Access to Anti-Obesity GLP-1s for Medicare-Aged Adults

Background Obesity is common among older adults in the US, but Medicare policies prohibit coverage of anti-obesity medications (AOMs) and may limit access to effective treatment. Objective To describe first-time prescribing and dispensing of AOM glucagon-like peptide-1 receptor agonists (GLP-1 RA) among eligible older adults, stratified by Medicare age eligibility. Methods Adults aged 60-69 with overweight or obesity and without Type II diabetes (T2D) were identified from Truveta Data. Data included EHR (encounters, prescriptions, conditions, BMI) and medication dispensing for a collective of US healthcare systems. Eligibility required an outpatient office encounter between June 2021 and January 2024 with a BMI ≥ 27, a negative history of GLP-1 RA use, and a follow-up ≥60 days later. Patients were stratified by Medicare age eligibility (60-64 vs. 65-69) and the proportions prescribed and subsequently dispensed AOM GLP-1 RA were compared. Results In total, 413,833 AOM eligible older adults were included in our cohort, with 208,067 (50.3%) Medicare-aged adults and 205,766 (49.7%) adults aged 60-64. Among eligible patients, 0.2% of Medicare-aged patients and 0.4% of patients aged 60-64 were prescribed AOM GLP-1 RA, a significant difference (p < 0.01). Among those prescribed AOM GLP-1 RA, 15.2% of Medicare-aged patients and 22.7% of patients aged 60-64 were dispensed AOM GLP-1 RA within 60 days, a significant difference (p<0.01). In both age groups, prescribing and dispensing were more common for females and those with higher BMI. Conclusions Fewer than 1% of older adults with overweight or obesity and without T2D were prescribed an AOM GLP-1 RA. New use of GLP-1 RA was significantly lower for Medicare-aged adults, compared to 60-64-year-olds, with differences occurring at both medication prescribing and dispensing stages. While coverage of AOMs is limited by many insurers, Medicare’s unique prohibition on AOM coverage may contribute to differentially lower use among Medicare-aged adults.