Obesity drugs, insurance companies are related to treatment persistence

DALLAS – Anti-obesity drug use may depend on certain factors, according to a retrospective cohort study.

In a sample of patients who filled at least one prescription for an anti-obesity drug, 44% were still taking the medication after 3 months, a percentage that dropped to 33% after 6 months and just 19% after 1 year, the report said. Hamlet Gasoyan, PhD, of the Cleveland Clinic Lerner College of Medicine of Case Western Reserve University in Cleveland, during the annual Obesity Week meeting.

Gasoyan said some non-perseverance may stem from limitations in insurance coverage or certain pre-certification criteria, such as step therapy. “A better understanding of anti-obesity medication non-persistence may help predict insurance-related costs and address barriers to medication continuation.”

Looking at naltrexone-bupropion, phentermine-topiramate (Qsymia), orlistat (Xenical, Alli), liraglutide (Saxenda), and semaglutide (Wegovy), the duration of all five drugs decreased by more than 1 year, although the rate This varies significantly with each drug.

After adjusting for age, sex, race/ethnicity, payer type, Regional Deprivation Index quartiles, and Charlson Comorbidity Index, semaglutide users had higher odds of continuing medication after 1 year was four times higher (OR 4.26, 95% CI 3.04) -6.05, P<0.001), while those using naltrexone-bupropion were least likely to continue, with borderline significance (OR 0.68, 95% CI 0.46-1.00, P= 0.049).

When the researchers looked only at patients with private insurance, a similar pattern emerged. Patients using semaglutide had longer survival at 1 year (OR 3.69, 95% CI 2.55-5.40, P<0.001) and those using naltrexone-bupropion had the least survival time (OR 0.64, 95% CI 0.42-0.97, P= 0.03).

Looking at insurance carriers, with Aetna as a reference, patients in the Cleveland Clinic Employee Health Plan had the lowest odds of persistence (OR 0.42, 95% CI 0.22-0, 80, P= 0.009). No significant difference in persistence was observed for patients with insurance from Blue Cross Blue Shield, Cigna, Medical Mutual Ohio or United Healthcare, but patients with commercial providers others also had a lower survival rate (OR 0.52, 95% CI 0.27-0.98, P= 0.046).

“We have received some anecdotal evidence that some employers and health plans are starting to think about limiting coverage for anti-obesity drugs,” often quoted leading to the unsustainable cost burden of GLP-1 receptor agonists and weight gain due to lack of persistence, Gasoyan told attendees.

Another predictor of persistence after 1 year of adjustment was weight loss at 6 months, based on a subset of 505 patients. For every 1% body weight loss after 6 months, patients had a 6% higher odds of survival at 1 year (OR 1.06, 95% CI 1.03-1.09, P<0.001).

“It makes sense that people who achieve their weight loss goals would be more likely to persist, and that’s true,” says Gasoyan.

Laura Schmidt, PhD, MSW, MPH, of the University of California San Francisco, pointed to significant selection bias in the study sample and the corresponding impact of drug shortages on this population.

“To stay in the study, people had to have private insurance, but when you think about interpreting results like that, you have a very, very unique sample of people,” Schmidt said. MedPage today. Because Cleveland Clinic is such a large institution, “some people may have been relieved of drug shortages,” which was not controlled for in the study.

She also noted that potential differences may exist between those who persisted in taking the medication and those who did not, which were not captured in the data. For example, people taking semaglutide may be told by their doctor that they will gain weight again if they stop taking the drug.

“There are big policy implications for such a study because it makes it possible for private insurance to pay for it,” Schmidt said, adding that she doubts the study will can overcome its limitations for that purpose.

In this study, Gasoyan and colleagues analyzed electronic health record data from all 1,911 adult patients at the Ohio and Florida Cleveland Clinic locations who had a body mass index (BMI) of at least was 30 and had an initial prescription for anti-obesity medication between July 2015 and June 2022, excluding patients who were pregnant, had cancer, or had bariatric surgery within the past 3 months. years from the first prescription filled.

They also reviewed Surescripts prescription records dispensed from January 2015 to July 2023.

Most patients were women (75%) and privately insured (84%); the median age was 44 and the median BMI was 38. The majority were white (76%), 16% were black, and 4.5% were Hispanic. One-third of patients were prescribed naltrexone-bupropion, 25% were prescribed semaglutide, 26% were prescribed phentermine-topiramate, 14% were given liraglutide, and 0.9% were given orlistat.

The researchers defined 3-month persistence as filling the first prescription and then repeating for 3 months until the patient had a cumulative gap of more than 15 days. Persistence lasts six months up to a 45-day gap and lasts 12 months up to a 90-day cumulative gap.

These findings are limited by the shortage of anti-obesity drugs that occurred during the study period. Gasoyan also acknowledged that the data set cannot capture patient-provider-related factors, such as stopping medication because of insufficient weight loss.

Disclosure

The research was funded by the National Cancer Institute.

Gasoyan and Schmidt did not reveal anything.

Main source

ObesityWeek

Reference source: Gasoyan H “Association between insurance characteristics and persistence with anti-obesity drugs and GLP-1 RA drugs” Obesity Week 2023.

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