Spending and Affordability of Glucagon-Like Peptide-1 Receptor Agonists and Other Incretin Mimetics in the United States, 2013–2023

BACKGROUND: Glucagon-like peptide-1 (GLP-1) receptor agonists are increasingly used for glycemic control, chronic weight management, and cardiovascular risk reduction. There is growing interest in understanding GLP-1 spending and affordability patterns. OBJECTIVE: To evaluate national trends in total and out-of-pocket (OOP) spending on GLP-1 s and other incretin mimetics. DESIGN: Cross-sectional study. PARTICIPANTS: U.S. adults (aged ≥ 18 years) in the 2013-2023 Medical Expenditure Panel Survey (MEPS). MAIN MEASURES: We included four measures: (1) total annual GLP-1 spending; (2) median annual GLP-1 OOP spending per individual; (3) OOP burden, defined as an individual's annual GLP-1 OOP spending as a share of their household income; and (4) high OOP burden, defined as the proportion of GLP-1 users with OOP burden ≥ 10%. KEY RESULTS: The analytic sample comprised 2,797 survey respondents, representing 33 million adults nationally; approximately 99% of these respondents were identified directly from medication names and the other 1% was identified using the MEPS code for other GLP-1 s/other incretin mimetics. Total GLP-1 spending increased nearly 15-fold, from $4.4 billion in 2013 to $64.9 billion in 2023, reflecting an average annual percentage change of 31.02% (95% CI, 27.6%-34.5%; P < .001). Median annual per-capita OOP spending was $1,528 and highest among privately insured patients and high-income adults. Mean OOP burden was 7.04% and highest among uninsured, publicly insured, and low-income adults. On average, nearly one in five (18.18%) GLP-1 users experienced high OOP burden, which was also highest among uninsured, publicly insured, and low-income adults. CONCLUSIONS: Spending on GLP-1 s and other incretin mimetics rose substantially over time, emphasizing the need to ensure the affordability of these key therapies, particularly among uninsured and lower-income populations.