Disparities in Adolescent and Young Adult Obesity Medication Dispensing: A Retrospective Linked EHR-Pharmacy Cohort, 2020-2025.

OBJECTIVE: This study aimed to describe real-world obesity medication (OM) prescribing and dispensing among adolescents and young adults (AYAs) and examine factors associated with dispensing. METHODS: A retrospective cohort linked Nemours Children's Health electronic health record (EHR) to Surescripts dispensing (2020-2025). AYAs aged 12-20 with prescriptions for liraglutide, semaglutide, phentermine, phentermine-topiramate, or tirzepatide were included; youth with diabetes were excluded. Primary outcome was ever dispensed. Multilevel logistic regression assessed the odds of dispensing by race and ethnicity, Child Opportunity Index (COI), health insurance, prescription (Rx) coverage, drug, and prescription year. RESULTS: Among 1194 AYAs with ≥ 1 OM prescription, 56.7% received ≥ 1 fill. Versus semaglutide, dispensing odds were higher for liraglutide (OR 2.40), phentermine (OR 3.32), and phentermine-topiramate (OR 2.16) and lower for tirzepatide (OR 0.45; all p ≤ 0.003). Hispanic AYAs had lower odds than non-Hispanic White peers (OR 0.61; p ≤ 0.001). Public (OR 1.31) and mixed insurance (OR 1.63) and Rx coverage (OR 2.00; all p ≤ 0.05) were associated with higher odds. Despite increased rates of prescribing each year, rates of dispensing declined. CONCLUSIONS: Nearly half of AYA OM prescriptions were never dispensed. Barriers to initiation persist and inequities affect Hispanic youth. Addressing insurance/Rx coverage constraints may improve equitable access.