- The prevalence of U.S. adults without diabetes who filled a GLP-1 receptor agonist prescription rose from 0.1% in 2018 to 0.4% in 2022.
- As a result, annual spending jumped from $1.6 billion to $5.8 billion.
- The average price was $1,540 per prescription, including $1,505 in third-party costs and $35 in out-of-pocket costs.
The number of U.S. adults without diabetes using GLP-1 receptor agonists more than tripled from 2018 to 2022, boosting annual spending from $1.6 billion to $5.8 billion, survey data showed.
Based on an unweighted sample of nearly 90,000 adults in the CDC's National Health Interview Survey (NHIS), the pooled annual prevalence of people who filled at least one prescription for a GLP-1 receptor agonist increased from 0.1% in 2018 to 0.4% in 2022, according to an Annals of Internal Medicine brief research report.
This reflects an uptick from 259,160 to 854,728 adults nationwide, Michelle Dowsey, PhD, of the University of Melbourne in Australia, and colleagues reported.
Adults without diabetes spent an average of $1,540 per prescription, including $1,505 in third-party costs and $35 in out-of-pocket for every prescription fill. They filled an average of 4.1 prescriptions every year, totaling $6,420 in annual costs including $144 in out-of-pocket costs per user. Those on semaglutide had the highest out-of-pocket costs at $156 per year.
"Average prices for these medications consistently exceeded $1,500 per prescription, although average out-of-pocket costs were well contained, potentially due to people without private insurance being disproportionately less likely to access these medications," Dowsey's group noted. Private insurance covered nearly 86% of GLP-1 agent users in 2022.
Despite people without diabetes spending billions on GLP-1 receptor agonists, the researchers said adoption was "limited" in this population, representing only one in 250 adults. In contrast, about 5.1 million adults with type 2 diabetes filled a prescription for one of these agents in 2022.
This indicates that the total national expenditure on GLP-1 agents was "largely driven by patients with diabetes during this period," they pointed out.
"The use of GLP-1 receptor agonist medications among people without diabetes, along with associated expenditures, has almost certainly increased since the period we studied," co-author Cade Shadbolt, MA, also of the University of Melbourne, told MedPage Today. "Since 2022, there have been eased supply constraints, new approvals, and growing public attention."
"Considerable attention has been given to the rapid rise in GLP-1 receptor agonist use since semaglutide's [Ozempic, Wegovy] approval for chronic weight management in 2021," he added. "Given this trend, the increase in use among patients without diabetes that we observed was unsurprising -- though, before our study, it had not been examined on a truly national scale."
Following semaglutide's approval for chronic weight management, a shift in the drug's popularity was noticeable in the NHIS data.
From 2018 to 2021, use of liraglutide (Victoza, Saxenda) and semaglutide were equal at 41% of GLP-1 agent users without diabetes. But in 2022, 65.1% of GLP-1 users were on semaglutide while 21.4% were on liraglutide.
In 2022, 11.9% were on dulaglutide (Trulicity; only indicated for diabetes) and 11.7% were on another GLP-1 agent, which included a cluster of exenatide (Byetta, Bydureon; only indicated for diabetes) and the combination GLP-1/GIP agent tirzepatide (Mounjaro, Zepbound). Tirzepatide was approved for chronic weight management in 2023.
In the sample of adults using a GLP-1 receptor agonist, most were female (64%) and white (73%); their average body mass index (BMI) was 35.7. Two-thirds had a BMI of 30 or greater, indicating clinical obesity.
Over half had comorbid hypertension and high cholesterol. About 35% had arthritis, 5.7% had a prior stroke or myocardial infarction, and 3.5% had coronary heart disease.
"As new nationally representative data become available, ongoing evaluation will be important to identify emerging trends in the use of these medications," said Shadbolt.
Data for the analysis came from the Medical Expenditure Panel Survey of the NHIS from 2018 to 2022. Households were selected from NHIS respondents to create a representative sample of people ages 18 and older who reported no prior diabetes diagnosis other than gestational diabetes.
Relatively few individuals in the unweighted sample used GLP-1 receptor agonists. This may have influenced the precision of the estimates reported in this study, the researchers acknowledged.
Disclosures
The study was partly supported by an Australian Government Research Training Program Scholarship.
Primary Source
Annals of Internal Medicine
Source Reference: Shadbolt C, et al "National trends in glucagon-like peptide-1 receptor agonist use in adults without diabetes, 2018 to 2022" Ann Intern Med 2025; DOI: 10.7326/ANNALS-24-02878.
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