gms | German Medical Science

Background: In Germany, or more generally in countries with a health care system organized both by the state and by the private sector, the initial prescription and dissemination of so-called innovative drugs could depend, besides others, on the insured status of the patients. It is possible that physicians may feel more pressured to prescribe these drugs for privately insured patients or may actually be under greater pressure from these patients, as anecdotal evidence suggests. However, reliable data are lacking on whether there is an “innovative time advantage” for privately insured patients at all, i.e. whether they are provided with new drugs earlier or more frequently after their market launch than patients insured under the statutory health insurance scheme. This study uses the prescription of glucagon-like peptide 1 (GLP-1) receptor agonists and sodium-glucose cotransporter 2 (SGLT2) inhibitors as an example for the speed of implementation of new drugs depending on health insurance membership.

Materials and methods: This secondary data analysis is based on anonymized prescription data from physicians in private practice, the Disease Analyzer database. The database consists of approximately 2,500 practices, selected nationwide by region, specialty, and age of physicians. For this study, we included patients from practices of general practitioners, community cardiologists, internists, possibly with specialization in endocrinology and diabetology. The primary outcome measure was the proportion of patients who received a new prescription for a GLP-1 receptor agonist or SGLT2 inhibitor as a diabetes medication, taking into account their health insurance status (privately insured vs insured under the statutory health insurance scheme), their age, sex, as well as BMI (as an obesity indicator) and HbA1c (if available/documented) and also the prescribing physician group. The target outcome was observed over time. In terms of an exploratory study, we report descriptive measures (absolute and relative frequencies). Logistic regressions are planned later to control for the influence of covariates on the outcome measure.

Results: Data from 1,293 practices could be analyzed. A total of 158,022 patients from these practices received an initial prescription of a GLP-1 receptor agonist and/or SGLT2 inhibitor between 2007 and 2022, 13,889 (8.8%) of them were privately insured. In the first years of the introduction of these drugs, the proportion of privately insured patients was significantly higher: in 2007, nearly under 20%, and one year later, about 17%. In subsequent years, their share declined steadily and then fluctuated between 7% and 9% in the years from 2015 onwards. The privately insured patients with a corresponding prescription were older than the legally insured patients by about 1 to 2 years, and this difference remained more or less constant over the entire study period. Also, over the entire period, the proportion of women with the corresponding medication was about 15 percentage points higher among the patients with statutory insurance than among those with private insurance. BMI and/or HbA1c was similar between both groups and remained more or less constant over the study period.

Conclusion: In the long term, the frequency of initial prescriptions of GLP-1 receptor agonists and/or SGLT2 inhibitors appears to be similar for those with statutory or a private health insurance. When the drugs were introduced, however, there was initially a higher willingness to prescribe them for privately insured persons. This may indicate the importance of health insurance status and, thus, on social status in the provision of health care and gives rise to further investigation of the issue, including the role of moderating factors such as gender.