{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T15:46:24Z","timestamp":1790178384566,"version":"4.1.0"},"reference-count":39,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2025,7,16]],"date-time":"2025-07-16T00:00:00Z","timestamp":1752624000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2025,7,16]],"date-time":"2025-07-16T00:00:00Z","timestamp":1752624000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/100000050","name":"National Heart, Lung, and Blood Institute","doi-asserted-by":"publisher","award":["R01HL153456"],"award-info":[{"award-number":["R01HL153456"]}],"id":[{"id":"10.13039\/100000050","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["dom-pubs.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Diabetes Obesity Metabolism"],"published-print":{"date-parts":[[2025,10]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>To assess associations between out\u2010of\u2010pocket (OOP) expenditures and adherence to glucagon\u2010like peptide\u20101 receptor agonists (GLP\u20101RAs) and sodium\u2010glucose cotransporter\u20102 inhibitors (SGLT2i) among low\u2010income Medicare beneficiaries with diabetes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and Methods<\/jats:title>\n                    <jats:p>\n                      We analysed Medicare Current Beneficiary Survey two\u2010year longitudinal data (2016\u20132021) on beneficiaries with diabetes using GLP\u20101RAs (\n                      <jats:italic>N<\/jats:italic>\n                      \u2009=\u2009168; weighted\u2009=\u20092\u2009187\u2009500) or SGLT2i (\n                      <jats:italic>N<\/jats:italic>\n                      \u2009=\u2009139; weighted\u2009=\u20091\u2009741\u2009910) in year one (baseline). Among these,\n                      <jats:italic>N<\/jats:italic>\n                      \u2009=\u200997 (weighted\u2009=\u20091\u2009117\u2009637) GLP\u20101RA and\n                      <jats:italic>N<\/jats:italic>\n                      \u2009=\u200973 (weighted\u2009=\u2009785\u2009301) SGLT2i users had an income below 200% of the Federal Poverty Level (low\u2010income). Survey\u2010weighted generalized Poisson regression assessed the association between baseline cumulative OOP drug expenses and year two adherence, defined as proportion of days covered (PDC). We repeated analyses in participants with higher income and using dual (Medicare\/Medicaid) enrolment as a proxy for full coverage in low income.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Year\u2010two PDC was 65.2% (95% CI: 57.9%\u201372.6%) for low\u2010income GLP\u20101RA users and 65.4% (95% CI: 58.3%\u201372.5%) for low\u2010income SGLT2i users. We did not observe a significant association between OOP costs (mean: $253; range: $0\u2013$4699) and adherence in low\u2010income GLP\u20101RA users. For low\u2010income SGLT2i users, higher OOP costs (mean: $204; $0\u2013$2649) were associated with lower adherence: adjusted adherence ratio 0.959 (95% CI: 0.932\u20130.987) per $100 increase. Dual Medicare\u2013Medicaid coverage was associated with increased adherence: adjusted adherence ratio 1.580 (95% CI: 1.061\u20132.352). For high\u2010income GLP\u20101RA users, higher OOP expenditures were associated with increased adherence in the highest income range.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>OOP costs for GLP\u20101RAs and SGLT2i are substantial, potentially posing a particular burden for low\u2010income Medicare beneficiaries. Policy changes may reduce this burden, although adherence improvements appear limited to beneficiaries using SGLT2i.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/dom.16619","type":"journal-article","created":{"date-parts":[[2025,7,17]],"date-time":"2025-07-17T02:55:05Z","timestamp":1752720905000},"page":"5683-5693","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Adherence to\n                    <scp>GLP<\/scp>\n                    \u20101 receptor agonists and\n                    <scp>SGLT2<\/scp>\n                    inhibitors by out\u2010of\u2010pocket spending among Medicare beneficiaries with diabetes"],"prefix":"10.1111","volume":"27","author":[{"given":"Nicklas S.","family":"Klepser","sequence":"first","affiliation":[{"name":"Institute for Healthcare Delivery Science Icahn School of Medicine at Mount Sinai  New York New York USA"},{"name":"Department of Population Health Science and Policy Icahn School of Medicine at Mount Sinai  New York New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ellerie S.","family":"Weber","sequence":"additional","affiliation":[{"name":"Department of Population Health Science and Policy Icahn School of Medicine at Mount Sinai  New York New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lihua","family":"Li","sequence":"additional","affiliation":[{"name":"Institute for Healthcare Delivery Science Icahn School of Medicine at Mount Sinai  New York New York USA"},{"name":"Department of Population Health Science and Policy Icahn School of Medicine at Mount Sinai  New York New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kirsten E.","family":"Fleischmann","sequence":"additional","affiliation":[{"name":"Department of Medicine University of California  San Francisco California USA"},{"name":"Division of Cardiology University of California  San Francisco California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Umesh","family":"Masharani","sequence":"additional","affiliation":[{"name":"Department of Medicine University of California  San Francisco California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Meyeon","family":"Park","sequence":"additional","affiliation":[{"name":"Department of Medicine University of California  San Francisco California USA"},{"name":"Division of Nephrology University of California  San Francisco California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wendy B.","family":"Max","sequence":"additional","affiliation":[{"name":"Institute for Health &amp; Aging and Department of Social and Behavioral Sciences University of California  San Francisco California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joseph","family":"Yeboah","sequence":"additional","affiliation":[{"name":"Heart and Vascular Center of Excellence, Wake Forest Baptist Health  Winston Salem North Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M. G. Myriam","family":"Hunink","sequence":"additional","affiliation":[{"name":"Department of Epidemiology Erasmus MC  Rotterdam The Netherlands"},{"name":"Department of Radiology Erasmus MC  Rotterdam The Netherlands"},{"name":"Center for Health Decision Sciences Harvard TH Chan School of Public Health  Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2754-545X","authenticated-orcid":false,"given":"Bart S.","family":"Ferket","sequence":"additional","affiliation":[{"name":"Institute for Healthcare Delivery Science Icahn School of Medicine at Mount Sinai  New York New York USA"},{"name":"Department of Population Health Science and Policy Icahn School of Medicine at Mount Sinai  New York New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,7,16]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00592-023-02154-4"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.3390\/jcdd10080322"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.2337\/dc23-S009"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2022.13885"},{"key":"e_1_2_10_6_1","article-title":"Race and ethnicity and pharmacy dispensing of SGLT2 inhibitors and GLP\u20101 receptor agonists in type 2 diabetes","volume":"34","author":"Rodriguez LA","year":"2024","journal-title":"Lancet Reg Health"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0297208"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2023.16290"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.diabres.2021.109035"},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2024.13172"},{"key":"e_1_2_10_11_1","doi-asserted-by":"publisher","DOI":"10.2147\/PPA.S277676"},{"key":"e_1_2_10_12_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13643-019-1014-8"},{"key":"e_1_2_10_13_1","doi-asserted-by":"publisher","DOI":"10.1186\/s41043-023-00459-2"},{"key":"e_1_2_10_14_1","doi-asserted-by":"publisher","DOI":"10.1111\/1475-6773.14152"},{"key":"e_1_2_10_15_1","doi-asserted-by":"publisher","DOI":"10.18553\/jmcp.2022.21481"},{"key":"e_1_2_10_16_1","doi-asserted-by":"publisher","DOI":"10.1111\/1475-6773.13990"},{"key":"e_1_2_10_17_1","volume-title":"Medicare current beneficiary survey","author":"Centers for Medicare & Medicaid Services","year":"2025"},{"key":"e_1_2_10_18_1","doi-asserted-by":"publisher","DOI":"10.18553\/jmcp.2019.25.6.705"},{"key":"e_1_2_10_19_1","doi-asserted-by":"publisher","DOI":"10.1377\/hlthaff.2020.02272"},{"key":"e_1_2_10_20_1","doi-asserted-by":"publisher","DOI":"10.18553\/jmcp.2019.25.10.1073"},{"key":"e_1_2_10_21_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ypmed.2021.106715"},{"key":"e_1_2_10_22_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2021.6139"},{"key":"e_1_2_10_23_1","doi-asserted-by":"publisher","DOI":"10.1080\/03007995.2024.2303413"},{"key":"e_1_2_10_24_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.1963.03060120024016"},{"key":"e_1_2_10_25_1","doi-asserted-by":"publisher","DOI":"10.1093\/aje\/kwq433"},{"key":"e_1_2_10_26_1","doi-asserted-by":"publisher","DOI":"10.1111\/1475-6773.13290"},{"key":"e_1_2_10_27_1","volume-title":"Medicare enrollees and the Part D drug benefit: improving financial protection through the low\u2010income subsidy","author":"U.S. Department of Health and Human Services, Office of the Assistant Secretary for Planning and Evaluation","year":"2024"},{"key":"e_1_2_10_28_1","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.123.032463"},{"key":"e_1_2_10_29_1","doi-asserted-by":"publisher","DOI":"10.1002\/edm2.245"},{"key":"e_1_2_10_30_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamacardio.2016.2724"},{"key":"e_1_2_10_31_1","doi-asserted-by":"publisher","DOI":"10.18553\/jmcp.2023.29.5.449"},{"key":"e_1_2_10_32_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2024.21739"},{"key":"e_1_2_10_33_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2023.17886"},{"key":"e_1_2_10_34_1","doi-asserted-by":"publisher","DOI":"10.1177\/0272989X231196916"},{"key":"e_1_2_10_35_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamahealthforum.2023.5237"},{"key":"e_1_2_10_36_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2024.22582"},{"key":"e_1_2_10_37_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2023.13872"},{"key":"e_1_2_10_38_1","volume-title":"Orange Book: approved drug products with therapeutic equivalence evaluations","author":"Food & Drug Administration","year":"2025"},{"key":"e_1_2_10_39_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamahealthforum.2020.1497"},{"key":"e_1_2_10_40_1","doi-asserted-by":"publisher","DOI":"10.24926\/iip.v11i2.3269"}],"container-title":["Diabetes, Obesity and Metabolism"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dom-pubs.pericles-prod.literatumonline.com\/doi\/pdf\/10.1111\/dom.16619","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/dom-pubs.pericles-prod.literatumonline.com\/doi\/full-xml\/10.1111\/dom.16619","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/dom-pubs.pericles-prod.literatumonline.com\/doi\/pdf\/10.1111\/dom.16619","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,17]],"date-time":"2026-02-17T06:20:36Z","timestamp":1771309236000},"score":1,"resource":{"primary":{"URL":"https:\/\/dom-pubs.pericles-prod.literatumonline.com\/doi\/10.1111\/dom.16619"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,7,16]]},"references-count":39,"journal-issue":{"issue":"10","published-print":{"date-parts":[[2025,10]]}},"alternative-id":["10.1111\/dom.16619"],"URL":"https:\/\/doi.org\/10.1111\/dom.16619","archive":["Portico"],"relation":{"has-review":[{"id-type":"doi","id":"10.1111\/DOM.16619\/v2\/review1","asserted-by":"object"},{"id-type":"doi","id":"10.1111\/DOM.16619\/v2\/review2","asserted-by":"object"},{"id-type":"doi","id":"10.1111\/DOM.16619\/v3\/review1","asserted-by":"object"},{"id-type":"doi","id":"10.1111\/DOM.16619\/v3\/decision1","asserted-by":"object"},{"id-type":"doi","id":"10.1111\/DOM.16619\/v1\/review2","asserted-by":"object"},{"id-type":"doi","id":"10.1111\/DOM.16619\/v1\/review1","asserted-by":"object"},{"id-type":"doi","id":"10.1111\/DOM.16619\/v3\/response1","asserted-by":"object"},{"id-type":"doi","id":"10.1111\/DOM.16619\/v1\/review4","asserted-by":"object"},{"id-type":"doi","id":"10.1111\/DOM.16619\/v2\/decision1","asserted-by":"object"},{"id-type":"doi","id":"10.1111\/DOM.16619\/v1\/review3","asserted-by":"object"},{"id-type":"doi","id":"10.1111\/DOM.16619\/v1\/decision1","asserted-by":"object"},{"id-type":"doi","id":"10.1111\/DOM.16619\/v2\/response1","asserted-by":"object"}]},"ISSN":["1462-8902","1463-1326"],"issn-type":[{"value":"1462-8902","type":"print"},{"value":"1463-1326","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,7,16]]},"assertion":[{"value":"2025-04-03","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-07-08","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-07-16","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}