The Real Cost of the GLP-1 Boom and What It Means for Patients

By now, most people have heard of Ozempic, Wegovy or semaglutide. What fewer people understand is just how dramatically the use of these medications has changed in a very short period of time, and what that surge means for patients trying to access them. A study published in the Journal of the American Heart Association using nationally representative data from more than 20 million American adults sheds light on exactly that, tracking the rise of GLP-1 receptor agonists from 2017 to 2022 and revealing a picture that is both remarkable and concerning.

What Are GLP-1 Medications?

GLP-1 receptor agonists are a class of medications originally developed to lower blood sugar in people with type 2 diabetes. They work by mimicking a hormone that stimulates insulin release, slows digestion and reduces appetite. Over time, researchers recognized that these medications also produced significant weight loss, leading to U.S. Food and Drug Administration (FDA) approvals for weight management and, more recently, cardiovascular disease prevention. The class includes several medications, but semaglutide, sold under brand names including Ozempic for diabetes and Wegovy for weight management, has become by far the most widely used.

The Numbers Tell a Striking Story

Researchers analyzed data from the Medical Expenditure Panel Survey, a nationally representative dataset that tracks medication use and costs across the United States. Between 2017 and 2022, GLP-1 medication use among people with diabetes increased by 230%, rising from approximately 1.5 million to 5.1 million adults. Among people without diabetes, the increase was even more dramatic at 643%, climbing from roughly 115,000 to 855,000 adults over the same period.

Semaglutide drove virtually all of that growth. In 2018, semaglutide represented just 10% of GLP-1 use among people with diabetes. By 2022 it had climbed to 54%. Among people without diabetes the shift was even more pronounced, with semaglutide rising from 8% to 65% of all GLP-1 use over the same period. The sharpest acceleration happened between 2020 and 2022, immediately following the FDA's 2021 approval of semaglutide specifically for weight management. At the same time, use of liraglutide, the previously dominant medication in the class sold as Victoza and Saxenda, fell sharply in both groups.

What Is It Actually Costing?

The cost picture is complicated and in some ways counterintuitive. Out-of-pocket costs, meaning what patients pay directly from their own pockets after insurance, actually decreased over the study period. For people with diabetes, average annual out-of-pocket costs fell from $414 in 2017 to $252 in 2022. For people without diabetes they fell from $212 to $157. In 2022, semaglutide users were paying an average of about $186 out of pocket annually if they had diabetes and $162 if they did not.

However, the total cost picture tells a very different story. Total payments, which include what insurance companies, Medicare, Medicaid and other payers contribute on top of what patients pay directly, rose significantly. For people with diabetes, total annual payments climbed from $4,936 to $6,722. For people without diabetes the increase was even steeper, rising from $2,651 to $6,811 by 2022. For semaglutide specifically, total annual payments reached $7,588 for people using it without a diabetes diagnosis.

What this means in practical terms is that while individual patients may be paying less out of pocket than they used to, the overall cost of these medications to the healthcare system has grown substantially. The investigative team flags this as a significant concern, particularly given the likelihood that demand will continue to increase and that many patients may need to use these medications indefinitely.

What the Study Could Not Capture

The researchers note several important limitations. The data relies on self-reported diabetes diagnoses, which may undercount people with diabetes. Tirzepatide, sold as Mounjaro and Zepbound, was not separately classified in the 2022 data and was not yet approved for weight management at that time, meaning it is not reflected in these figures. The costs are reported in nominal dollars without inflation adjustment. And the data does not capture why each individual was prescribed a GLP-1 medication, which matters because insurance coverage differs significantly depending on whether the medication is prescribed for diabetes, weight management or another indication.

The Cost Conversation You Need to Have With Your Doctor

The surge in GLP-1 use reflects both the genuine effectiveness of these medications and the enormous unmet need they are addressing. But as use continues to grow, the question of long-term affordability and equitable access becomes increasingly urgent. If you are considering or currently using a GLP-1 medication, talking openly with your doctor about cost, insurance coverage and long-term treatment planning is an important part of the conversation.