New research has revealed significant disparities in which patients receive semaglutide prescriptions for obesity treatment among commercially insured adults without diabetes, with women being more than twice as likely as men to receive the medication.
In the study, published in JAMA Network Open, investigators analyzed data from 97,456 commercially insured adults with obesity but no diabetes diagnosis. Only 2% of eligible patients initiated semaglutide within 6 months of their obesity diagnosis.
"These findings suggest that inequities persist in medication access in this understudied subgroup," wrote Meghan I. Podolsky, MS, of Boston University School of Public Health, and her colleagues.
The investigators found that being female was associated with a 2.3 times higher likelihood of receiving semaglutide. Insurance plan type also played a crucial role, with point-of-service plans associated with a 1.78 times higher likelihood of semaglutide initiation compared with exclusive provider organization or health maintenance organization plans.
Employment sector emerged as another significant factor. Individuals working in nondurable goods manufacturing, finance/insurance/real estate, and services were more likely to receive prescriptions.
The study also found associations between certain medication use and semaglutide initiation. Patients taking antidepressants had a 1.62 times higher likelihood of receiving semaglutide prescriptions.
Geographic variations were notable, with patients in the Northeast having a 3.41 times higher likelihood of receiving semaglutide compared with those in the West.
The investigators observed a temporal trend in prescribing patterns, with rates increasing from June 2021 through March 2022, followed by a decline. This pattern coincided with documented medication shortages.
The study highlighted potential barriers to access, including insurance coverage variations.
"Approximately 1 in 4 employers report offering coverage for [glucagon-like peptide-1] receptor agonists for weight loss indications, while more than three-fourths cover them for diabetes," the study authors noted.
Body mass index (BMI) also influenced prescription patterns, with higher initiation rates among patients with class III obesity (BMI ≥ 40). This finding "reflects the disconnect between clinician behavior and treatment guidelines," the investigators suggested, noting that current guidelines recommend these medications for individuals with BMI ≥ 30 or ≥ 27 with weight-related comorbidities.
The study's limitations included its reliance on claims data, which lagged 3 to 6 months behind actual prescribing patterns, and the inability to capture prescriptions that were written but never filled.
The investigators concluded that these findings may help clinicians identify patients less likely to access obesity treatment and assist policymakers in addressing structural barriers to care, particularly regarding insurance coverage for weight management medications.
One study author reported receiving grants from Swiss Re and Johnson & Johnson outside the submitted work. No other disclosures were reported.