医保受益人群中 2 型糖尿病患者的 SGLT2i 或 GLP1-RA 起始用药与目录限制的关联。
Association of formulary restrictions and initiation of an SGLT2i or GLP1-RA among Medicare beneficiaries with type 2 diabetes.
机构信息
Division of General Internal Medicine, University of Pittsburgh School of Medicine, United States.
University of California, San Diego, Skaggs School of Pharmacy and Pharmaceutical Sciences, United States.
出版信息
Diabetes Res Clin Pract. 2022 May;187:109855. doi: 10.1016/j.diabres.2022.109855. Epub 2022 Mar 25.
BACKGROUND
Use of SGLT2 inhibitors (SGLT2i) and GLP-1 receptor agonists (GLP1-RA) among older adults with type 2 diabetes (T2D) has been limited.
OBJECTIVE
To examine factors associated with initiation of an SGLT2i or GLP-1RA among Medicare beneficiaries with T2D in the early years after their market approval, with a particular focus on formulary restrictions (e.g. prior authorization, step therapy requirements, higher co-pays).
METHODS
A retrospective cohort study using data from a 5% random sample of Medicare beneficiaries with T2D followed from 1/1/2015-12/31/16. Formulary restrictiveness was defined as: (1) the number of target drugs (i.e. SGLT2is or GLP1-RAs) included in tiers 1-3 of a beneficiary's formulary (greater number of drugs in tiers 1-3 being less restrictive) and (2) the number of drugs without prior authorization or step therapy (requirement to try less expensive drugs prior to "stepping up" to more expensive therapies). We used multivariable logistic regression models to estimate the association between measures of formulary restrictiveness and initiation of a target drug, controlling for patient demographics, diabetes duration, clinical comorbidities, and provider specialty.
RESULTS
Among 112,985 beneficiaries with T2D, 5,619 (5%) initiated an SGLT2i or GLP1-RA. After adjusting for baseline characteristics, patients enrolled in formularies with ≥ 2 target drugs available in tiers 1-3 had 17% higher odds of initiating an SGLT2i or GLP1-RA (aOR 1.17, 95% CI 1.05-1.31) compared to patients enrolled in formularies with 0 drugs available in tiers 1-3. There was no significant association between the number of drugs without prior authorization or step therapy requirements and initiation of a target drug (aOR 0.96, 95% CI, 0.85-1.09). Age 75 years or older (vs < 65, aOR 0.23, 95% CI 0.21-0.26) and black race (vs white, aOR 0.65, 95% CI 0.59-0.71) were associated with lower odds of initiating a target drug.
CONCLUSIONS
Having a greater number of target drugs available on less expensive formulary tiers is associated with increased odds of initiating an SGLT2i or GLP-1RA among Medicare beneficiaries with T2D.
背景
在 2 型糖尿病（T2D）的老年患者中，使用 SGLT2 抑制剂（SGLT2i）和 GLP-1 受体激动剂（GLP1-RA）的情况受到限制。
目的
本研究旨在检查在市场批准后的早期，医疗保险受益人群中 T2D 患者开始使用 SGLT2i 或 GLP1-RA 的相关因素，特别关注处方限制（例如，事先授权、阶梯治疗要求、更高的共付额）。
方法
本研究采用回顾性队列研究设计，使用了 2015 年 1 月 1 日至 2016 年 12 月 31 日期间接受 T2D 治疗的医疗保险受益人的 5%随机样本数据。处方限制程度定义为：（1）患者处方中 1-3 层包含的目标药物数量（即 SGLT2i 或 GLP1-RAs）（1-3 层中的药物数量越多限制越小）和（2）无需事先授权或阶梯治疗的药物数量（需要先尝试较便宜的药物，然后才能“升级”到更昂贵的治疗方案）。我们使用多变量逻辑回归模型来估计处方限制措施与目标药物使用的关联，同时控制患者的人口统计学特征、糖尿病病程、临床合并症和提供者专业。
结果
在 112985 名 T2D 患者中，有 5619 名（5%）患者开始使用 SGLT2i 或 GLP1-RA。在调整基线特征后，与在 1-3 层中有 0 种目标药物的患者相比，在 1-3 层中有 ≥2 种目标药物的患者开始使用 SGLT2i 或 GLP1-RA 的可能性高 17%（调整后的比值比[OR]为 1.17，95%置信区间[CI]为 1.05-1.31）。无事先授权或阶梯治疗要求的药物数量与目标药物的使用之间没有显著关联（调整后的 OR 为 0.96，95%CI，0.85-1.09）。75 岁或以上（<65 岁，调整后的 OR 为 0.23，95%CI 0.21-0.26）和黑人（与白人相比，调整后的 OR 为 0.65，95%CI 0.59-0.71）与较低的使用目标药物的可能性相关。
结论
在医疗保险受益人群中，较便宜的处方层中提供更多的目标药物与使用 SGLT2i 或 GLP-1RA 的可能性增加有关。
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