R, Le P, et al. Factors associated with prescription of anti-obesity and GLP-1 RA medications in people with obesity. Presentation at Obesity Week, October 14–17, 2023. Abstract Poster 316.
Disclosures
Hamlet Gasoyan – Nothing to disclose