Having insurance coverage alone doesn’t guarantee that people can afford or would be willing to pay continuously for chronic disease medications like Ozempic, a new, large-scale study finds.
Looking at insured patients with type 2 diabetes and heart failure, researchers found that people with higher prescription copayments were less likely to consistently take glucagon-like peptide-1 receptor agonists (GLP-1) and sodium-glucose cotransporter 2 inhibitors (SGLT2i) — two classes of drugs that yield additional, long-term benefits compared with older treatments but are also costlier.
For example, people with high copayments, defined as over $50, were about 50% less likely to adhere to GLP-1 drugs such as Ozempic and Trulicity than those with low copayments, defined as less than $10, according to the study published in JAMA Network Open Thursday.
With SGLT2i drugs such as Jardiance and Farxiga, people with high copayments were about 30% less likely to adhere than those with low copayments.
The findings — which are based on data on over 94,000 people from 2014 to 2020 — highlight the barriers that people face in accessing medications.
A previous study estimated that about 80% of U.S. adults with type 2 diabetes would meet current criteria for taking a GLP-1 or SGLT2i drug, but in the past few years, only 9% were using them. This study additionally suggests that even if patients are covered and start taking the medications, high copays could bar them from regularly using them.
“It’s another reminder of why we need to address the exorbitant cost of medications for these patients,” said Utibe Essien, co-first author of the new study and assistant professor of medicine at UCLA.
In addition to helping people with diabetes manage their blood sugar levels, the two classes of drugs have shown to improve people’s cardiovascular outcomes over the long term, so lack of adherence to the drugs could mean losing out on those benefits, Essien said.
The study covers a time period before Wegovy, a GLP-1 drug similar to Ozempic that treats obesity, was approved in 2021. As more obesity medications enter the market, issues of access could be further heightened.
Medicare doesn’t cover weight loss drugs and private insurance coverage is spotty, since the drugs have long been seen as serving cosmetic rather than medical purposes. The study suggests that even if more insurers do cover obesity drugs, the amount that patients have to pay out of pocket could still significantly affect whether they continuously take the treatments.
With medications like Wegovy that have shown significant weight loss effects, lack of access has led people to seek out risky alternative sources such as compounding pharmacies or websites where they order what appears to be the underlying chemical to mix themselves — prompting the Food and Drug Administration to warn this week about certain off-brand forms of the medications.
The authors defined medication adherence as taking the drug for 80% or more days covered in a year. Among people with low copayments, 72% of those taking GLP-1 drugs adhered and 77% taking SGLT2i drugs adhered, compared with 60% and 73% among people with high copayments.
Of course, factors other than copayments, such as side effects, can affect adherence. The GLP-1 drugs often cause nausea, vomiting, and diarrhea, particularly in early weeks. This study shows that even with low copayments, not all patients stick with these drugs.
Though the study didn’t look at medication adherence among people who don’t have insurance, the authors note that “even among those with health insurance, the variability of co-payment was associated with reduced medication adherence, which may be even more pronounced among those who are underinsured or uninsured.”