US GLP-1 Use and Payments Rose Rapidly as Semaglutide Expanded

US use of GLP-1 receptor agonists rose sharply from 2017 through 2022, largely as semaglutide became the dominant drug in the class. A nationally representative analysis also found a split in the payment data: average patient out-of-pocket payments fell while average total payments per user increased.

What the study measured

Researchers analyzed the Medical Expenditure Panel Survey, a repeated cross-sectional survey designed to represent the US population. The pooled dataset included 1,878 survey participants who represented an estimated 20.3 million adults reporting GLP-1 use across six survey years. That estimate describes accumulated survey-year observations, not a single cohort of 20.3 million people followed over time.

The analysis separated people with and without a reported history of diabetes and examined utilization by drug type. It also tracked two financial measures: annual out-of-pocket payments by patients or families and annual total payments from all recorded sources, including public programs, private insurance, employers, patients, and other payers.

Use increased in both groups

Among people reporting diabetes, estimated GLP-1 use increased from 1.55 million users in 2017 to 5.09 million in 2022, a 230% rise. Among people without reported diabetes, estimated use increased from 115,000 to 855,000, a 643% rise. Both trends were statistically significant in the analysis.

Semaglutide drove much of the change. Among users with diabetes, its share rose from 10% in 2018 to 54% in 2022. Among users without reported diabetes, its share rose from 8% to 65% over the same period. The survey did not capture prescribing indication, so the non-diabetes group cannot be treated as a direct count of weight-management prescriptions.

Out-of-pocket payments fell while total payments rose

Mean annual out-of-pocket payments fell from $414 to $252 for users with diabetes and from $212 to $157 for users without reported diabetes. Mean annual total payments moved in the opposite direction: from $4,936 to $6,722 in the diabetes group and from $2,651 to $6,811 in the group without reported diabetes.

For semaglutide users without reported diabetes in 2022, mean annual total payments were $7,588 while mean annual out-of-pocket payments were $162. The contrast shows why patient spending and system-wide spending should not be used interchangeably.

Important limitations

• The survey relied on self-reported diabetes status and did not identify the clinical indication for each prescription.
• Tirzepatide was not identified separately in the 2022 data.
• Payments were reported in nominal dollars without an inflation adjustment.
• The repeated cross-sectional design describes population-level change and did not follow the same patients over time.

The study documents two simultaneous trends rather than a simple affordability verdict: more people used GLP-1 medicines, especially semaglutide, and average total payments rose even as average direct patient payments declined. Evaluating access therefore requires both measures, along with insurance coverage and treatment duration.