Completion Date

Spring 6-13-2025

Document Type

Thesis

Degree Name

Master of Science (MS)

Program or Discipline Name

Project Management

First Advisor

Ella Ponsford-Gullacci

Second Advisor

Sarah Dyson

Abstract

This study examines how healthcare system design influences access, adherence, and financial burden associated with glucagon-like peptide-1 receptor agonists (GLP-1 RAs) in high-income countries. Through a literature review of peer-reviewed articles published between 2020 and 2025, it compares outcomes across universal and multi-payer systems. Findings reveal significant disparities. For example, the 12-month persistence reaches 68% in centralized systems like Denmark, but falls to 32–46% in the U.S., largely due to financial burdens, insurance denials, and administrative barriers. Among uninsured U.S. patients, 45% report significant financial hardship while using GLP-1 RA therapy. However, only 20% of patients enrolled in high-deductible health insurance plans reported difficulty affording the medication. System structure strongly shapes both initial access and therapy continuation. While universal systems generally reduce cost barriers, socioeconomic status and strict clinical thresholds still impact adherence. The study recommends multifaceted reforms, including copay caps, streamlined prior authorizations, formulary stability, and patient support programs. Limitations include reliance on secondary data, heterogeneous study designs, and a focus on high-income countries, which may affect generalizability. Nonetheless, the findings highlight urgent policy priorities for improving equitable access to GLP-1 RAs and sustaining their clinical benefits.

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