Rise of GLP-1s raises long-term affordability questions
Average total payments per user more than doubled for adults without diabetes from 2017 to 2022, study found
- GLP-1 use increased 643% among adults without diabetes between 2017 and 2022
- Average total payments per user in that group increased 157%
- Findings point to questions about the long-term affordability of GLP-1s and who ultimately pays for them
CHICAGO — As use of GLP-1s surged across the U.S., average total payments per user also climbed sharply, according to a new Northwestern University study that analyzed national trends in GLP-1 use and spending between 2017 and 2022. These total payments included out-of-pocket costs paid by patients as well as payments from insurers, employers and government programs.
The study authors say the findings raise questions about the long-term affordability of drugs that many patients may take for years or even decades. Those questions became even more relevant earlier this month when Medicare launched a temporary program that gives millions of eligible seniors potential access to GLP-1s for a flat $50 monthly copayment.
“Higher total costs of GLP-1 drugs might drive up taxes and increase insurance premium payments both for people taking GLP-1s and those not,” said study first author Dr. Michael Hammond, a recent graduate of the internal medicine residency program at Northwestern’s McGaw Medical Center.
The study will publish on Thursday (July 16) in the Journal of the American Heart Association.
The findings
Using data from the Medical Expenditure Panel Survey (MEPS), Northwestern scientists analyzed usage and spending trends for nearly 1,900 participants who reported using a GLP-1 drug between 2017 and 2022. The authors estimate that these participants were representative of more than 20 million U.S. adults.
The study period coincided with semaglutide's FDA approvals for Type 2 diabetes in 2017 (Ozempic) and weight management in 2021 (Wegovy). Tirzepatide (Zepbound, Mounjaro) was approved for weight loss after the study period and was not included in the analysis.
For the spending trends, the research team looked at total payments (from patients, insurance, employers, Medicare, Medicaid and other programs) and out-of-pocket payments made directly by patients and their families.
The scientists found that between 2017 and 2022:
- Average total payments per patient increased 157% among adults without diabetes and 36% among those with diabetes
- Despite rising total payments, average out-of-pocket payments per patient declined 26% among adults without diabetes and 39% among those with diabetes
- GLP-1 use increased 643% among adults without diabetes and 230% among adults with diabetes
- Semaglutide became the dominant GLP-1 drug by 2022, accounting for 54% of usage among adults with diabetes and 65% among adults without diabetes
The authors note that while this study only used data through 2022, Medicare and Medicaid spending on GLP-1s has continued to surge in recent years.
Who foots the bill?
As spending on GLP-1s continues to grow, the discussion about who foots the bill extends beyond those taking the drugs, the Northwestern scientists said.
“On the commercial side, employers and insurers facing higher drug spending tend to pass it through in the form of higher premiums, higher deductibles or tighter rules,” said study senior author Xiaoning Huang, assistant professor of medicine in the division of cardiology at Northwestern University Feinberg School of Medicine.
“On the public side, it shows up as higher Medicare and Medicaid spending funded by taxpayers, and some state Medicaid programs have started dropping coverage under budget pressure,” Huang added. “So, the bill ultimately lands on premium payers, taxpayers and, in some cases, on patients who lose coverage or face new hurdles.”
Huang says more studies are needed to evaluate policies and strategies that can reduce overall and out-of-pocket payments for GLP-1s
Other Northwestern University authors include Lucia Petito and Dr. Sadiya Khan.
The study is 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.” It was funded by the National Institutes of Health (grant 1R01HL180694- 01).
Journal
Journal of the American Heart Association
Article Title
Trends in Utilization and Payments for Glucagon-Like Peptide 1 Receptor Agonists in the United States, 2017-2022: A Nationally Representative Repeated Cross-Sectional Study
Article Publication Date
16-Jul-2026
Study identifies patients with obesity most likely to benefit from GLP-1-based treatment
Research identifies subtype of `hungry gut' obesity phenotype
Mayo Clinic
ROCHESTER, Minn. — Why do some people lose substantial weight with GLP-1-based medications while others see more modest results? A Mayo Clinic study offers a potential answer by identifying a distinct biological subtype of obesity that responds especially well to tirzepatide, a medication that mimics two naturally occurring hormones involved in appetite and blood sugar regulation, moving the field closer to precision medicine for obesity.
The research, published in Gastroenterology, identified a subgroup of patients with obesity who produce lower levels of natural appetite-regulating hormones, experience faster stomach emptying and report greater hunger after meals. This is a subtype of the "hungry gut" obesity phenotype, characterized by an abnormal duration of fullness. People with hungry-gut obesity may eat normal portion sizes but snack more frequently.
These patients lost nearly twice as much weight after six months of tirzepatide treatment as patients with other obesity subtypes.
"Obesity is a complex disease driven by different biological mechanisms," says senior author Andres Acosta, M.D., Ph.D., a gastroenterologist and obesity researcher at Mayo Clinic in Minnesota. "Our findings suggest we can begin identifying which patients are most likely to respond to specific therapies rather than treating obesity as a single disease."
Researchers studied 483 adults with obesity and found three different biological types of the disease. About 1 in 4 participants produced lower levels of GLP-1 and other hormones that help people feel full after eating. Patients in this group lost an average of 21.5% of their body weight after six months of treatment with tirzepatide, compared with 11.7% for patients in the other groups.
The findings support growing efforts to personalize obesity treatment using an individual's underlying biology rather than relying on a one-size-fits-all approach. Because obesity increases the risk of diabetes, heart disease, certain cancers and many other serious chronic conditions, identifying the right therapy sooner could improve long-term health outcomes.
The researchers also found that the reduced hormone levels were associated with decreased hormone production in the intestine rather than differences in the gut microbiome, providing new insight into the biology underlying this subtype of obesity.
The authors caution that prospective studies are needed before this approach can be incorporated into routine clinical practice, but these findings represent an important step toward more precise, individualized treatment for obesity.
For financial disclosures and other details, please see the paper.
About Mayo Clinic
Mayo Clinic is a nonprofit organization committed to innovation in clinical practice, education and research, and providing compassion, expertise and answers to everyone who needs healing. Visit the Mayo Clinic News Network for additional Mayo Clinic news.
Media contact:
- Sharon Theimer, Mayo Clinic Communications, newsbureau@mayo.edu
Journal
Gastroenterology
DOI
Impact of overweight on cancer risk may be significantly underestimated
German Cancer Research Center (Deutsches Krebsforschungszentrum, DKFZ)
Being overweight and obesity may contribute to significantly more cancer cases than previously thought. This is the conclusion reached by researchers at the German Cancer Research Center (DKFZ). Their analysis shows that when more accurate measures of body fat and methodological biases are considered, more than 10 percent of all cancer cases can be attributed to increased body weight—nearly twice as many as previous estimates suggested.
Overweight and, in particular, obesity are known cancer risk factors. Previous studies have estimated that they account for about two to eight percent of all cancer cases. However, Hermann Brenner, an epidemiologist at the DKFZ, has long suspected that this risk proportion may have been underestimated due to methodological biases. Together with his team, he therefore analyzed data from 458,543 women and men stored in the UK Biobank to investigate the links between being overweight and cancer.
The participants were followed for a median of nearly twelve years. During this period, more than 50,000 new cancer cases occurred.
Weight and height alone are not enough
Most studies on obesity and cancer have relied on the body mass index (BMI), which is calculated from weight and height. However, BMI does not distinguish between fat and muscle mass and provides no information about where fat accumulates in the body. Yet abdominal fat, in particular, is especially metabolically active and is closely linked to inflammatory processes and other mechanisms that can promote cancer.
The DKFZ researchers therefore compared not only BMI but also waist circumference and the waist-to-hip ratio as measures of fat distribution. These parameters proved to be significantly more informative regarding cancer risk.
Methodological Bias: Cancer Often Leads to Weight Loss Even Before Diagnosis
In their current study, Brenner and his team also addressed a previously underestimated methodological issue: Many tumors cause unintentional weight loss years before they are diagnosed. As a result, patients appear slimmer at the time of their actual diagnosis, which weakens the statistical link between obesity and cancer.
To avoid potential biases caused by weight loss prior to diagnosis, the researchers gradually excluded the first few years following the participants’ enrollment in the study. This made the association much clearer. The explanation: A significant proportion of the cancers diagnosed during the first few years of follow-up were likely already present at the start of the study and had already led to weight loss in those affected.
More than 10 percent of all cancer cases could be preventable
In summary, the new analyses yielded significantly higher figures for the proportion of all cancer cases attributable to obesity. Considering all methodological improvements in the analyses, the estimated proportion of cancer cases caused by excess weight rose from about 5.5 percent to as high as 11.5 percent. This means that more than one in ten cases could be linked to excess body fat.
Women appear to be more affected
The analyses also suggest that the proportion of cancer cases caused by obesity may be higher among women than among men. Body fat may also tend to play a greater role among younger adults under the age of 60.
According to Hermann Brenner, the results underscore the urgency of taking decisive action to counter the global rise in obesity. “Since the prevalence of obesity continues to rise in most countries and the population is aging at the same time, the number of cancer cases caused by obesity is likely to continue to rise significantly in the future. Effective strategies for the prevention and treatment of obesity could therefore make a much greater contribution to cancer prevention than previously assumed,” says Brenner, summarizing the significance of the new findings.
Publication:
Luna Kiran Adhikari; Fatemeh Safizadeh; Marko Mandic; Hermann Brenner: Excess Weight May Account for More than Ten Percent of all Cancers: The Underestimated Impact of the Obesity Epidemic.
Cancer Communications 2026, DOI: 10.34133/cancomm.0040
With more than 3,000 employees, the German Cancer Research Center (Deutsches Krebsforschungszentrum, DKFZ) is Germany’s largest biomedical research institute. DKFZ scientists identify cancer risk factors, investigate how cancer progresses and develop new cancer prevention strategies. They are also developing new methods to diagnose tumors more precisely and treat cancer patients more successfully. The DKFZ's Cancer Information Service (KID) provides patients, interested citizens and experts with individual answers to questions relating to cancer.
To transfer promising approaches from cancer research to the clinic and thus improve the prognosis of cancer patients, the DKFZ cooperates with excellent research institutions and university hospitals throughout Germany:
National Center for Tumor Diseases (NCT, 6 sites)
German Cancer Consortium (DKTK, 8 sites)
Hopp Children's Cancer Center (KiTZ) Heidelberg
Helmholtz Institute for Translational Oncology (HI-TRON Mainz) - A Helmholtz Institute of the DKFZ
DKFZ-Hector Cancer Institute at the University Medical Center Mannheim
National Cancer Prevention Center (jointly with German Cancer Aid)
The DKFZ is 90 percent financed by the Federal Ministry of Research, Technology and Space and 10 percent by the state of Baden-Württemberg. The DKFZ is a member of the Helmholtz Association of German Research Centers.
Journal
Cancer Communications
DOI
Postshortage compounded GLP-1 RA market in 2 states with potentially high demand
JAMA Health Forum
About The Study:
The findings of this study show that, after the end of the semaglutide and tirzepatide shortages, compounding facilities have continued to manufacture glucagon-like peptide-1 receptor agonists (GLP-1 RAs) with added ingredients. Compounded GLP-1 RA sourcing is diverse but includes facilities without licenses to perform sterile compounding or that have been subject to recent disciplinary action, posing clinical and regulatory challenges.
Corresponding Author: To contact the corresponding author, Michael J. DiStefano, PhD, email michael.j.distefano@cuanschutz.edu.
To access the embargoed study: Visit our For The Media website at this link https://media.jamanetwork.com/
(doi:10.1001/jamahealthforum.2026.2207)
Editor’s Note: Please see the article for additional information, including other authors, author contributions and affiliations, conflict of interest and financial disclosures, and funding and support.
Embed this link to provide your readers free access to the full-text article This link will be live at the embargo time
Journal
JAMA Health Forum
Study finds no statistical link between use of semaglutide and other GLP-1 drugs and risk of degenerative eye disease in adults with type 2 diabetes
A study following more than 200,000 adult, first-time users of GLP-1 drugs found the medications did not increase or decrease the risk of developing a blinding eye condition
An estimated 27% of U.S. adults with diabetes are using glucagon-like peptide-1 receptor agonists (GLP-1 RAs) — a type of medication that mimics the GLP-1 hormone — to lower blood sugar and support weight loss. Some research has suggested that their use can reduce the risk of developing other diseases.
A new, federally funded retrospective study led by Johns Hopkins Medicine strongly suggests that semaglutide and other GLP-1 RAs did not statistically change the risk of developing neovascular age-related macular degeneration (NVAMD) — a fast-progressing, blinding condition that is caused by uncontrolled, abnormal blood vessel growth in the back of the eye — in adults with type 2 diabetes without a prior history of GLP-1 use.
A peer-reviewed report of the work, funded by the National Institutes of Health, published online June 2 in Ophthalmology.
Cindy Cai, M.D., principal investigator and Jonathan and Marcia Javitt Rising Professor of Ophthalmology at Johns Hopkins Medicine, says the study was designed to resolve existing, conflicting research on the possible link between GLP-1 RAs and age-related macular degeneration.
“Prior to our study, GLP-1s were reported to both increase AND decrease the risk of developing AMD in the literature,” Cai says. “We wanted to resolve the lack of consensus with our work.”
Analyzing de-identified patient data collected from December 2017 through December 2024 across 12 databases managed by the Observational Health Data Sciences and Informatics (OHDSI) network — an international and interdisciplinary collaborative of researchers and observational health databases — the researchers followed the health outcomes of adults with type 2 diabetes who had been prescribed semaglutide (227,971), dulaglutide (68,588), exenatide (5,460), empagliflozin (252,356), sitagliptin (100,083) or glipizide (213,515) for the first time. First-time users were defined as individuals who did not have GLP-1 RAs listed on their health records for at least 365 days and who only initiated the medications as a second-line treatment to metformin.
“We included other GLP-1 receptor agonists in our analysis to show our findings weren’t specific to a single drug,” says Cai.
People who developed neovascular AMD were identified based on specific medical codes present in their database profiles. Two researcher-devised definitions of the disease were used to ensure they did not miss any cases: 1) condition-procedure NVAMD (NVAMD-CP) and 2) condition-only NVAMD (NVAMD-C). Under the first definition, medical codes for both NVAMD and NVAMD treatment were required on a medical profile to have the condition. Under the second definition, a patient only needed an NVAMD diagnostic code to qualify.
Using both NVAMD definitions, Cai’s team performed two sets of analyses to calculate the rates of neovascular age-related macular degeneration onset for semaglutide and the other medications: an active-comparator cohort analysis and a self-controlled case-series analysis.
In the active-comparator cohort analysis, the researchers compared the risk of neovascular age-related macular degeneration onset between statistically similar patients on each medication to see whether people were more or less likely to develop NVAMD. They found that the risk of developing neovascular age-related macular degeneration while taking semaglutide was comparable to the other GLP-1s and non-GLP-1 treatments.
In the self-controlled case-series analysis, the researchers only studied patients who developed neovascular age-related macular degeneration. Cai’s team determined that the incidence-risk ratio — the likelihood of developing NVAMD while taking a treatment versus the likelihood of developing the disease while not on the medication — for semaglutide was 1.02 using the NVAMD-CP definition and 0.92 using the NVAMD-C definition. A risk ratio of 1 suggests no difference between the two groups.
Overall, in both analyses, the risk of developing neovascular age-related macular degeneration while taking semaglutide or the other study medications for type 2 diabetes did not differ enough to be considered greater or less than random chance, the researchers concluded.
While the study clarifies some conflicting findings on NVAMD risk in adults taking GLP-1s for type 2 diabetes, Cai warns that her group’s findings should not be applied to other groups, such as people taking GLP-1 drugs primarily for weight loss, and additional research should be done in people without type 2 diabetes.
“Our study only looked at patients with existing type 2 diabetes who were prescribed semaglutide and other GLP-1 RAs,” she says. “But you don’t need a type 2 diabetes diagnosis to take these medications, so we can’t say if our findings hold true beyond this patient group.”
In addition to Cindy Cai, researchers who authored the study, in alphabetical order, are Mohammed Adibuzzaman, Thamir Alshammari, Karen Armbrust, Andrew J. Barkmeier, Sally Baxter, Clair Blacketer, Michael V. Boland, William J. O'Brien, Eric N. Brown, Aiyin Chen, Hannah Morgan-Cooper, Priya Desai, David A. Dorr, Scott DuVall, Thomas Falconer, Ruochong Fan, Kerry Goetz, Michelle Hribar, Izabelle Humes, George Hripcsak, Ghazala O'Keefe, Yashwant Kothari, Cecilia S. Lee, Haeun Lee, Theodore Leng, Rumel Mahmood, Nestoras Mathioudakis, Benjamin Martin, David McCoy, Nitish Mehta, Paul Nagy, Akihiko Nishimura, Shikha Anna Ostropolets, Philip R.O. Payne, Gowtham Rao, Patrick Ryan, Anthony Sena, Azza Shoaibi, Jacqueline C. Stocking, Marc A. Suchard, Brian Toy, Diep Tran, Edmund Tsui, Sophia Wang, Erik Westlund and Linying Zhang.
The study authors have the following conflict-of-interest disclosures to share: Cai receives grant support from Regeneron Pharmaceuticals, Inc. and equipment support from Optomed. Goetz is an employee of Topcon Healthcare, Inc. and Baxter has received consulting fees from Topcon. Boland is a speaker for Carl Zeiss Meditec and provides consulting services to the company as well as Abbvie. Mehta serves on the 4DMT, Regeneron Pharmaceuticals and Eyepoint Pharmaceuticals advisory boards. DuVall is an employee and shareholder of PurpleLab. Sena, Blacketer and Ostropoiets. Shoaibi and Ryan are employees and shareholders of Johnson & Johnson. Finally, Suchard receives contacts and grants from Janssen Research & Development and Gilead Sciences, Inc., which are outside the scope of this work.
The study was supported by the National Institutes of Health (K23EY033440; K23EY032985, UL1TR001855, T15LM013979, R35GM160458, U24HD113136, R01DK125780, R01DK134955, K12GCAEI0492E, P30EY022589, OT2OD032644, K23EY03263501, 1K01HL168222, R01AG060942, OT2OD32644, UL1TR002345, UL1TR002369, UL1TR002369, UL1TR002369, UL1TR002369, and R01HL169954, R01HL167858).
DOI: 10.1016/j.ophtha.2026.05.034
Journal
Ophthalmology
