GLP-1 Access Limited for Teens with T2D, Obesity

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In an abstract presented at the Endocrine Society’s ENDO 2024 annual meeting in Boston, Massachusetts, researchers explored access to GLP-1s for teenagers with and without type 2 diabetes.

Insurance coverage of liraglutide (Victoza, Saxenda) is limited in adolescents with type 2 diabetes (T2D) and obesity despite FDA approval of glucagon-like peptide 1 (GLP-1) agonists for this patient population, according to a poster presented at ENDO 2024, the annual meeting of the Endocrine Society.

Study authors found that insurance denied 41% of all liraglutide prescriptions for a cohort of patients with or without T2D and obesity. When analyzing prescriptions for children under 18 years old from 2019 to 2023, researchers also found that half of the participants needed extra time to reach their full dosage and one-third of the cohort was unable to reach full dosage entirely.1

“Health insurance companies often deny coverage for new medications that treat children and teens with obesity and [T2D], meaning many patients who need treatment are unable to afford it,” according to a press release covering the ENDO abstract titled “Real-world implications and limitations of GLP-1 prescriptions in adolescents.”2

Key Takeaways

  • Researchers addressed the insurance coverage of GLP-1 prescriptions for T2D in adoloescents under 18 years old.
  • They found that coverage for liraglutide was often limited since insurers denied 41% of prescriptions.
  • They concluded that more needs to be done for teenagers to gain necessary access to these life-saving diabetes drugs.

By the end of 2023, semaglutide became the highest-selling prescription drug in the US, doubling its expenditures while being predicted to rise even higher in 2024.3 Semaglutide, like liraglutide, is one of many GLP-1RAs to recently hit the market. In the study, however, researchers focused on the limitations of liraglutide prescriptions.

Liraglutide is one of many GLP-1RAs to hit the market. | image credit: Avi / stock.adobe.com

Liraglutide is one of many GLP-1RAs to hit the market. | image credit: Avi / stock.adobe.com

The researchers analyzed data from 599 patients (mean age, 14.99 years; 63% White; 58% women; 74% with T2D) from Texas Children’s Hospital. With 90% of prescriptions for liraglutide and the other 10% for other GLP-1s like semaglutide, the researchers also observed dose titration, side effects, and insulin doses for those who completed their treatment regimens.

In this retrospective review, researchers found that 41% of all prescriptions analyzed were denied. Denials for patients without T2D exceeded denials for patients with T2D, where 64% of patients without diabetes were denied compared with 32% of patients with T2D.

The researchers also addressed the titration and adverse effects of taking drugs like GLP-1RAs. Of the 599 study participants, just 34% (n=204) finished the 26-week follow-up. For patients with T2D, 50% (n=95) reached their intended titration at 1.8 mg doses, 33% (n=62) reached titration by 6 months, and 17% (n=32) never reached 1.8 mg.

READ MORE: Exploring the Expanded Potential of GLP-1s

“This has significant clinical implications since the expected improvements with the use of GLP-1RA in weight or glucose control are likely dose-dependent. If patients are unable to reach the prescribed dose, they will likely not experience the full beneficial effects of the medication,” said Castano.2

Some notable side effects of GLP-1s are nausea, vomiting, and diarrhea, but one stuck out to researchers as dangerous but important: pancreatitis, an adverse effect that has not yet been reported in those taking GLP-1s.

Finally, researchers addressed the types of insurance patients both with or without diabetes were granted or denied access to GLP-1s. “In patients with [T2D], private insurance denied 54% of the prescriptions, while Medicaid denied 27%. In patients without [T2D], private insurance denied 55%, and Medicaid denied 69% of prescriptions,” continued Castano.2

GLP-1RAs were first introduced in 2005 when the FDA approved exenatide for the treatment of T2D.4 Since then, these prescription drugs have been approved to treat obesity and cardiovascular health, and researchers are currently exploring their use in other avenues such as treatment for smoking cessation, alcohol use disorder, and more.5

But with the recent expansion of GLP-1s on the prescription drug market, it makes sense why denials for those without T2D would exceed patients with T2D. However, whether study participants had T2D or not, the researchers still identified a widespread issue of prescription denials from public and private insurers. Adding to this issue is the newly identified possible side effect of pancreatitis, putting the drug’s overall efficacy into question.

With several apparent hurdles coming with the inception of GLP-1s in the marketplace—such has higher-income individuals without T2D using up the supply and raising out-of-pocket spending—researchers continue to explore GLP-1 access, titration, side effects, and more.

“Our research shows that [GLP-1RA] medications are difficult to get for the patients who need them, patients may not be able to follow the recommended titration regimen when starting a [GLP-1RA], and additional side effects may be possible than what has been reported previously,” concluded Castano.2

Click here for more of our coverage from ENDO 2024.

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References
1. Castano G, Sisley S. Real-world implications and limitations of GLP-1 prescriptions in adolescents. Presented at: ENDO 2024; June 1-4; Boston, MA.
2. Insurance often denies GLP-1 medications for teens with type 2 diabetes, obesity. News release. The Endocrine Society. June 1, 2024. Accessed June 3, 2024.
3. Enormous demand for weight-loss drugs drives up total U.S. prescription spending. American Society of Health System Pharmacists. April 24, 2024. Accessed May 2, 2024. https://www.prnewswire.com/news-releases/enormous-demand-for-weight-loss-drugs-drives-up-total-us-prescription-spending-302125178.html
4. Sheahan KH, Wahlberg EA, Gilbert MP. An overview of GLP-1 agonists and recent cardiovascular outcomes trials. Postgrad Med J. 2020;96(1133):156-161. doi:10.1136/postgradmedj-2019-137186
5. Rubin R. Could GLP-1 Receptor Agonists Like Semaglutide Treat Addiction, Alzheimer Disease, and Other Conditions? JAMA. 2024;331(18):1519–1521. doi:10.1001/jama.2024.1017
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