Barriers to Diabetes Treatment Linked With Increased Monthly Costs

^{By Julie Gould} 

Researchers recently found that use of glucagon-like peptide-1 (GLP-1) receptor agonists positively impacted glycemic control, weight, and reduced polytherapy, however, “the increase in monthly glucose-lowering medication cost was significant and may serve as a barrier to treatment.” 

According to the researchers, GLP-1 receptor agonists are often a preferred option for patients with type 2 diabetes. However, because their high cost often concerns many, researchers sought to examine and evaluate monthly glucose-lowering medication cost and clinical impact after initiating a GLP-1 receptor agonist.   

To better understand the study, its findings, and why providers should be mindful of the high cost of diabetes agents, we spoke with lead study author Tayla Rose, PharmD, MEd, RPh, BCACP, CDE, assistant clinical professor in the Department of Pharmacy and Health Systems Sciences at Northeastern University School of Pharmacy.  

What existing data led you and your co-investigators to conduct this research? 

My co-investigators and I provide care for underserved patients with chronic diseases, most notably patients with diabetes. We found that the population of patients we serve did not match those included in the clinical trials that led to the approval of the glucagon-like peptide-1 receptor agonists (GLP-1 RAs) in that they were largely non-Caucasian, non-English speaking, had more complex baseline glucose-lowering medication regimens, and had higher baseline hemoglobin A1c (HbA1c) and weight. We wanted to understand the real-world implications, in terms of clinical outcomes and cost, for our patients who are prescribed GLP-1 RAs.  

Please briefly describe your study and its findings. Were any of the outcomes particularly surprising? 

We retrospectively reviewed 120 patients with uncontrolled type 2 diabetes. Using a pre-post cohort design, we assessed their HbA1c, weight, and glucose-lowering medication regimen at baseline and 6-12 months after addition of the GLP-1 RA.  On average, HbA1c decreased by 1.7% after addition of the GLP-1 RA, and weight decreased by 1.8kg. These effects were greatest in patients who had higher baseline HbA1c and weight, respectively. Another interesting finding was that patients who were taking insulin at baseline were able to significantly reduce their dose, and of those patients who were using basal-bolus insulin regimens, 60.9% were able to discontinue their bolus insulin following addition of the GLP-1 RA. While these clinical findings are encouraging, on average, the cost of the patient’s glucose lowering medication regimen increased by $586 per month. This cost was calculated using the average wholesale price of the medications, and does not reflect the actual negotiated price, or the cost to the patient. The population in this study was largely insured by Medicaid, and thus the actual cost increase incurred by the patient was minimal.  

What are the possible real-world applications of these findings in clinical practice? 

GLP-1 RAs were effective at reducing HbA1c, weight, and glucose-lowering medication regimen complexity in this real-world cohort of underserved patients. Providers may consider GLP-1 RAs for their patients with diabetes who are not achieving optimal outcomes on their current glucose-lowering regimen, and/or for those who are seeking to decrease their use of insulin. However, providers should also be mindful of the high cost of these agents, which may be particularly prohibitive for patients with insurance plans that include high deductibles and/or high co-pays.  

Do you and your co-investigators intend to expand upon this research? 

Future research is warranted to determine if the overall increase in cost to the health care system attributable to use of GLP-1 RAs is offset by potential decreased expenditures related to improved clinical outcomes in patients with type 2 diabetes. Additionally, longer term follow-up would allow for measuring the durability of clinical improvement and potential impact on micro and macro-vascular outcomes in the real-world underserved patient population. 

Dr Rose practices as an ambulatory care clinical pharmacist at Lynn Community Health Center in Lynn, MA. She completed a Post-Graduate Year 1 (PGY1) Pharmacy Residency with a focus in Ambulatory Care at Northeastern University and Federally Qualified Health Centers (FQHCs)/Program of All-Inclusive Care for the Elderly (PACE). Dr. Rose received her B.S. in Pharmacy Studies and Doctor of Pharmacy (PharmD) from the University of Connecticut.  She completed her Masters in Education at Northeastern University. 

Reference:

Rose TN, Jacobs ML, Reid DJ, et al. Real-world impact on monthly glucose-lowering medication cost, HbA_1c, weight, and polytherapy after initiating a GLP-1 receptor agonist. J Am Pharm Assoc (2003). 2020;60(1):31–38.e1. doi:10.1016/j.japh.2019.09.001