EXAMINING THE EQUITY OF DISTRIBUTION OF GLP-1 PRESCRIPTIONS IN A LARGE URBAN PRIMARY CARE SYSTEM
Author(s)
Richard W. Hass, PhD1, Scott Orlov, BA1, Joshua Bartosz, BA2, Meghan Smith, MPH3, Janine V. Kyrillos, MD, FACP4, Amy Cunningham, PhD, MPH3, Anna Flattau, MD, MSc, MS3;
1Thomas Jefferson University, Philadelphia, PA, USA, 2Jefferson Health, Philadelphia, PA, USA, 3Thomas Jefferson University, Family and Community Medicine, Philadelphia, PA, USA, 4Thomas Jefferson University, Internal Medicine, Philadelphia, PA, USA
1Thomas Jefferson University, Philadelphia, PA, USA, 2Jefferson Health, Philadelphia, PA, USA, 3Thomas Jefferson University, Family and Community Medicine, Philadelphia, PA, USA, 4Thomas Jefferson University, Internal Medicine, Philadelphia, PA, USA
OBJECTIVES: A 2024 survey estimated that 1 in 8 US adults have taken a Glucagon-like peptide-1 receptor agonist (GLP-1), with 6% currently on the medication. Literature examining sociocultural and systemic factors affecting GLP-1 prescribing shows mixed findings vis a vis disparities across patients from different levels of deprivation. To add to the evidence base, we asked whether distribution of GLP-1s among patients in a large primary care system was equitable.
METHODS: Data from primary care patients (n = 101,863) who were not currently pregnant, not regularly checked for A1c levels, not in end-stage renal or liver disease, aged 18 or older or with BMI greater than 18.5 were included. The outcome was a binary indicator of whether any GLP-1 appeared in the EPIC active medication list at the patient's last visit. Practice ID was modeled as a random effect. Mean ADI per practice was included as a practice-level fixed effect. Patient level fixed effects were mean-centered ADI, biological sex, race, age, BMI, and systolic blood pressure in a multilevel logistic regression model.
RESULTS: Overall, 2.7% of patients had an active prescription, with variability across 122 practices. Practice-level mean ADI did not reliably relate to the odds of a prescription. Within practices, there was a small reduction in log-odds (b = -0.0059) as patient-level ADI increased, but the effect does not seem to be clinically meaningful. Rather, the strongest predictors were the patient’s last BMI and the patient’s biological sex, with females in the typical practice having almost 3 times the odds of a GLP-1 prescription compared males.
CONCLUSIONS: There is equitable distribution of GLP-1 prescriptions across practices that vary by deprivation of the patients, though odds are higher for females. With lifestyle medicine programs now recommended for GLP-1 users, clinicians should take care to ensure those programs are also equitable.
METHODS: Data from primary care patients (n = 101,863) who were not currently pregnant, not regularly checked for A1c levels, not in end-stage renal or liver disease, aged 18 or older or with BMI greater than 18.5 were included. The outcome was a binary indicator of whether any GLP-1 appeared in the EPIC active medication list at the patient's last visit. Practice ID was modeled as a random effect. Mean ADI per practice was included as a practice-level fixed effect. Patient level fixed effects were mean-centered ADI, biological sex, race, age, BMI, and systolic blood pressure in a multilevel logistic regression model.
RESULTS: Overall, 2.7% of patients had an active prescription, with variability across 122 practices. Practice-level mean ADI did not reliably relate to the odds of a prescription. Within practices, there was a small reduction in log-odds (b = -0.0059) as patient-level ADI increased, but the effect does not seem to be clinically meaningful. Rather, the strongest predictors were the patient’s last BMI and the patient’s biological sex, with females in the typical practice having almost 3 times the odds of a GLP-1 prescription compared males.
CONCLUSIONS: There is equitable distribution of GLP-1 prescriptions across practices that vary by deprivation of the patients, though odds are higher for females. With lifestyle medicine programs now recommended for GLP-1 users, clinicians should take care to ensure those programs are also equitable.
Conference/Value in Health Info
2026-05, ISPOR 2026, Philadelphia, PA, USA
Value in Health, Volume 29, Issue S6
Code
HSD104
Topic
Health Service Delivery & Process of Care
Disease
SDC: Diabetes/Endocrine/Metabolic Disorders (including obesity), STA: Biologics & Biosimilars