{"doi":"10.2337/dc24-2746","title":"Association of Patient Cost Sharing With Adherence to GLP-1RA and Adverse Health Outcomes","abstract":"OBJECTIVE: To examine the associations between patient out-of-pocket (OOP) costs and nonadherence to glucagon-like peptide 1 receptor agonists (GLP-1RA), and the consequent impact on adverse outcomes, including hospitalizations and emergency department (ED) visits. RESEARCH DESIGN AND METHODS: This retrospective cohort study used MarketScan Commercial data (2016-2021). The cohort included nonpregnant adults aged 18-64 years with type 2 diabetes who initiated GLP-1RA therapy. Participants were continuously enrolled in the same private insurance plan for 6 months before the prescription date and 1 year thereafter. Exposures included average first 30-day OOP costs for GLP-1RA, categorized into quartiles (lowest [Q1] to highest [Q4]). Primary outcomes were the annual proportion of days covered (PDC) for GLP-1RA and nonadherence, defined as PDC <0.8. Secondary outcomes included diabetes-related and all-cause hospitalizations and ED visits 1 year after GLP-1RA initiation. RESULTS: Among 61,907 adults who initiated GLP-1RA, higher 30-day OOP costs were associated with decreased adherence. Patients in the highest OOP cost quartile (Q4: $80-$3,375) had significantly higher odds of nonadherence (odds ratio [OR] 1.25; 95% CI 1.19-1.31) compared with those in Q1 ($0-$21). Nonadherence was linked to increased incidence rates of diabetes-related hospitalizations or ED visits (incidence rate ratio [IRR] 1.86; 95% CI 1.43-2.42), cumulative length of hospitalization (IRR 1.56; 95% CI 1.41-1.72), all-cause ED visits (IRR 1.38; 95% CI 1.32-1.45), and increased ED-related costs ($69.81, 95% CI $53.54-$86.08). CONCLUSIONS: Higher OOP costs for GLP-1RA were associated with reduced adherence and increased rates of adverse outcomes among patients with type 2 diabetes.","journal":"Diabetes Care","year":2025,"id":516193,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":10,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.721,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2025-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":929842,"name":"Nihan Gencerliler","orcid":"0000-0002-8269-5437","position":1,"is_corresponding":false},{"id":960673,"name":"Amrita Mukhopadhyay","orcid":"0000-0002-7768-459X","position":2,"is_corresponding":false},{"id":449312,"name":"Saul Blecker","orcid":"0000-0003-4460-1046","position":3,"is_corresponding":false},{"id":73169,"name":"Morgan E. Grams","orcid":"0000-0002-4430-6023","position":4,"is_corresponding":false},{"id":608018,"name":"Davene R. Wright","orcid":"0000-0002-8574-4572","position":5,"is_corresponding":false},{"id":675450,"name":"Vivian Hsing-Chun Wang","orcid":"0000-0002-5638-204X","position":6,"is_corresponding":false},{"id":1381526,"name":"Anand Prem Rajan","orcid":"0000-0001-5659-0386","position":7,"is_corresponding":false},{"id":1382025,"name":"Eisha Butt","orcid":null,"position":8,"is_corresponding":false},{"id":484667,"name":"Jung‐Im Shin","orcid":"0000-0003-0374-6927","position":9,"is_corresponding":false},{"id":312220,"name":"Yunwen Xu","orcid":"0000-0002-5946-2272","position":10,"is_corresponding":false},{"id":284104,"name":"Karan R. Chhabra","orcid":"0000-0001-6620-8777","position":11,"is_corresponding":false},{"id":342446,"name":"Jasmin Divers","orcid":"0000-0003-0120-7620","position":12,"is_corresponding":false},{"id":395622,"name":"Donglan Zhang","orcid":"0000-0001-5225-4721","position":0,"is_corresponding":true}],"reference_count":35,"raw_metadata":null,"created_at":"2026-07-19T02:48:49.486328Z","pmid":"40202527","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}