NOT JUST GLP-1 COSTS: WHY LOWER DIABETES DRUG EXPENDITURES MAY NOT REFLECT BETTER CARE
Author(s)
Paroma Arefin, M.Pharm, Sujit Sansgiry, MS, PhD.
Department of Pharmaceutical Health Outcomes and Policy, College of Pharmacy, University of Houston, Houston, TX, USA.
Department of Pharmaceutical Health Outcomes and Policy, College of Pharmacy, University of Houston, Houston, TX, USA.
OBJECTIVES: Because GLP-1 receptor agonist (GLP-1 RA) medications are widely used and expected to increase prescription expenditures, we evaluated how GLP-1 RA regimens, other treatment patterns, clinical complexity, and access-related factors were associated with prescription expenditures (RXEXP) among U.S. adults with diabetes.
METHODS: We analyzed pooled 2018-2021 MEPS data for adults with diabetes. RXEXP (log(RXEXP + $1)) was modeled using survey-weighted multivariable linear regression, with therapy type as the primary independent variable (SAS 9.4).
RESULTS: Results:
The analytic sample included 11,436 adults (weighted N≈22,771,988). Overall, 45.7% received non-GLP-1 monotherapy, 31.5% combination therapy without GLP-1, 12.7% GLP-1-based combination therapy, 1.2% GLP-1 monotherapy, and 8.9% no antidiabetic medication. Compared with GLP-1 monotherapy, adjusted RXEXP were 106.52% (95% CI: 81.13-139.86) for GLP-1 combinations, 34.86% (95% CI: 26.49-45.40) for combinations without GLP-1, 15.41% (95% CI: 11.78-20.14) for non-GLP-1 monotherapy, and 8.51% (95% CI: 6.15-12.64) for no therapy. RXEXP increased with complexity: vs none, 130.38% (95% CI: 116.78-145.57) with one comorbidity and 319.73% (95% CI: 195.39-523.19) with ≥4. Relative to 0-4 years, RXEXP was 162.05% (95% CI: 137.24-191.34) at 10-14 years and 238.55% (95% CI: 206.92-275.00) at ≥20 years. Lower RXEXP occurred among uninsured adults (45.39%; 95% CI: 32.12-64.14), among adults whose providers did not discuss alternative medication options (78.05%; 95% CI: 70.05-86.96), and among Hispanic (69.02%; 95% CI: 59.64-79.89) and non-Hispanic Black adults (75.82%; 95% CI: 66.20-86.84) compared with non-Hispanic Whites.
CONCLUSIONS: Prescription expenditures were higher among adults receiving GLP-1 RA regimens and among those suffering from diabetes for longer period and with greater clinical burden. Lower expenditures were observed among uninsured adults, hispanics and in visits where providers did not discuss alternative medication options to patients. Differences in expenditure may reflect variation in treatment intensity and access, while lower expenditure may sometimes signal restricted access to needed therapies rather than better quality of care.
METHODS: We analyzed pooled 2018-2021 MEPS data for adults with diabetes. RXEXP (log(RXEXP + $1)) was modeled using survey-weighted multivariable linear regression, with therapy type as the primary independent variable (SAS 9.4).
RESULTS: Results:
The analytic sample included 11,436 adults (weighted N≈22,771,988). Overall, 45.7% received non-GLP-1 monotherapy, 31.5% combination therapy without GLP-1, 12.7% GLP-1-based combination therapy, 1.2% GLP-1 monotherapy, and 8.9% no antidiabetic medication. Compared with GLP-1 monotherapy, adjusted RXEXP were 106.52% (95% CI: 81.13-139.86) for GLP-1 combinations, 34.86% (95% CI: 26.49-45.40) for combinations without GLP-1, 15.41% (95% CI: 11.78-20.14) for non-GLP-1 monotherapy, and 8.51% (95% CI: 6.15-12.64) for no therapy. RXEXP increased with complexity: vs none, 130.38% (95% CI: 116.78-145.57) with one comorbidity and 319.73% (95% CI: 195.39-523.19) with ≥4. Relative to 0-4 years, RXEXP was 162.05% (95% CI: 137.24-191.34) at 10-14 years and 238.55% (95% CI: 206.92-275.00) at ≥20 years. Lower RXEXP occurred among uninsured adults (45.39%; 95% CI: 32.12-64.14), among adults whose providers did not discuss alternative medication options (78.05%; 95% CI: 70.05-86.96), and among Hispanic (69.02%; 95% CI: 59.64-79.89) and non-Hispanic Black adults (75.82%; 95% CI: 66.20-86.84) compared with non-Hispanic Whites.
CONCLUSIONS: Prescription expenditures were higher among adults receiving GLP-1 RA regimens and among those suffering from diabetes for longer period and with greater clinical burden. Lower expenditures were observed among uninsured adults, hispanics and in visits where providers did not discuss alternative medication options to patients. Differences in expenditure may reflect variation in treatment intensity and access, while lower expenditure may sometimes signal restricted access to needed therapies rather than better quality of care.
Conference/Value in Health Info
2026-05, ISPOR 2026, Philadelphia, PA, USA
Value in Health, Volume 29, Issue S6
Code
P42
Topic
Health Policy & Regulatory
Topic Subcategory
Health Disparities & Equity, Public Spending & National Health Expenditures, Reimbursement & Access Policy
Disease
No Additional Disease & Conditions/Specialized Treatment Areas, SDC: Diabetes/Endocrine/Metabolic Disorders (including obesity)