Adults with diabetes who used GLP-1 drugs spent about $7,000 more per year on healthcare than non-users, with usage more than doubling between 2016 and 2020.
$22,029 vs $15,165Annual total healthcare expenditures for GLP-1 RA users versus non-users with diabetes — a ~45% cost premium that remained significant after adjusting for other health factors.
What the researchers found
GLP-1 receptor agonist users with diabetes had significantly higher total healthcare expenditures ($22,029) compared to non-users ($15,165). Use of GLP-1 RAs increased from 4.3% in 2016 to 10.6% in 2020 — roughly 1 in 13 adults with diabetes.
After adjusting for age, sex, race, obesity, physical activity, and other conditions, GLP-1 RA use was independently associated with significantly higher total, payer, and out-of-pocket expenditures (all p ≤ 0.001). The economic burden fell on both insurance systems and patients themselves.
Why it matters
GLP-1 drugs like semaglutide and liraglutide have proven clinical benefits — better blood sugar control, weight loss, cardiovascular protection. But this study quantifies the other side of the equation: the financial cost. With usage more than doubling in just four years and total spending nearly $7,000 higher per user annually, the economic sustainability of widespread GLP-1 prescribing is a real concern for healthcare systems, insurers, and patients paying out-of-pocket.
The numbers in context
n=7,670 (representing ~28.6 million US adults with diabetes) · 7.5% overall GLP-1 RA use · 4.3% in 2016 → 10.6% in 2020 · $22,029 vs $15,165 total expenditures (users vs non-users) · all expenditure differences p ≤ 0.001
How the study worked
A cross-sectional analysis using the Medical Expenditure Panel Survey (MEPS), a nationally representative US dataset. Researchers identified 7,670 adults with diabetes across 2016, 2018, and 2020, compared healthcare spending between GLP-1 RA users and non-users, and used statistical models adjusted for demographics, social determinants, obesity, physical activity, and comorbidities to estimate excess expenditures.
Who was studied
7,670 US adults with diabetes (representing approximately 28.6 million individuals nationally), from the 2016, 2018, and 2020 Medical Expenditure Panel Survey
What this study cannot tell us
Cross-sectional design captures spending at a point in time, not long-term cost trajectories. MEPS data may not capture all indirect costs or newer GLP-1 drugs that entered the market after 2020. The study doesn't account for potential cost savings from reduced complications (e.g., fewer hospitalizations from better diabetes control). Some expenditure data in the abstract appears truncated.
How to read the evidence
Moderate evidence: uses a large, nationally representative US dataset (MEPS) with appropriate statistical adjustments. However, cross-sectional design limits causal claims, and the study doesn't capture potential downstream cost savings from improved diabetes outcomes.
When this study was published
Published in 2026 using data through 2020. While the data predates the semaglutide obesity prescribing boom, the findings establish a baseline cost trajectory that has likely accelerated since.
The bigger picture
The GLP-1 drug class is one of the fastest-growing segments in all of medicine, with usage expanding beyond diabetes into obesity and potentially cardiovascular disease. This study provides hard numbers on the economic impact at a population level. As tens of millions more people are prescribed these drugs — many for weight loss — the financial strain on healthcare systems, insurers, and individual patients will only intensify. The central policy challenge: how to make clinically beneficial drugs economically sustainable.
Questions still open
- Do the higher upfront costs of GLP-1 drugs get offset by reduced hospitalizations and complications over time?
- How has the cost picture changed since 2020, given the explosion of semaglutide prescribing for both diabetes and obesity?
- What policy interventions — drug pricing reforms, biosimilar competition, insurance coverage mandates — could improve affordability without limiting access?
Common questions
Why do GLP-1 drug users spend so much more on healthcare overall?
Does this mean GLP-1 drugs aren't worth the cost?
Read the original research
Estimating the excess expenditures associated with glucagon-like peptide-1 receptor agonist use among adults with diabetes in the United States.
Journal of managed care & specialty pharmacy, 32(1), 14-26
Citation
Akpan, Nsima; Zhou, Bo; Rasu, Rafia S; Sambamoorthi, Usha. (2026). Estimating the excess expenditures associated with glucagon-like peptide-1 receptor agonist use among adults with diabetes in the United States.. Journal of managed care & specialty pharmacy, 32(1), 14-26. https://doi.org/10.18553/jmcp.2026.32.1.14