Prescription Denials For GLP-1 Receptor Agonists Across Commercial, Medicare, And Medicaid Coverage, 2018–2024

Abstract

Structured Abstract Background 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 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 commercial coverage (12.6% versus 5.6%) and for obesity-indicated than diabetes-indicated brands (16.8% versus 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.