A Primary Care Physician's Perspective: Dr. Norris Brown, Austin, TX
When the GLP-1 analogs first came out I was slow to start using them. As a primary care physician in a busy multi-practitioner office I was used to working with oral medications for diabetes, and only as a last resort would I put patients on basal insulin. If my patients needed to have more intense glucose management I would refer them to an endocrinologist in our building. Over the years I watched as my practice colleagues used more of the GLP-1 analogs and so I started using them based on the results that my partners were having.....
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It has become easy over the past couple of years to get my patients to start on these medications, and with the advent of once daily dosing the job has gotten even easier.
I find that many of my patients stay on the medications because of the results that they get. When patients come back for their first follow-up after starting the on the GLP-1 analog, I have one of my medical assistants fill out a sheet with the important information I think keeps the patient on the medication.
This sheet lists the patient's A1c for the past 3 appointments and their current A1c. This gives the patient the opportunity to see that the addition of a GLP-1 analog has stopped the rise in A1c and, in fact, lowered it. The sheet also contains the patient's weight for the past 3 visits so that they can see that the GLP-1 analog has stopped the weight gain they had been experiencing and in many cases has even caused them to lose weight.
Our biggest battle in keeping our patients on GLP-1 analog therapy has been the insurance companies. Although they seem to have good formulary coverage for these products the co-pays are often very high. We are also in an area where a lot of patients are not insured and so the cost of these medications can be prohibitive. In both of these cases I will give the patient samples for the first month and then if the copay is high I will supply them with samples every other month in order to make the effective cost of a month's supply half of what it could be. This method seems to have a positive effect on the patient and often times this is all that it takes to get the patient to stay on the product.
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