Home Medizin Unterschiede bei der Verschreibung und Füllung von Medikamenten zur Gewichtsreduktion

Unterschiede bei der Verschreibung und Füllung von Medikamenten zur Gewichtsreduktion

von NFI Redaktion

New research shows that socioeconomic factors and type of insurance have a significant impact on the likelihood of a person with obesity receiving a prescription for weight loss medication and subsequently filling it. The findings come from a retrospective study of electronic health records of over 50,000 adults with a body mass index (BMI) of ≥ 30 kg/m² in Florida and Ohio seeking treatment for obesity from 2015 to June 2023. Only 8.0% overall received prescriptions for weight loss medications and only 4.4% filled them. Factors associated with a lower likelihood of receiving and filling prescriptions included male gender, Hispanic ethnicity, Medicaid, traditional Medicare, and Medicare Advantage insurance types.

The fill rate increased to 26% in the period 2022–2023 after newer glucagon-like peptide 1 (GLP-1) agonists became available, but the observed differences persisted, said study author Hamlet Gasoyan, PhD. „Things are changing, but this study provides a very good picture of who gets prescriptions and what impact this has on policy decisions.“

Gasoyan, from the Center for Value-Based Care Research at the Cleveland Clinic in Ohio, noted that Medicare currently does not cover obesity medications nor do most Medicaid programs (neither Florida nor Ohio), but there is at least one bill in Congress to change that. „Medicare and other state payers are currently facing important policy decisions about coverage for obesity medications. I think they should think about how their policies might impact existing inequalities in the treatment of obesity.“

Another notable finding, Gasoyan said, is that „the actual data, despite the recent hype, shows that these medications are not being utilized sufficiently and likely will continue to be underused.“

David B. Sarwer, PhD, director of the Center for Obesity Research and Education at Temple University in Pennsylvania, commented, „In the obesity treatment community, there is tremendous enthusiasm that these newer medications have the potential to be groundbreaking. I think this study, as well as other work from this and other groups, shows that we still have some substantial issues.“

There are significant issues related to access to care and the long-term use of these medications that we need to address for them to reach their full potential.“

Sarwer, like Gasoyan, acknowledged that the study timeframe is a limitation and that more prospective data on the newer incretin medications need to be collected. „At this point, these medications are very expensive. While some insurance plans offer coverage for them, many do not. Until we get to the bottom of that, there will always be questions about whether these medications are reaching the people who need them the most.“

He is not sure if we were trained: „Physicians learn how to have productive, targeted conversations that lead to effective use of weight loss measures. Perhaps, in a way, that’s what we’re seeing here.“

Prescription and Filling Differences

Of the 50,678 study participants, all met not only the BMI criteria (≥ 30 kg/m²) but also attended at least one weight management program (n = 48,711) and/or received a prescription for weight loss medication (n = 4047). „We know that BMI is not a perfect indicator of obesity. That’s why we specifically looked at where the patient or provider identified obesity as a problem and wanted to do something about it … One would expect that in this group, medications for obesity would be high, but unfortunately it wasn’t,“ commented Gasoyan.

The participants had an average BMI of 38 kg/m² and an average age of 50 years. Slightly more than half (54%) were women, 66% were White, 24% were Black, and 5.3% were Hispanic. The majority (56%) had private insurance and 41% had diabetes. The mean follow-up time was 4.7 years.

The main measures were prescriptions for naltrexone-bupropion, orlistat, phentermine-topiramate, 3.0 mg liraglutide, 2.4 mg semaglutide, and a refill of one of these prescriptions during the study follow-up.

Overall, 8.0% received a new prescription for obesity medications, and of these, 55% had at least one documented filling of the prescription. Among the fillings, 39% were for naltrexone-buproprion, 29% for phentermine-topiramate, 19% for semaglutide, 11% for liraglutide, and 1.2% for orlistat.

In the multivariable model, the likelihood of receiving a prescription for obesity medications was significantly lower for Black patients (adjusted odds ratio 0.68), Hispanic individuals (0.72), and individuals of other race or ethnic background (0.70) compared to White patients. Men had lower odds than women (0.38).

Compared to privately insured patients, the likelihood of receiving a prescription was significantly lower for patients with Medicaid (0.44), traditional Medicare (0.35), Medicare Advantage (0.36), as well as self-payers (0.65) and other insurance types (0.53). Those in the highest quartile of economic disadvantage also had a lower likelihood of receiving obesity medications (0.81).

With a lower likelihood of receiving prescriptions were also associated with a younger age, a higher age-adjusted Charlson comorbidity score, having a diagnosis of diabetes, and a history of myocardial infarction or heart failure.

Factors associated with a lower likelihood of prescriptions for obesity medications included Hispanic ethnicity versus White ethnicity (0.51), but not Black race. Compared to private insurance, the likelihood of filling prescriptions was lower for those with Medicaid (0.41), traditional Medicare (0.38), and Medicare Advantage (0.37).

During the study period, phentermine-topiramate had higher odds of being filled compared to naltrexone-buproprion (1.27), while liraglutide (0.61) and orlistat (0.11) had lower odds, and semaglutide showed no significant differences (0.90).

Older age, female gender, and having a diagnosis of diabetes were associated with a higher likelihood of filling a prescription, while deprivation quartile, history of myocardial infarction, history of heart failure, and age-adjusted Charlson comorbidity score were not significantly associated with filling medications.

Gasoyan told Medscape, „This study is unique in that we were able to look at consumption patterns and barriers over multiple stages … We recently published another study in which we found that patients are not often taking these medications over a longer period. So, patients are facing challenges“ over obtaining pharmacotherapy for obesity at multiple stages … We hope that this data will highlight the issues and influence future decisions. We see clear areas where we could obviously do better.“

Gasoyan disclosed no relevant financial relationships. Sarwer received grants from the National Institutes of Health and reported consultant relationships with NovoNordisk and Twenty30 Health.

Miriam E. Tucker is a freelance journalist based in the Washington DC area. She regularly writes for Medscape, with additional work appearing in the Washington Post, NPR’s Shots blog, and Diatribe.

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