Are Glucagon-Like Peptide-1 Receptor Agonists Prescribed for Weight Loss Slipping Through the Net of Japan’s Strict Guidelines? An Analysis of Health Insurance Claims Data
Author(s)
Tomomi Takeshima, PhD, Ayano CHIDA, N/A, Kosuke Iwasaki, MBA.
Milliman, Inc., Tokyo, Japan.
Milliman, Inc., Tokyo, Japan.
OBJECTIVES: In Japan, physicians have the authority to prescribe medications, including off-label use, when medically justified, although they are subject to reimbursement constraints under the national health insurance system. Glucagon-like peptide-1 receptor agonists (GLP-1RAs) have long been used for diabetes treatment, and their weight-reducing effects have recently led to approval for obesity management. In Japan, this effect has drawn growing public attention, including for cosmetic purposes, but government guidelines for GLP-1RAs for obesity impose various limitations, including restrictions on prescribers and patients (e.g., BMI thresholds and comorbidities). However, some prescriptions may circumvent these strict regulations. We investigated recent prescribing trends of GLP-1RAs.
METHODS: We used a database provided by DeSC Healthcare Inc. containing health insurance claims and health checkup data (April 2014—August 2024, approximately 17.5 million individuals). We analyzed trends in the age- and sex-adjusted number of individuals prescribed any antidiabetic agents (ADAs) or GLP-1RAs in the month of first type 2 diabetes (T2DM) diagnosis (April 2016—March 2024). For those with health checkup data, HbA1c levels within 6 months before the first GLP-1RA prescription were also assessed.
RESULTS: The age- and sex-adjusted number of patients prescribed ADA showed a recurring annual peak in April, while the number prescribed GLP-1RA increased sharply from 2021 and was 3.04 times higher in 2023 than 2020, despite only a 1.05-fold increase in T2DM patients, and without a similar April peak. Among GLP-1RA recipients, mean pre-prescription HbA1c values decreased over time, and the proportion with HbA1c <7 was higher after 2021 (55.2%) than before 2020 (18.5%).
CONCLUSIONS: GLP-1RA prescriptions have increased in recent years without the seasonal peaks seen with ADA. Along with lower pre-prescription HbA1c values and a growing number of GLP-1RA recipients with normal HbA1c since 2021, these patterns may indicate a change in prescribing practices specific to GLP-1RAs in recent years.
METHODS: We used a database provided by DeSC Healthcare Inc. containing health insurance claims and health checkup data (April 2014—August 2024, approximately 17.5 million individuals). We analyzed trends in the age- and sex-adjusted number of individuals prescribed any antidiabetic agents (ADAs) or GLP-1RAs in the month of first type 2 diabetes (T2DM) diagnosis (April 2016—March 2024). For those with health checkup data, HbA1c levels within 6 months before the first GLP-1RA prescription were also assessed.
RESULTS: The age- and sex-adjusted number of patients prescribed ADA showed a recurring annual peak in April, while the number prescribed GLP-1RA increased sharply from 2021 and was 3.04 times higher in 2023 than 2020, despite only a 1.05-fold increase in T2DM patients, and without a similar April peak. Among GLP-1RA recipients, mean pre-prescription HbA1c values decreased over time, and the proportion with HbA1c <7 was higher after 2021 (55.2%) than before 2020 (18.5%).
CONCLUSIONS: GLP-1RA prescriptions have increased in recent years without the seasonal peaks seen with ADA. Along with lower pre-prescription HbA1c values and a growing number of GLP-1RA recipients with normal HbA1c since 2021, these patterns may indicate a change in prescribing practices specific to GLP-1RAs in recent years.
Conference/Value in Health Info
2025-11, ISPOR Europe 2025, Glasgow, Scotland
Value in Health, Volume 28, Issue S2
Code
HSD7
Topic
Health Service Delivery & Process of Care, Study Approaches
Disease
Diabetes/Endocrine/Metabolic Disorders (including obesity)