Insurance denials may pose substantial barrier to GLP-1 drugs for teens
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Key takeaways:
- Public insurance covered GLP-1s for type 2 diabetes more often than private insurers.
- Even when prescriptions were covered, patient engagement was not complete.
BOSTON — From 2019 to 2023, insurance covered GLP-1 receptor agonist prescriptions at a Texas hospital for less than 70% of young people with type 2 diabetes and less than 40% of those with obesity.
In addition, 44% of pediatric patients with obesity and 17% with type 2 diabetes prescribed liraglutide (Saxenda, Victoza; Novo Nordisk) discontinued the medication before reaching the approved treatment dose, according to data presented at ENDO 2024.
“We have medications that have proven to improve weight as well as type 2 diabetes control. However, getting the patient to take it as indicated has several barriers, starting with insurance approval, proper titration and adequate medication engagement,” Gabriel Castano, MD, a PGY6 pediatric endocrinology fellow at Texas Children’s Hospital, Baylor College of Medicine, told Healio. “Very few patients actually stay on the medication for more than 6 months. On top of this, fewer patients are at an optimal treatment dose for their condition and have adequate medication engagement.”
Castano and Stephanie Sisley, MD, a pediatric endocrinologist, also at Baylor, performed a retrospective chart review of all 599 patients at their hospital younger than 18 years (mean age, 15 years; 58% girls; 63% white; 52% Hispanic; 30% Black; 2.3% Asian) who were prescribed a GLP-1 receptor agonist from 2019 to 2023. Of the cohort, 74% had type 2 diabetes, and 58% had public insurance. Most prescriptions (90%) were for liraglutide; exenatide (Bydureon BCise, AstraZeneca), dulaglutide (Trulicity, Eli Lilly) and semaglutide (Wegovy, Novo Nordisk) made up 10% of prescriptions.
For patients with type 2 diabetes, public insurance approved 70% of GLP-1 drug prescriptions and private insurers approved 60%. For patients with obesity and without diabetes, public insurance approved 29% of prescription and private insurers approved 41%.
“There may be a tendency that public insurance may have higher approval rates than private insurance for patients with type 2 diabetes,” Castano said.
Even among patients whose prescriptions were covered by insurance, treatment engagement was not complete.
Nearly half of the 22% of patients with prescriptions approved by insurers were lost to follow-up in the first 3 months.
Of the 34% of the cohort with insurance coverage who filled their liraglutide prescriptions for at least 26 weeks, many never reached the recommended dose. Of those with type 2 diabetes prescribed 1.8 mg per day, 50% titrated to that dosage within 3 months of initiation and 33% by 6 months. Of those prescribed 3 mg per day, 42% reached that dosage at 5 weeks. The rest never reach that dose.
Four patients discontinued medication due to adverse events — one with hypoglycemia, one with mild pancreatitis and two with severe pancreatitis — and 12% of charts noted gastrointestinal adverse effects.
The researchers said more study is needed on how real-world adherence affects clinical outcomes.
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Castano G, et al. SAT-097. Presented at: ENDO annual meeting; June 1-4, 2024; Boston.
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