Poor Access to Anti-Obesity Medications in Metabolic Dysfunction-Associated Steatotic Liver Disease

##BACKGROUND Weight loss is a cornerstone of therapy for metabolic dysfunction-associated steatotic liver disease (MASLD). Incretin medications (IM) including glucagon-like peptide 1 receptor agonists (GLP-1) and combination glucose-dependent insulinotropic polypeptide/GLP-1 RAs have been approved by the Food and Drug Administration (FDA) for weight management. Access to these medications can be difficult due to insurance approvals, cost, and availability of drugs. ##METHODS A 10-month, single center retrospective chart review was conducted for patients referred to a clinical pharmacist practitioner (CPP) at an academic medical center in North Carolina for review of pharmacological weight loss options as part of a multidisciplinary MASLD team. ##RESULTS Forty-two patients with MASLD were referred for medical weight loss therapy. Initial IM approval was granted for 11 patients (26%). After prior authorization (PA), appeal, or failure of an alternative medication, 22 patients (52%) started IM. A total of 132 minutes of CPP time was required to achieve a single IM start. ##LIMITATIONS The sample size of 42 patients may be too small to make statistically significant comparisons and detect differences among groups. Additionally, all patients were seen by a CPP at an academic medical center (AMC), which may not be applicable to the general population. ##CONCLUSIONS Incretin therapies are a beneficial option for patients with MASLD complicated by obesity and diabetes, but access needs to be improved and time burden on providers and clinical staff should be recognized.