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Peer-reviewedCC BY-NCHealth affairs scholar

Prescription denials for GLP-1 receptor agonists across commercial, Medicare, and Medicaid coverage, 2018-2024.

  • Miaoqing Jia1
  • Joseph F Levy2
  • Emma E McGinty1
  • Sri Lekha Tummalapalli3,4
  • Yongkang Zhang1
4 affiliations
  1. 1Division of Health Policy and Economics, Department of Population Health Sciences, Weill Cornell Medical College, New York, NY 10022, USA.
  2. 2Department of Health Policy and Management, Johns Hopkins School of Public Health, Baltimore, MD 21205, USA.
  3. 3Division of Healthcare Delivery Science & Innovation, Department of Population Health Sciences, Weill Cornell Medicine, New York, NY 10022, USA.
  4. 4Cornell Health Policy Center, New York, NY 10065, USA.
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Abstract

Introduction

Access to GLP-1 receptor agonists (GLP-1 RAs) remains strongly shaped by payer coverage and utilization management. Patient-level evidence on GLP-1 RA denial across payer types is limited.Methods

Using a national multi-payer claims database capturing adjudication status of pharmacy claims, we examined GLP-1 RA prescription denial and whether individuals with an index denial subsequently obtained a paid fill from 2018 to 2024. The index claim was defined as each individual's first observed GLP-1 RA claim. We estimated multivariable logistic regressions to examine factors associated with index-claim denial and the likelihood of receiving a paid fill within 90 days among individuals with a denied index claim.Results

Overall, 7.9% of individuals had a denied index GLP-1 RA claim, increasing from 4.0% (2018) to 9.6% (2022) before declining to 6.6% (2024). Denial was higher in Medicaid than in commercial coverage (12.6% vs 5.6%) and for obesity-indicated than diabetes-indicated brands (16.8% vs 6.3%). Among individuals with a denied index claim, 34.1% obtained a paid fill within 90 days, declining from 45.9% (2018) to 24.8% (2024).Conclusion

Denial was concentrated in Medicaid and obesity-indicated products, and most individuals with a denied index claim did not obtain a paid fill within 90 days.

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Cite

BibTeXRIS
BibTeX
@article{jia2026prescription,
  title = {{Prescription denials for GLP-1 receptor agonists across commercial, Medicare, and Medicaid coverage, 2018-2024.}},
  author = {Miaoqing Jia and Joseph F Levy and Emma E McGinty and Sri Lekha Tummalapalli and Yongkang Zhang},
  journal = {Health affairs scholar},
  year = {2026},
  month = oct,
  doi = {10.1093/haschl/qxag284},
  url = {https://europepmc.org/article/MED/42948647},
  note = {CC BY-NC},
}
RIS
TY  - JOUR
TI  - Prescription denials for GLP-1 receptor agonists across commercial, Medicare, and Medicaid coverage, 2018-2024.
AU  - Miaoqing Jia
AU  - Joseph F Levy
AU  - Emma E McGinty
AU  - Sri Lekha Tummalapalli
AU  - Yongkang Zhang
PY  - 2026
DA  - 2026/10/15
JO  - Health affairs scholar
DO  - 10.1093/haschl/qxag284
UR  - https://europepmc.org/article/MED/42948647
AB  - Introduction  Access to GLP-1 receptor agonists (GLP-1 RAs) remains strongly shaped by payer coverage and utilization management. Patient-level evidence on GLP-1 RA denial across payer types is limited.Methods  Using a national multi-payer claims database capturing adjudication status of pharmacy claims, we examined GLP-1 RA prescription denial and whether individuals with an index denial subsequently obtained a paid fill from 2018 to 2024. The index claim was defined as each individual's first observed GLP-1 RA claim. We estimated multivariable logistic regressions to examine factors associated with index-claim denial and the likelihood of receiving a paid fill within 90 days among individuals with a denied index claim.Results  Overall, 7.9% of individuals had a denied index GLP-1 RA claim, increasing from 4.0% (2018) to 9.6% (2022) before declining to 6.6% (2024). Denial was higher in Medicaid than in commercial coverage (12.6% vs 5.6%) and for obesity-indicated than diabetes-indicated brands (16.8% vs 6.3%). Among individuals with a denied index claim, 34.1% obtained a paid fill within 90 days, declining from 45.9% (2018) to 24.8% (2024).Conclusion  Denial was concentrated in Medicaid and obesity-indicated products, and most individuals with a denied index claim did not obtain a paid fill within 90 days.
SN  - 2976-5390
ER  -