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Cited by 69Medication Adherence and ComplianceDiabetes Treatment and ManagementHeart Failure Treatment and Management

Association of Prescription Co-payment With Adherence to Glucagon-Like Peptide-1 Receptor Agonist and Sodium-Glucose Cotransporter-2 Inhibitor Therapies in Patients With Heart Failure and Diabetes

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Essien, Utibe R., Singh, Balvindar, Swabe, Gretchen, Johnson, Amber E., Eberly, Lauren A., Wadhera, Rishi K., Breathett, Khadijah, Vaduganathan, Muthiah +1 more·2023·JAMA Network Open
DOI 10.1001/jamanetworkopen.2023.16290PMC PMC10236237
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Abstract

Importance: Type 2 diabetes (T2D) and heart failure (HF) prevalence are rising in the US. Although glucagon-like peptide-1 receptor agonists (GLP1-RA) and sodium-glucose cotransporter 2 inhibitors (SGLT2i) improve outcomes for these conditions, high out-of-pocket costs may be associated with reduced medication adherence. Objective: To compare 1-year adherence to GLP1-RA and SGLT2i therapies by prescription co-payment level in individuals with T2D and/or HF. Design, Setting, and Participants: This retrospective cohort study used deidentified data from Optum Insight’s Clinformatics Data Mart Database of enrollees with commercial and Medicare health insurance plans. Individuals aged 18 years or older with T2D and/or HF who had a prescription claim for a GLP1-RA or SLGT2i from January 1, 2014, to September 30, 2020, were included. Exposures: Prescription co-payment, categorized as low (<$10), medium ($10 to<$50), and high (≥$50). Main Outcomes and Measures: The primary outcome was medication adherence, defined as a proportion of days covered (PDC) of 80% or greater at 1 year. Logistic regression models were used to examine the association between co-payment and adherence, adjusting for patient demographics, medical comorbidities, and socioeconomic factors. Results: A total of 94 610 individuals (mean [SD] age, 61.8 [11.4] years; 51 226 [54.1%] male) were prescribed GLP1-RA or SGLT2i therapy. Overall, 39 149 individuals had a claim for a GLP1-RA, of whom 25 557 (65.3%) had a PDC of 80% or greater at 1 year. In fully adjusted models, individuals with a medium (adjusted odds ratio [AOR], 0.62; 95% CI, 0.58-0.67) or high (AOR, 0.47; 95% CI, 0.44-0.51) co-payment were less likely to have a PDC of 80% or greater with a GLP1-RA compared with those with a low co-payment. Overall, 51 072 individuals had a claim for an SGLT2i, of whom 37 339 (73.1%) had a PDC of 80% or greater at 1 year. Individuals with a medium (AOR, 0.67; 95% CI, 0.63-0.72) or high (AOR, 0.68; 95% CI, 0.63-0.72) co-payment were less likely to have a PDC of 80% or greater with an SGLT2i compared with those with a low co-payment. Conclusions and Relevance: In this cohort study of individuals with T2D and/or HF, 1-year adherence to GLP1-RA or SGLT2i therapies was highest among individuals with a low co-payment. Improving adherence to guideline-based therapies may require interventions that reduce out-of-pocket prescription costs.

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  • In the United States, the cost of GLP-1 RAs can range from $800 to $1300 per month without insurance.

    “In the United States, the cost of GLP-1 RAs can range from $800 to $1300 per month without insurance, which poses a substantial barrier to access and adherence for many patients.4,5”

    From The expanding role of GLP-1 receptor agonists: a narrative review of current evidence and future directions (2025) · cites this paper as [4]

    The Introduction says high out-of-pocket costs can limit access and initiation, and the Results report lower GLP-1 RA adherence among patients with higher co-payments. Neither section gives an $800–$1300 monthly price or a price for patients without insurance; the study examines insured patients’ co-payments instead. (LLM, conf=0.86)

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Authors
Essien, U. R., Singh, B., Swabe, G., Johnson, A. E., Eberly, L. A., Wadhera, R. K., Breathett, K., Vaduganathan, M., & Magnani, J. W.
Affiliations
  • University of California, Los Angeles (US)
  • University of Pittsburgh (US)
  • Hospital of the University of Pennsylvania (US)
  • Beth Israel Deaconess Medical Center (US)
  • Indiana University Indianapolis (US)
  • Brigham and Women's Hospital (US)
Corresponding author
Essien, Utibe R.
ORCID
Venue
JAMA Network Open
Publisher
American Medical Association (AMA)
Published
2023-06-01
Volume
6
Issue
6
Pages
e2316290
ISSN
2574-3805 (ISSN-L)
DOI
10.1001/jamanetworkopen.2023.16290
PMC
PMC10236237
OpenAlex
W4378953950
Cited by
69
References
7
Citations by year
2026: 26 · 2025: 19 · 2024: 17 · 2023: 7
FWCI
21.42
Type
journal article
Language
en
Open access
Licence
cc-by
Locations
  • JAMA Network Open (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
Funders
National Heart, Lung, and Blood Institute (K24HL160527)
Topics
  • Health Sciences › Medicine › Family Practice › Medication Adherence and Compliance
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Failure Treatment and Management
Keywords
medication adherence, GLP-1 receptor agonists, SGLT2 inhibitors, heart failure, type 2 diabetes, out-of-pocket costs, proportion of days covered, cost sharing, socioeconomic factors, health plans, financial barriers to treatment, health disparities, racial and ethnic disparities
MeSH terms
Glucagon-Like Peptide-1 Receptor, Sodium-Glucose Transporter 2 Inhibitors, Glucagon-Like Peptide-1 Receptor Agonists, Aged, Diabetes Mellitus, Type 2, Female, Glucose, Medicare, Heart Failure, Humans, Male, Middle Aged, Retrospective Studies, Sodium, United States, Cohort Studies, Prescriptions

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