Project Summary/Abstract
The prescribing of, and adherence to, glucose-lowering medications is increasingly being driven by health
insurance factors such as high out-of-pocket medication costs and formulary practices that restrict use (e.g.
requirements for prior authorization). These types of cost-related medication restrictions (defined as high
copayments, high deductibles, formulary restrictions) can limit appropriate use of evidence-based medications,
especially when formularies lag behind a rapidly evolving evidence base. For example, recent evidence
suggests that SGLT-2 inhibitors and GLP-1 receptor agonists reduce the risk of cardiovascular disease (CVD)
events and mortality in patients with type 2 diabetes and elevated CV risk. If cost-related medication
restrictions limit the use of evidence-based, guideline recommended therapies in these patients, it may
ultimately result in worse health outcomes. Such policies can also increase administrative burden for the
practitioner and contribute to provider burnout. The goal of this proposal is to develop a provider-facing
intervention to address cost-related restrictions and improve medication use for patients with type 2 diabetes. It
has 3 specific aims: 1) To examine the association between cost-related medication restrictions and initiation
of, and adherence to, newer 2nd line glucose-lowering medications among patients with type 2 diabetes (T2D)
with and without established CVD, 2) To describe the cost-related restrictions experienced by health care
providers seeking to prescribe glucose-lowering medications, and how they respond to such restrictions in
contemporary practice and 3) To develop and pilot test a provider-facing, educational outreach intervention to
help address cost-related restrictions and improve the optimal use of glucose lowering medications. These
aims will be complemented by a career development plan that incorporates didactic coursework, participation
in workshops, and intensive mentorship under an outstanding team led by Dr. Walid Gellad, an R01-funded
investigator with a track record of successfully mentoring K awardees. The plan fills important gaps in the PI’s
training and will generate pilot data to form the basis of a follow-up R01 application testing whether a provider-
facing educational outreach intervention can improve the evidence-based use of glucose lowering medications
and clinical outcomes for patients with type 2 diabetes.