Factors such as gender, type of insurance plan, and use of common medications influenced whether people with obesity but without diabetes started semaglutide treatment
A recent one JAMA Network Open The study investigated factors associated with initiation of semaglutide in obese adults without diabetes and with commercial insurance.
Increased demand for semaglutide
Demand for new GLP-1 receptor agonist drugs, such as tirzepatide (Zepbound, Mounjaro) and semaglutide (Wegovy, Ozempic), has increased. Originally prescribed for type 2 diabetes (T2D), these drugs are now FDA-approved for weight management and cardiovascular disease prevention.
Obesity, often overlooked as a treatable disease, is an important risk factor for diabetes and cardiometabolic diseases. Despite the availability of effective therapies such as GLP-1 receptor agonists, many obese individuals are still undertreated, with lifestyle counseling is the main recommendation.
In the US, where 73.6% of the population is overweight or obese, a significant number of people use GLP-1 agonists for weight management without physician guidance.
However, access to these drugs is often limited by insurance coverage disparities, disproportionately affecting people from low socioeconomic backgrounds and black and Hispanic communities. Addressing these disparities is critical to reducing the burden of obesity.
About the study
The current study sought to explore the factors controlling initiation of semaglutide among obese nondiabetic adults with commercial insurance. A machine learning approach was used to identify factors, and a multivariate regression modeling strategy helped quantify the association of top factors with semaglutide initiation.
All relevant data was obtained from the Merative MarketScan Commercial Claims and Encounters database (formerly IBM Marketscan) from the period between June 5, 2020 and December 31, 2022. MarketScan is a commercial health insurance provider whose databases offer demographic information, hospitalized and outpatient claims and prescription drugs for insured customers between the ages of 18 and 64.
A cohort was created, including individuals with at least one encounter with a health care professional for obesity in inpatient or outpatient settings. The first claim identified by the database was used as baseline data for the diagnosis of obesity. Subjects who underwent bariatric surgery, those prescribed antihyperglycemic medication, and subjects pregnant six months prior to obesity diagnosis were excluded.
Study findings
A total of 97,456 individuals between the ages of 45 and 54 met inclusion criteria, among whom 50.7% of the cohort was covered by preferred provider organization (PPO) plans. Over 50% of the cohort resided in the Southern region.
Approximately 2% of selected participants were prescribed semaglutide within 6 months of their initial obesity diagnosis. People between the ages of 55 and 64 were more often prescribed semaglutide than those between the ages of 18 and 24.
People with the highest body mass index were the largest group to receive semaglutide prescriptions. An AUROC model identified gender, economic status, age, region, employee status, and insurance plan type as the top factors associated with initiation of semaglutide.
Compared with men, women and older people from the Northeast and South who worked in the service industry and had PPO plans were more likely to receive semaglutide prescriptions. Those with unknown employer industries were less likely to have started semaglutide.
Multivariate logistic regression analysis revealed that subjects with more recent index dates had higher odds of starting semaglutide within 6 months, which peaked in March 2022 and declined by June 2022. In addition, subjects from the north-central and northeast regions were more likely to start semaglutide compared to those living in the West.
People with employers in nondurable goods manufacturing, insurance, real estate, and finance were more likely to start semaglutide. Participants with prescriptions for amphetamine stimulants and antidepressants were more likely to receive semaglutide.
conclusions
This study used a novel machine learning approach to identify health care, sociodemographic, and clinical factors associated with initiation of semaglutide within 6 months of obesity diagnosis.
The group studied showed the presence of inequalities in access to medicines. More research could be conducted to understand whether co-use of common drugs affects efficacy and utilization in a sample that includes those with public payment plans.
