A recent study published in the Journal of the American Heart Association found that semaglutide has become the predominant glucagon-like peptide-1 receptor agonist (GLP-1RA) in the United States, with data showing a widening gap between decreasing out-of-pocket costs for patients and rising overall payments from all sources. The findings were released on Jul. 20.
Researchers used nationally representative federal survey data to examine trends in GLP-1RA utilization and associated payments between 2017 and 2022. The analysis revealed a significant increase in GLP-1RA use among Americans both with and without diabetes, largely driven by increased semaglutide prescriptions following its approval for weight management. According to the study, mean annual patient out-of-pocket payments decreased during this period, while mean total annual payments per user increased, raising concerns about long-term affordability if treatment continues over a lifetime.
The expanding availability of GLP-1RAs and their effectiveness in glucose lowering and weight management have led to broader use beyond type 2 diabetes patients. Semaglutide's reported greater weight-management effectiveness compared to older drugs has contributed to its rapid uptake. However, researchers said that prior to this study there was limited nationally representative data characterizing trends across different subtypes of GLP-1RAs or tracking payment changes over time.
To address these gaps, investigators analyzed Medical Expenditure Panel Survey (MEPS) data from 2017 through 2022, focusing on usage patterns and payment differences by drug type and diabetes status among an estimated 20 million US adults who reported using a GLP-1RA during this period. They found that overall utilization grew by 230% among individuals with diabetes—from approximately 1.5 million users in 2017 to more than five million by 2022—and by over sixfold among those without diabetes.
By drug type, semaglutide's share of users rose sharply: from just under one-tenth of diabetic users in 2018 to more than half by 2022; similarly for non-diabetic users, its share increased from eight percent to sixty-five percent over the same timeframe. Payment analyses showed mean annual out-of-pocket costs fell for both groups, but mean total annual payments per user climbed substantially—for example, reaching $6,722 for diabetic users and $6,811 for non-diabetic users in 2022.
The authors noted limitations including reliance on self-reported data regarding diabetes status and prescription indication, as well as nominal rather than inflation-adjusted payment reporting. They concluded that while semaglutide is now the most widely used GLP-1RA among surveyed US adults—likely due to its approval for weight management—the rising total cost burden warrants further policy evaluation.
