SHAP worth plots for every characteristic are proven, ranked by significance (imply absolute SHAP worth). Every dot represents 1 particular person, with their place representing their SHAP worth. Colour is used to point the required characteristic attribute. Crimson dots point out those that have the listed attribute, whereas blue dots point out those that don’t. For instance, for the attribute feminine, people with a crimson dot are feminine and seem predominantly to the best, indicating that they’re extra more likely to provoke semaglutide, whereas these with a blue dot are male. Age is a steady variable representing age at analysis (18 to 64 years) and index month ranged from June 2021 to June 2022. MSA signifies metropolitan statistical space; NEC, not elsewhere categorized; PPO, most popular supplier group. Credit score: Boston College College of Public Well being
Developed initially to handle diabetes, glucagon-like peptide-1 (GLP-1) receptor agonists have skyrocketed in recognition because the US Meals & Drug Administration first accredited semaglutide (model identify Ozempic/Wegovy) for weight reduction in 2021. Approval of tirzepatide (model identify Mounjaro/Zepbound), an much more efficacious treatment, quickly adopted in 2023.
Regardless of hovering use amongst celebrities and the general public alike, not everybody who can profit from anti-obesity drugs has entry to those novel medication, in response to a brand new research led by Boston College College of Public Well being (BUSPH) researchers.
Printed in JAMA Community Open, the research discovered disparities in entry to semaglutide. Charges of acquiring a prescription for semaglutide diverse broadly based mostly on a person’s insurance coverage plan and kind, in addition to their job trade, intercourse, and use of different drugs.
Amongst commercially insured, non-diabetic people with weight problems, individuals who recognized as feminine, obtained point-of-service or most popular supplier group insurance coverage protection, and took drugs corresponding to antidepressants or thyroid or hormone drugs have been extra more likely to start taking semaglutide in comparison with individuals who recognized as males, or those that have been coated by well being administration group or unique supplier group plans
People employed in sure industries, such because the monetary and actual property sectors, have been additionally extra more likely to be prescribed semaglutide in comparison with folks in different jobs, corresponding to retail.
The findings make clear the boundaries that individuals with weight problems expertise in accessing weight-loss remedy in a well being care system that usually views weight problems as a threat issue for different illnesses that needs to be managed by means of way of life adjustments alone. Whereas weight problems can result in different circumstances, additionally it is an unbiased illness worthy of pharmacological interventions, even when it impacts nondiabetic individuals who might in any other case be characterised as metabolically wholesome, the researchers say.
“The paradigm for treating people with obesity has often been to recommend lifestyle changes, and then if they develop diabetes or another metabolic condition, to treat them with metformin, insulin, or GLP-1 drugs,” says research senior and corresponding writer Andrew Stokes, affiliate professor of world well being at BUSPH.
“However, emerging evidence suggests that due to biological resistance to weight loss and systemic external barriers, achieving sustainable lifestyle change can be challenging. The care paradigm is starting to shift, with the understanding that it’s beneficial to treat metabolic health conditions before they progress to an advanced stage.”
The staff hopes this new information will help physicians higher perceive and establish sufferers who’re much less more likely to entry weight problems remedy, with challenges starting from issue in acquiring care from weight problems medication practitioners to lack of formulary protection for weight-management drugs.
Presently, only one in 4 employers provide insurance coverage protection for GLP-1 medication for weight administration—with variability in ease of entry, because of step remedy and prior authorization necessities—whereas the vast majority of employers do cowl this class of medicines for diabetes.
The research can inform coverage adjustments that develop insurance coverage protection for GLP-1 medication throughout a wider vary of insurance policy, employment industries, revenue ranges, intercourse, and different elements.
“The substantial barriers to access to GLP-1s reflect existing inequities and poor alignment of incentives in our health care system,” says research co-author Katherine Hempstead, senior coverage officer on the Robert Wooden Johnson Basis. “Research is needed to help illustrate the size and nature of access gaps so that we can design better coverage policies.”
In the end, “there is a need for policymakers to recognize that factors unrelated to whether an individual has a medical necessity for treatment can affect whether or not a person is likely to receive these medications,” says research lead writer Meghan Podolsky, analysis fellow within the Division of World Well being at BUSPH.
“Increasing access will require addressing the significant barriers to care, such as treatment cost, site of care, and the policies that insurance plans can implement, such as step therapy and prior authorizations.”
For the research, the staff used nationwide insurance coverage claims information for greater than 97,000 commercially insured US adults identified with weight problems, however not diabetes, between June 2021 and July 2022. They used a machine studying mannequin to establish the sociodemographic, scientific, and well being care elements related to being prescribed semaglutide, after which quantified the impression of an important elements.
Along with insurance coverage sort and employment trade, they discovered that semaglutide initiation was considerably greater amongst People who lived within the northeast area, in addition to those that have been taking antidepressants, thyroid or hormone drugs, and amphetamines.
Members with the best physique mass index (BMI) values (40 or above) have been most probably to entry semaglutide, which isn’t shocking on condition that this group has the best threat for creating additional metabolic illness.
Nevertheless, Podolsky says it displays a development that physicians could also be proscribing GLP-1 medication to sufferers with the best weight, and solely recommending way of life interventions to sufferers with BMI values of 35 or much less. This method contradicts the FDA’s approval of the treatment for folks with BMIs of 30 or greater, or 27 or greater with a comorbidity. These people may additionally profit from GLP-1 drugs, however might face extra challenges in accessing them.
The staff will proceed learning inequities in GLP-1 entry for diabetic and non-diabetic populations, together with potential variations in response to socioeconomic standing, race and ethnicity, and Medicare and Medicaid protection. Medicare at present solely covers GLP-1 medication for diabetic and cardiovascular remedy, whereas Medicaid gives restricted protection in sure states.
After criticizing GLP-1 medication, US well being secretary nominee Robert F. Kennedy, Jr. just lately recommended that these remedies “have a place” within the well being care system, however whether or not and the way entry to those drugs will change below the second Trump administration stays within the steadiness.
The research was coauthored by Rafeya Raquib, analysis fellow within the Division of World Well being at BUSPH; Paul Shafer, assistant professor of well being regulation, coverage & administration at BUSPH; and Randall Ellis, professor of economics at Boston College Faculty of Arts & Sciences.
Extra info:
Meghan I. Podolsky et al, Components Related With Semaglutide Initiation Amongst Adults With Weight problems, JAMA Community Open (2025). DOI: 10.1001/jamanetworkopen.2024.55222
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