Adherence to GLP ‐1 receptor agonists and SGLT2 inhibitors by out‐of‐pocket spending among Medicare beneficiaries with diabetes

作者：Nicklas S. Klepser, Ellerie Weber, Lihua Li, Kirsten E. Fleischmann, Umesh Masharani, Meyeon Park, Wendy Max, Joseph Yeboah, M. G. Myriam Hunink, Bart S. Ferket · 发表于：Diabetes Obesity and Metabolism · 年份：2025 · DOI：10.1111/dom.16619 · 被引用次数：5 · 研究领域：Medication Adherence and Compliance、Diabetes Treatment and Management、Food Security and Health in Diverse Populations

AIMS: To assess associations between out-of-pocket (OOP) expenditures and adherence to glucagon-like peptide-1 receptor agonists (GLP-1RAs) and sodium-glucose cotransporter-2 inhibitors (SGLT2i) among low-income Medicare beneficiaries with diabetes. MATERIALS AND METHODS: We analysed Medicare Current Beneficiary Survey two-year longitudinal data (2016-2021) on beneficiaries with diabetes using GLP-1RAs (N = 168; weighted = 2 187 500) or SGLT2i (N = 139; weighted = 1 741 910) in year one (baseline). Among these, N = 97 (weighted = 1 117 637) GLP-1RA and N = 73 (weighted = 785 301) SGLT2i users had an income below 200% of the Federal Poverty Level (low-income). Survey-weighted generalized Poisson regression assessed the association between baseline cumulative OOP drug expenses and year two adherence, defined as proportion of days covered (PDC). We repeated analyses in participants with higher income and using dual (Medicare/Medicaid) enrolment as a proxy for full coverage in low income. RESULTS: Year-two PDC was 65.2% (95% CI: 57.9%-72.6%) for low-income GLP-1RA users and 65.4% (95% CI: 58.3%-72.5%) for low-income SGLT2i users. We did not observe a significant association between OOP costs (mean: $253; range: $0-$4699) and adherence in low-income GLP-1RA users. For low-income SGLT2i users, higher OOP costs (mean: $204; $0-$2649) were associated with lower adherence: adjusted adherence ratio 0.959 (95% CI: 0.932-0.987) per $100 increase. Dual Medicare-Medicaid coverage was assoc...