Income and Utilization of GLP-1 RAs: A Role for Patient Wage in Type 2 Diabetes Management

OBJECTIVES: Treatment choice in type 2 diabetes (T2D) is driven by multiple factors including disease severity and therapy history. Medication costs can also play a role, even among commercially insured patients, as multiple factors (e.g., wage, coverage status, formulary tier, etc.) may influence patient’s ability to afford their medication. This study used the Merative^TM MarketScan^® Commercial and Medicare databases, including wage information, to investigate the impact of wage on GLP-1 RA utilization for T2D.

METHODS: Adults diagnosed with T2D newly initiating a GLP-1 RA between 2017 and 2022 were selected in the MarketScan databases. The first GLP-1 fill was the index date; patients were continuously eligible for 12-months pre- and post-index and had no prior GLP-1 RA claims. Post-period medication utilization, including adherence and persistence, was assessed among 8 annual wage-based subgroups.

RESULTS: The study sample included 18,671 patients; mean age was 52.8 and 61.3% were male. Wage groups included: 3.5% <$30k, 18.5% $30-<50k, 27.7% $50-<70k, 17.4% $70-<90k, 12.7% $90-<110k, 11.5% $110-<150k, 5.6% $150-<200k, and 3.1% ≥$200k. The proportion of males steadily increased across higher wage groups from 59.6% in $50-<70k to 80.9% in ≥$200k. Initiation of newer GLP-1 RAs (e.g., semaglutide, tirzepatide) increased with wage. Adherence and persistence also increased with wage. Adherence (medication possession ratio ≥0.80) ranged from 48.0% in $30-<50k to 69.0% in ≥$200k; persistence over the 12-month follow-up ranged from 45.6% in $30-<50k to 65.4% in ≥$200k. Patients in the <$30k group had slightly higher adherence and persistence than the $30-<50k group at 52.1% and 50.8%, respectively.

CONCLUSIONS: Even among T2D patients with medical and drug coverage, wage plays a role in GLP-1 RA initiation, adherence, and persistence. Findings from this study indicate that consideration of patient social determinants of health, like medication costs and socioeconomic status, may help to improve patient outcomes.