Abstract | BACKGROUND: OBJECTIVE: To evaluate trends in Medicare formulary restrictions of GLP1-RAs and SGLT2is following the recommendations by the ADA for first-line use. METHODS: We conducted a retrospective cohort study of Quarter 1 Medicare formulary restrictions on GLP1-RAs and SGLT2is from 2019 to 2023. We analyzed changes in formulary restrictions by year, before and after the ADA first-line recommendations, single vs combination products, and products with and without other indications on a medication level (ie, each unique National Drug Code number on each unique formulary) and formulary level (ie, any prior authorization or step therapy requirements yield formulary restriction). RESULTS: We analyzed 12,212 unique Medicare formularies. GLP1-RAs were 12.5% less likely (relative risk [RR] = 0.87; 95% CI = 0.84-0.91; P < 0.001) and 33.2% less likely (RR = 0.67; 95% CI = 0.60-0.74; P < 0.001) to have restrictions after the ADA guideline changes on a medication and formulary level, respectively. SGLT2is were 87.8% less likely (RR = 0.12; 95% CI = 0.11-0.13; P < 0.001) and 53.0% less likely (RR = 0.47; 95% CI = 0.27-0.80; P = 0.005) to have restrictions after the ADA guideline changes on medication and formulary levels, respectively. CONCLUSIONS: Decreasing trends of medications and formularies with restrictions may indicate payers are recognizing GLP1-RAs and SGLT2is as potential first-line agents, aligning with ADA recommendations.
|
Authors | Brady Wisniewski, Eric Smith, Jasmeen Kaur, Ciara Sherling, Shravani Vanapalli, Mia Lussier |
Journal | Journal of managed care & specialty pharmacy
(J Manag Care Spec Pharm)
Vol. 30
Issue 1
Pg. 34-42
(Jan 2024)
ISSN: 2376-1032 [Electronic] United States |
PMID | 38153863
(Publication Type: Journal Article)
|
Chemical References |
- Sodium-Glucose Transporter 2 Inhibitors
- Hypoglycemic Agents
- Glucagon-Like Peptide 1
- Glucagon-Like Peptide-1 Receptor
|
Topics |
- Humans
- Aged
- United States
- Diabetes Mellitus, Type 2
(drug therapy)
- Sodium-Glucose Transporter 2 Inhibitors
(therapeutic use)
- Hypoglycemic Agents
(therapeutic use, pharmacology)
- Retrospective Studies
- Medicare
- Glucagon-Like Peptide 1
- Glucagon-Like Peptide-1 Receptor
(agonists)
|