How much do Americans spend on GLP-1 medications? VCU medical students measure drug affordability

By Olivia Trani

The number of people using GLP-1 treatments like Ozempic and Wegovy for weight loss or chronic conditions has increased rapidly, with more than 1 in 10 U.S. adults currently taking such medications. A new study led by medical students at Virginia Commonwealth University has shed light on how this rise in GLP-1 drug use is affecting Americans' wallets.

By analyzing long-term healthcare spending data, the research team found that:

• Total health spending on GLP-1 drugs in the United States increased nearly 15-fold between 2013 and 2023, reaching almost $65 billion.
• Median out-of-pocket spending per GLP-1 user exceeded $1,500 annually, and nearly 1 in 5 users spent more than 10% of their annual household income on these medications. Uninsured and lower-income populations experienced the highest out-of-pocket burden.

The findings were published in July in the Journal of General Internal Medicine.

"GLP-1 use has expanded dramatically in recent years, with many novel agents like semaglutide and tirzepatide now on the market, but a frequent concern is their affordability," said David T. Zhu, an M.D./Ph.D. candidate in the VCU School of Medicine and School of Public Health and one of the study authors. "Our results show that more work is needed by clinicians, public health professionals, health systems and policymakers to help improve GLP-1 accessibility."

What are GLP-1 drugs used for?

GLP-1 agonists are a type of medication that helps manage blood sugar levels, slow digestion and reduce appetite. While this class of drugs was initially approved to help manage Type 2 diabetes, subsequent clinical studies have shown that GLP-1 medications are also beneficial for other health conditions, including obesity, kidney disease, heart disease and liver disease.

With more GLP-1 options on the market to address a growing number of health conditions, there has been a rapid expansion of GLP-1 utilization. However, there is limited research on the financial toll of GLP-1 use for patients, and how this impacts accessibility.

"Surveys show that in 2024, about 6% of all adults in the United States were actively using GLP-1 medications. By 2026, that rate has increased to 12%, representing 30 million people. There are many more who could benefit from this treatment but can't afford the out-of-pocket costs," said Alan Lai, a medical student at the School of Medicine and one of the study authors.

How did the study authors measure GLP-1 spending?

To better understand the financial impact of GLP-1 use, the researchers analyzed data collected between 2013 and 2023 through the Medical Expenditure Panel Survey, a national data source that measures how Americans use and pay for healthcare. This includes all costs that are covered through insurance or paid for directly out of pocket by patients. The team assessed responses from nearly 2,800 participants and used this data to estimate trends among approximately 33 million U.S. adults.

Their analysis revealed that:

• Total health spending on GLP-1 medications increased from $4.4 billion in 2013 to $64.9 billion in 2023. The largest spike occurred between 2021 and 2023, when cumulative spending on GLP-1 medications nearly doubled.
• On an individual level, median out-of-pocket spending per GLP-1 user was $1,528 annually, which is notably higher than previous spending estimates. The researchers believe this is because prior studies largely used data from claims filed by patients with insurance, whereas the new study captures spending from both insured and uninsured patients.

How affordable are GLP-1 drugs?

The team assessed trends in GLP-1 affordability by measuring the proportion of annual household income spent out of pocket on medications. On average, patients spent 7% of their household income on out-of-pocket costs for GLP-1 medications annually. Nearly 1 in 5 of GLP-1 users overall experienced high out-of-pocket burden, where they spent at least 10% of their household income on medications.

"This may reflect the novelty of these medications, since a lot of GLP-1 drugs are brand name only and don't have generic equivalents available for a cheaper alternative," Zhu said.

The data also showed notable socioeconomic differences in GLP-1 medication spending and affordability:

• On average, individuals who were privately insured, had a higher-income or were non-Hispanic White paid the most out of pocket for GLP-1 medications annually.
• In contrast, publicly insured, uninsured or lower-income individuals faced lower out-of-pocket costs for GLP-1 drugs, but these costs made up a larger proportion of their income, which is a more direct measure of these drugs' affordability. Among this group, nearly 1 in 3 GLP-1 users spent at least 10% of their household income on medications.

"Our findings show that even modest out-of-pocket spending on GLP-1 medications can impose substantial financial strain when household financial resources are limited," Zhu said.

The researchers say their findings emphasize the need for more solutions to make these medications more affordable, particularly among uninsured and lower-income populations. Such action could include policy efforts that prioritize reducing out-of-pocket spending and promote drug price negotiations. They added that expanding insurance coverage for GLP-1 drugs could also increase the accessibility and affordability of these medications.

For future studies, the researchers hope to focus on patient spending for other medications, including diabetes and cancer drugs.

"Understanding the financial side of healthcare allows for clinicians to determine who benefits most from improved access to treatments," Lai said. "It also provides a launching pad for clinicians to advocate for future change."