TRENDS IN GLP-1 RECEPTOR AGONIST UTILIZATION, EXPENDITURE, OUT-OF-POCKET BURDEN, AND FINANCIAL TOXICITY AMONG US ADULTS, 2017-2023
Author(s)
Omkar Nitin Ghodke, MS1, Kunal Ashok Pimpalkar, MS2, Florent Richy, PhD.2, Tavneet Singh, PhD2.
1University of Mississippi, Oxford, MS, USA, 2BioMarket Solution, New Delhi, India.
1University of Mississippi, Oxford, MS, USA, 2BioMarket Solution, New Delhi, India.
OBJECTIVES: Evaluate the trends in GLP-1 receptor agonist (GLP-1 RA) utilization, prescription expenditure, and correlates of out-of-pocket (OOP) spending and financial toxicity in the US.
METHODS: Retrospective analysis of the Medical Expenditure Panel Survey (2017-2023) was conducted. GLP-1 RA fills were identified from the Prescribed Medicines files using Multum therapeutic class and active-ingredient names. To ensure isolation of single-agonist GLP-1 RAs, Tirzepatide was excluded. Expenditures were adjusted to 2023 dollars using the CPI Medical Care series. OOP spending was estimated using a two-part model: survey-weighted logistic regression for any OOP spending and survey-weighted log-linear regression among positive OOP spenders, adjusting for sociodemographic, insurance, regional, educational, and clinical covariates. All estimates incorporated MEPS pooled variance-linkage weights and design strata/PSUs.
RESULTS: Among 145,299 adult person-years between 2017 and 2023, 2,392 reported ≥1 GLP-1 RA fill, representing a weighted 4.05 million users. GLP-1 RA usage increased from 0.66% in 2017 to 3.12% in 2023. Per-prescription spending rose from $1,200 to $1,395, peaking at $1,535 in 2021. GLP-1 RA users reported higher prevalence of type 2 diabetes (89.4% vs 8.8%), obesity diagnoses (6.7% vs 0.5%), and cardiovascular disease (14.9% vs 5.1%). OOP levels were higher among adults aged ≥65 years (+56.5%), older adults with public insurance (+128.7%), married individuals (+22.0%), and individuals with type 2 diabetes (+70.1%). In contrast, public insurance (-59.6%), low income (-46.1%), and less than high school education (-50.8%) were associated with lower conditional OOP spending.
CONCLUSIONS: GLP-1 RA use grew nearly fivefold from 2017-2023, while per-prescription spending remained high. OOP exposure varied by age-insurance interactions, income, marital status, and diabetes, supporting continued affordability monitoring as uptake expands.
METHODS: Retrospective analysis of the Medical Expenditure Panel Survey (2017-2023) was conducted. GLP-1 RA fills were identified from the Prescribed Medicines files using Multum therapeutic class and active-ingredient names. To ensure isolation of single-agonist GLP-1 RAs, Tirzepatide was excluded. Expenditures were adjusted to 2023 dollars using the CPI Medical Care series. OOP spending was estimated using a two-part model: survey-weighted logistic regression for any OOP spending and survey-weighted log-linear regression among positive OOP spenders, adjusting for sociodemographic, insurance, regional, educational, and clinical covariates. All estimates incorporated MEPS pooled variance-linkage weights and design strata/PSUs.
RESULTS: Among 145,299 adult person-years between 2017 and 2023, 2,392 reported ≥1 GLP-1 RA fill, representing a weighted 4.05 million users. GLP-1 RA usage increased from 0.66% in 2017 to 3.12% in 2023. Per-prescription spending rose from $1,200 to $1,395, peaking at $1,535 in 2021. GLP-1 RA users reported higher prevalence of type 2 diabetes (89.4% vs 8.8%), obesity diagnoses (6.7% vs 0.5%), and cardiovascular disease (14.9% vs 5.1%). OOP levels were higher among adults aged ≥65 years (+56.5%), older adults with public insurance (+128.7%), married individuals (+22.0%), and individuals with type 2 diabetes (+70.1%). In contrast, public insurance (-59.6%), low income (-46.1%), and less than high school education (-50.8%) were associated with lower conditional OOP spending.
CONCLUSIONS: GLP-1 RA use grew nearly fivefold from 2017-2023, while per-prescription spending remained high. OOP exposure varied by age-insurance interactions, income, marital status, and diabetes, supporting continued affordability monitoring as uptake expands.
Conference/Value in Health Info
2026-11, ISPOR Europe 2026, Vienna, Austria
Value in Health, Volume 29, Issue 12S
Code
EPH219
Topic
Epidemiology & Public Health, Real World Data & Information Systems
Disease
Diabetes/Endocrine/Metabolic Disorders (including obesity)