Health Disparity Clusters of Off Label Prescriptions for Glucagon-Like Peptide 1 Receptor Agonists

Background Off-label prescribing of glucagon-like peptide 1 receptor agonists (GLP-1 RAs) may exacerbate health disparities. Methods We performed a retrospective analysis of data from the Trilliant Health national all-payer claims database, US Census Bureau data (race, ethnicity, median household income), and Centers for Disease Control and Prevention social vulnerability index (SVI). Patients with prescriptions for GLP-1 RAs approved for type 2 diabetes mellitus (T2DM) between January 1, 2022, and December 31, 2022 were included. Those without an ICD-10 code for T2DM in their medical claims were considered off-label. Correlations between county-level off-label rates and health disparity variables were examined using visual mapping, geographically weighted regression models, and hierarchical clustering on principle components (HCPC). Results A total of 3,688,430 GLP-1 RA prescriptions from 2783 (89%) US counties were included. The median off-label prescribing rate was 37.7% [30.0%-46.3%]. Higher household income was modestly correlated with a higher off-label prescribing rate. HCPC modeling produced seven clusters with distinct geographic locations. The highest off-label prescribing rate (51.6%) occurred in a cluster of counties in Hawaii with high median income ($92,124). The lowest off-label prescribing rate (31.2%) occurred in a cluster of counties that included American Indian Tribal reservation lands, with low median income ($52,437) and high SVI (0.88). Other clusters showed unique patterns of racial and ethnic diversity, income, SVI, and off-label prescribing rates. Conclusions We identified distinct populations with varying GLP-1 RA off-label prescribing and known health disparities. These results could inform clinical and market strategies to increase access to GLP-1 RAs in underserved populations.