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Daily Dose: Adherence to GLP1RA, SGLT2i Therapies & Prescription Copayment Level


Patient Care brings primary care clinicians a lot of medical news every day—it’s easy to miss an important study. The Daily Dose provides a concise summary of one of the website's leading stories you may not have seen.

On June 2, 2023, we reported on a study published in JAMA Network Open that compared 1-year adherence to GLP1-RA and SGLT2i therapies by prescription copayment level in individuals with type 2 diabetes (T2D) and/or heart failure (HF).

The study

Researchers used data from Optum Insight’s deidentified Clinformatics Data Mart Database of persons enrolled with commercial and Medicare health insurance plans. A total of 94 610 adults (mean age, 61.8 years, 54.1% men) with T2D and/or HF with a prescription claim for a GLP1-RA or SLGT2i from January 1, 2014, to September 30, 2020, were included in the study.

Prescription copayment was categorized as low (<$10), medium ($10 to <$50), and high (≥$50). The primary outcome was medication adherence, defined for the purpose of the study as a proportion of days covered (PDC) of ≥80% at 1 year. Investigators used logistic regression models to analyze the association between insurance copayment and adherence, and adjusted for patient demographics, medical comorbidities, and socioeconomic factors.

The findings

GLP1-RA adherence. The final cohort included 39 149 participants who had a pharmacy claim for a GLP1-RA medication, of whom 25 557 (65.3%) achieved 12-month adherence.

In fully adjusted models, participants 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) copayment were less likely to achieve 12-month adherence to GLP1-RA therapies compared with those with a low copayment.

SGLT2i adherence. The final cohort also included 51 072 persons with a claim for an SGLT2i medication, of whom 37 339 (73.1%) achieved 12-month adherence. Researchers found that participants with a medium (aOR 0.67, 95% CI 0.63-0.72) or high (aOR 0.68, 95% CI 0.63-0.72) copayment were less likely to achieve 12-month adherence compared with those with a low copayment.

Clinical implications

"This finding in a commercially insured cohort has important implications for ensuring equitable access to medical management of chronic cardiometabolic diseases. Lowering high out-of-pocket prescription costs may be key to improving adherence to guideline-recommended therapies and advancing overall quality of care in T2D and HF management."

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