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Trends in GLP-1 Receptor Agonist and SGLT2-Inhibitor Utilization and Expenditure Between 2017-2023: Demographic,
Molly Jacobs1, Qianqian Fang2, Charles Ellis3
1Department of Health Services Research, Management and Policy, College of Public Health and Health Professions, University of Florida, Gainesville, FL, USA. mollyjacobs@ufl.edu.
Journal of General Internal Medicine
|April 15, 2026
Summary
Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) and sodium glucose transporter-2 inhibitors (SGLT2-Is) use increased significantly from 2017-2023, but rising costs create access barriers for lower-income individuals. Policy should address equitable access and cost containment for these vital medications.
Area of Science:
- Pharmacoeconomics
- Health Services Research
- Clinical Pharmacology
Background:
- Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) and sodium glucose transporter-2 inhibitors (SGLT2-Is) are effective treatments for multiple conditions.
- Factors influencing the access and utilization of these medications remain poorly understood.
Purpose of the Study:
- To quantify the utilization, expenditure, and off-label prescribing of GLP-1 RAs/SGLT2-Is from 2017-2023.
- To identify determinants of access and utilization for these drug classes.
Main Methods:
- Utilized data from the 2017-2023 Medical Expenditure Panel Survey (MEPS).
- Employed survey-weighted logistic and generalized linear regression models.
- Adjusted for demographic, insurance, time, and clinical characteristics.
Main Results:
- GLP-1 RA/SGLT2-I utilization rose from 0.42% to 4.45% (GLP-1 RAs) and 8.50% to 31.36% (SGLT2-Is) among adults with approved conditions.
- Blacks, Hispanics, lower-income, publicly insured, uninsured, and less educated individuals showed lower utilization rates.
- Per-prescription spending increased by nearly 50%, while off-label utilization decreased from 27% to 12%.
Conclusions:
- GLP-1 RA and SGLT2-I use expanded significantly between 2017 and 2023, particularly for approved indications.
- Increased costs present access challenges for socioeconomically disadvantaged populations.
- Policy interventions are needed to ensure equitable access, control costs, and guide appropriate off-label prescribing.
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