The Meeting at the Pharmacy

Surprise! Most Prescriptions for Obesity Meds Are Never Filled

A new study of real world primary non-adherence (PNA, not filling an Rx) for obesity medicines provides documentation for something that should surprise no one. More than 90% prescriptions for obesity meds are never filled. Writing in the Journal of Managed Care + Specialty Pharmacy, Hong Kan and colleagues say this is unusual, especially for medicines that treat chronic conditions:

“Rates of PNA were higher in this study than in studies of other medications, especially in comparison with medications for other chronic diseases. In a 2012 retrospective cohort study in primary care patients in an outpatient setting, the overall rate of PNA for all newly prescribed medications, excluding only pro re nata medications, was 58%. Among studies specifically evaluating adherence to medications for chronic conditions, a meta-analysis by Lemstra et al found a pooled PNA rate of 14.6% among patients prescribed antihypertensive, lipid-lowering, antihyperglycemic, and antidepressant agents.”

We note that these data come from a period spanning 2012 to 2019 – before semaglutide received FDA approval for obesity treatment.

No Surprise

The reason this should surprise no one is quite simple. The bias in our culture is to stigmatize obesity and its treatment. Because of this pervasive stigma, at every turn people hear and feel they are wrong to seek obesity treatment. Jillian Michaels, the fitness coach who made her fame by shaming people with obesity in The Biggest Loser, brags about scaring people away from getting prescriptions for obesity medicines filled. Friends and family will frequently shame a person for seeking treatment – sometimes subtly and sometimes not.

Health insurers will do everything they can do discourage people from getting a prescriptions filled for obesity meds. They call it “vanity.” Frequently, they deny coverage or impose burdensome copays. In short, health insurers do everything they can to discourage people from getting these medicines. No matter how much people need them for medical reasons.

So no. This is not surprising. But it really needs to change.

Click here for the study in JMCP, here and here for more on the stigmatization of obesity treatment.

The Meeting at the Pharmacy, painting by Jose Gutierrez Solana / WikiArt

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August 22, 2023