A study using nationally representative MEPS data from 2017 to 2022 found that GLP-1RA use among US adults with diabetes grew 230% and among those without diabetes grew 643%, driven largely by semaglutide. Mean annual out-of-pocket payments dropped from $414 to $252 for diabetes patients and from…
The study was covered in a report dated July 20, 2026, by writer Hugo Francisco de Souza and reviewed by Susha Cheriyedath, M.Sc. The report detailed how the expanding role of GLP-1RAs, originally developed for type 2 diabetes T2D but increasingly used for weight management, has reshaped the pharmaceutical landscape in the United States. Semaglutide, in particular, has drawn intense public interest due to its greater weight-management effectiveness compared to older GLP-1RAs, as noted by the study authors, and its 2021 approval for weight management.
GLP-1RAs were initially designed to help people with type 2 diabetes control blood sugar, but they have demonstrated significant weight-loss benefits even in individuals without diabetes. This has led to a sharp increase in their use for weight management. Prior to this study, researchers lacked a clear national picture of how usage shifted among older and newer GLP-1RA subtypes or how mean prescription payments changed over time. Tracking these shifts is critical because GLP-1RA therapy may continue for extended periods, making affordability a pressing concern.
To address this knowledge gap, the research team analyzed MEPS data, which provides a comprehensive, nationally representative, repeated cross-sectional sample of US adults. The study focused on the period from 2017 to 2022 to capture usage and payment trends immediately before and after the expansion of GLP-1RA indications. The pooled sample included 1,878 participants, representing an estimated 20,343,000 US adults who reported GLP-1RA use across the six survey years. Summary statistics showed that 52% of participants were women and 90% had a history of diabetes. The average participant age was 59.8 years for individuals with diabetes and 47.8 years for those without.
For the analysis by drug type, semaglutide and liraglutide were evaluated separately, while dulaglutide, exenatide, and unspecified glucagon-like peptide-1 agonists were grouped together as “other GLP-1RAs.” The study’s primary financial endpoints were mean annual out-of-pocket payments and mean total annual payments per person. Out-of-pocket payments included deductibles, copays, coinsurance, and payments for services or providers not covered by other sources. Total annual payments combined payments from Medicare, Medicaid, patients or families, state or local government, Tricare, veterans’ programs, employers, private insurance, other federal sources, and other insurers.
The analysis documented a substantial nationwide expansion in GLP-1RA use. Among individuals with diabetes, overall GLP-1RA utilization grew by 230% from 2017 to 2022. Estimated use increased from 1,545,000 users to 5,092,000 users, with a P for trend of less than 0.01, indicating strong statistical significance. Among individuals without a reported history of diabetes, GLP-1RA use surged from 115,000 to 855,000 users, representing a 643% increase P for trend less than 0.01 .
The primary driver of this growth was semaglutide. In 2018, semaglutide accounted for just 10% of users with diabetes and 8% of users without diabetes. By 2022, these proportions had jumped to 54% and 65%, respectively. Meanwhile, liraglutide’s share decreased from 42% to 12% among users with diabetes and from 58% to 21% among those without diabetes, although its estimated absolute number of users without diabetes increased. These shifts underscore the rapid adoption of semaglutide, likely reflecting its greater weight-management effectiveness and its approval for weight management in 2021, as noted in the study.
The study found that mean annual out-of-pocket payments decreased in nominal dollars over the study period. For patients with diabetes, out-of-pocket costs dropped from $414 to $252. For patients without diabetes, they fell from $212 to $157. This suggests that patients themselves bore a lower financial burden at the pharmacy counter in 2022 compared to 2017.
In contrast, mean total annual payments per user increased substantially. For users with diabetes, total payments from all sources rose from $4,936 to $6,722. For those without diabetes, the increase was from $2,651 to $6,811. The narrowing gap between the two groups reflects the growing share of semaglutide use among non-diabetes patients. In 2022, users without diabetes who received semaglutide had a mean annual total payment of $7,588, with a mean annual out-of-pocket payment of just $162. These high total payments raise concerns about the overall cost burden to the healthcare system and the sustainability of long-term use, especially if treatments continue for a lifetime.
The study concludes that by 2022, semaglutide had become the predominant GLP-1RA among surveyed US users. This shift likely reflects its greater weight-management effectiveness reported in earlier research and its 2021 approval for that indication. The observed decrease in mean annual out-of-pocket payments is a positive trend for patients, but the high mean annual total payments raise affordability concerns. The authors call for further studies to evaluate policies and strategies for reducing both total and out-of-pocket GLP-1RA payments.
The study has several limitations. It did not capture prescribing indication and relied on self-reported diabetes status. Tirzepatide was not identified separately in 2022. Payments were reported in nominal dollars without adjusting for inflation. Differences in insurance coverage may have influenced prescribing and out-of-pocket payment patterns. Because MEPS uses a repeated cross-sectional design, the study described population-level changes and did not follow individual patients or demonstrate medication switching. Despite these limitations, the nationally representative data provide important insights into the rapid uptake of GLP-1RAs and the associated financial trends.
The journal article titled “Trends in Usage and Payments for Glucagon-Like Peptide-1 Receptor Agonists in the United States, 2017 to 2022: A Nationally Representative Repeated Cross-Sectional Study” has a DOI of 10.1161/JAHA.125.046302 and can be accessed via the American Heart Association’s journals website. The study was written by Hugo Francisco de Souza and reviewed by Susha Cheriyedath, M.Sc., in a report published on July 20, 2026.
Peptides referenced: Semaglutide, Tirzepatide, Liraglutide, Exenatide, Dulaglutide, Glucagon, GLP-1.
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