OBJECTIVES: Although, safety and efficacy of exenatide BID (exenatide) and liraglutide for treating type 2 diabetes (T2D) has been demonstrated in trials, their comparative economic benefits are unknown. This study examined cost offsets and medication adherence with use of exenatide versus liraglutide in managed care population. METHODS: A retrospective cohort analysis was conducted using the LifeLink database, comprising adult patients with T2D who initiated exenatide (n=2383) or liraglutide (n=1535) between January 1, 2010 and June 30, 2010 and with 6 months pre- and post-index continuous eligibility. Patients were propensity score matched to control for on baseline differences. Medication adherence was measured using the proportion of days covered (PDC). The paired t-test and McNemar’s test were used to compare outcomes. RESULTS: Matched exenatide and liraglutide cohorts (n=1347 pairs) had comparable age (54 vs. 53 years), gender (55% vs. 57% female), and comorbidities (86% vs. 86%). In the 6-month follow-up, exenatide and liraglutide patients had similar mean total costs ($6688 vs. $7346). Significant cost savings were observed in mean total pharmacy costs ($2925 vs. $3272, P <0.001). There were no significant differences in mean total outpatient ($2541 vs. $3050) or inpatient ($1222 vs. $1025) costs. Among patients who initiated liraglutide, those on 1.8 mg doses (n=638) had significantly higher mean total costs than those on 1.2 mg doses (n=438) ($8046 vs. $6737, P = 0.043) due to higher mean total pharmacy costs in the 1.8 mg cohort ($4017 vs. $3295, P <0.001); 35% higher mean drug cost for liraglutide claims in the 1.8 mg cohort largely accounted for this difference ($1876 vs. $1390, P <0.001). There was no significant difference in medication adherence between groups (mean PDC: exenatide 56% vs. liraglutide 57%). CONCLUSIONS: Patients initiating exenatide versus liraglutide for the management of T2D had similar medication adherence and total medical costs however; exenatide patients had significantly lower total pharmacy costs.