Disparities in Prescription of Long-Acting GLP-1s.

Abstract

Broadening usage of new antiobesity medications (AOMs, e.g., GLP-1 and GLP-1/GIP agonists) has prompted access concerns. We analyzed patient and appointment factors associated with AOM prescriptions, including changing AOM coverage in state Medicaid programs (MassHealth). This was a retrospective pre-post study of medical weight management appointments at a large tertiary care center in January and April 2024, bracketing a MassHealth coverage change for AOMs. Patient and visit characteristics and AOMs prescribed were analyzed. A total of 2060 patients were analyzed. Multivariable analysis demonstrated that patients were more likely to receive Sema/Tirz compared to no or a different AOM with private insurance (aOR 2.744, p < 0.001), diabetes (aOR 2.507, p < 0.001), and established patient relationships (aOR 1.706, p < 0.001). In January 2024, Black and Hispanic patients were 49% and 47% less likely to be prescribed Sema/Tirz (p = 0.003, p = 0.025); in April 2024, after MassHealth changes, only patients of "Not Disclosed" race were less likely to receive these medications (p < 0.001). Black and Hispanic patients were less likely and patients with private insurance, diabetes, and established patient relationships were more likely to be prescribed Sema/Tirz. Racial and ethnic disparities in medication prescription were less apparent after a state Medicaid policy change to cover new GLP-1s.