Recently published research from experts at the AMA and the Centers for Disease Control and Prevention (CDC) is shedding light on how much spending has grown for glucagon-like peptide-1 receptor agonists (GLP-1 RAs), and how use of the effective weight-loss medications has varied at the state level.
For a study published in JAMA Network Open, researchers examined spending trends on GLP-1s for adults. They obtained data on patient and insurer spending from Symphony Health that captured 85% of retail and 74% of mail-order prescription fills.
From 2018 to 2023, they found, spending on GLP-1s rose by more than 500%, from $13.7 billion to $71.7 billion, with the amounts being adjusted to 2023 dollars. Yet not all GLP-1s grew alike.
Of the medications with indications for type 2 diabetes, spending on Ozempic (semaglutide) grew the most, rising from $410 million in 2018 to $26.42 billion by 2023. Mounjaro also saw rapid spending growth after it was first indicated for type 2 diabetes in 2022, when patients and payers shelled out $2.51 billion. By 2023, that rose to $12.42 billion.
Of medications indicated for obesity at the time of the study, Saxenda (liraglutide) rose from $560 million in 2018 to $890 million in 2023. Spending on Wegovy (the form of semaglutide indicated for obesity) grew from $580 million in 2021 to $6.99 billion by 2023.
The expanded indications and coverage determination in future years could drive demand and spending, says the JAMA Network Open research letter, which was published this spring. The study was co-written by Stavros Tsipas, MA, Tamkeen Khan, PhD, Klodiana Myftari, PharmD, and Gregory Wozniak, PhD, of the AMA’s Improving Health Outcomes unit, and Fleetwood Loustalot, PhD, of the CDC.
“Dataset limitations excluded sales at compounding pharmacies, prescription indication, and prevented adjustment for rebates, discounts, or price concessions,” the researchers added, sounding a note of caution. “These vary across manufacturers and can be substantial, especially on newly released products. For example, manufacturer discounts for GLP-1 RAs prior to the introduction of tirzepatide have been estimated to be as much as approximately 40% to 60%. Although this study’s results suggest dramatic increases in net spending on GLP-1 RAs, the actual spending is likely somewhat lower than our estimates.”
More indications for this medication and class and wider payer coverage “could continue to drive demand and spending,” says the research letter. “Challenges in long-term adherence, spending in competition with other health care costs, lack of price transparency and the integration of new products and indications will continue to drive demand for ongoing research in this area.”
Learn more about AMA MAP™ Prediabetes Solutions, which help health care organizations adopt and execute strategies to prevent type 2 diabetes. Effective and early identification and management of prediabetes are critical steps in preventing the progression to type 2 diabetes and improving patient outcomes. This collection of evidence-based resources is designed to support health care team members in implementing and optimizing diabetes prevention strategies within their organizations.
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Which states spend most on GLP-1s
This same group of researchers and Lindsay Zasadzinski, MPH, also of the AMA, teamed up for another study that was published in the Journal of the American Heart Association and examined how spending on, and fills of, GLP-1s varied at the state level. The researchers also compared GLP-1 use and spending by state-level prevalence of obesity across the country, drawing on a Symphony Health dataset for 2023.
“Many Southern states demonstrated both high obesity prevalence and higher fill rates, and spending per person with obesity ranged from $672 in Mississippi to $888 in West Virginia,” says the study. “Lower obesity prevalence and lower fill rates were found in the Western region, including Colorado, Utah, Montana and Washington.”
Some states, the study notes, had “low obesity prevalence and high fill rates, with a range of spending in Idaho ($556), District of Columbia ($727), New Jersey ($803), Connecticut ($888) and New York ($919).”
While there were not any states high rates of obesity and low use of GLP-1s, “Iowa was in the highest obesity prevalence category but in the midtier for fills ($525).”
Looking at the big picture, the GLP-1 “spending rate was highest in New York, at $918, and lowest in Oregon, at $267,” says the study.
“Some states had discordant associations with high fill rates and spending but low obesity prevalence,” the researchers noted. “This relationship might be partially explained by geographic variations in insurance coverage, local prescriber practices, patient demand or patient-assistance program engagement.”
The team at the AMA’s Improving Health Outcomes unit has taken part in several other notable peer-reviewed publications this year. Here is a great opportunity to catch up:
- “The Rapid Evolution of Continuous Blood Pressure Measurement: Future Considerations,” American Journal of Hypertension.
- “Metformin Prescription Orders among Patients with Prediabetes in a National Network of Federally Qualified Health Centers,” Journal of General Internal Medicine.
- “Long COVID and Days of Work Missed Due to Illness or Injury by Adults in the United States, 2022,” The Journal of the American Board of Family Medicine.
- “Implementing the H&P 360 in Three Medical Institutions: Usability Study,” JMIR Medical Education.
AMA members can explore an entire range of cutting-edge, peer-reviewed research and clinical information. The JAMA Network™ is a world-class resource for the whole medical community. If you are a member or interested in becoming one, learn how to access these educational materials and innovative tools.
