GLP-1 Drug Spending Rose 500% in 5 Years — What It Means for Patients

The numbers are staggering. Total US spending on glucagon-like peptide-1 (GLP-1) receptor agonists — the drug class that includes Ozempic, Wegovy, Mounjaro, and Zepbound — surged from $13.7 billion in 2018 to $71.7 billion in 2023, according to a peer-reviewed study published in JAMA Network Open. That is a 523% increase in five years, making GLP-1 drugs the fastest-growing drug category in American pharmaceutical history by total spending.

This analysis examines the data behind the GLP-1 boom: who is taking these drugs, what they cost, how insurance coverage has evolved, and what the trajectory means for patients who need them but cannot afford them.

Methodology

Spending data in this analysis is drawn primarily from a 2025 study by Tsipas et al. published in JAMA Network Open, which analyzed GLP-1 spending across all US payers from 2018 to 2023 using IQVIA MIDAS data. Medicare Part D figures are from the CMS Medicare Part D Spending by Drug dataset (2023). KFF polling data (November 2025) provides context on patient affordability and access. RxGuide's own drug database provides current list price data for individual GLP-1 medications.

The Scale of the GLP-1 Spending Surge

Source: Tsipas et al., JAMA Network Open, 2025. Figures represent gross spending across all US payers.

The acceleration is notable: growth was relatively modest from 2018 to 2021, then exploded after the FDA approved semaglutide (Wegovy) for chronic weight management in June 2021. This approval transformed GLP-1s from a diabetes medication into a mainstream weight-loss treatment, dramatically expanding the eligible patient population.

What Individual GLP-1 Drugs Cost

Understanding aggregate spending requires context about individual drug prices. GLP-1 medications are among the most expensive commonly prescribed drugs in the United States.

Source: RxGuide drug database, current list prices. Actual out-of-pocket costs vary significantly based on insurance coverage and manufacturer coupons.

A critical point: no GLP-1 drug currently has a generic equivalent available in the United States. All are still under patent protection. This means patients cannot access the 80–90% cost savings that typically accompany generic entry.

The Affordability Gap

The spending surge has not translated into broad patient access. A November 2025 KFF poll found that 1 in 8 American adults (12%) are currently taking a GLP-1 drug, but half of current and former users say the drugs are difficult to afford. Among those who stopped taking GLP-1 medications, cost was the most commonly cited reason.

The affordability gap is particularly acute for:

Patients without insurance coverage for weight loss. While most commercial insurance plans cover GLP-1s for diabetes, coverage for obesity treatment is inconsistent. Medicare was prohibited from covering weight-loss drugs until the Treat and Reduce Obesity Act provisions took effect, and even now coverage varies by plan. Patients paying out of pocket face monthly costs of $900–$1,350 for Wegovy or Zepbound.

Patients who lose manufacturer coupons. Novo Nordisk and Eli Lilly offer savings cards that can reduce out-of-pocket costs to as low as $25/month for commercially insured patients. However, these coupons do not apply to Medicare or Medicaid beneficiaries, creating a two-tier access system.

Lower-income patients. A 2024 NYU analysis found that GLP-1 medications are disproportionately used by higher-income patients, with uptake significantly lower among patients earning under $50,000 per year — precisely the population with the highest rates of obesity-related conditions.

Medicare's Growing GLP-1 Burden

Medicare Part D spending on GLP-1 drugs reached approximately $11.3 billion in 2023 (Ozempic + Mounjaro combined), representing roughly 5% of total Part D gross drug spending. This figure is projected to grow substantially as:

1. Medicare Part D plans began covering semaglutide for cardiovascular risk reduction in 2024 (following FDA approval of this indication)
2. The Inflation Reduction Act's $2,000 out-of-pocket cap reduces the cost barrier for Medicare beneficiaries
3. The patient population taking GLP-1s for diabetes continues to grow with an aging population

CMS has not yet selected any GLP-1 drug for price negotiation under the IRA, but Ozempic and Wegovy are likely candidates for future negotiation cycles given their spending trajectory.

International Price Comparison

The US price for GLP-1 drugs is dramatically higher than in other developed countries. Ozempic (semaglutide 1mg/week) costs approximately:

Sources: KFF International Drug Price Comparison; various national health authority price lists.

The US-to-Canada price ratio of approximately 8:1 for Ozempic is one of the most extreme examples of international drug price variation in the pharmaceutical industry. The gap reflects the absence of government price negotiation in the US prior to the IRA, combined with patent exclusivity and manufacturer pricing power.

What Comes Next

Several developments will shape GLP-1 affordability over the next 3–5 years:

Generic entry. Semaglutide's core patents begin expiring in the late 2020s. Several manufacturers have already filed abbreviated new drug applications (ANDAs) for generic semaglutide. When generics enter the market, prices could fall by 80–90%, as has occurred with other blockbuster drugs after patent expiry.

IRA negotiation. GLP-1 drugs are strong candidates for future Medicare price negotiation cycles. A negotiated price for Ozempic could reduce Medicare spending by billions annually and set a reference price that influences commercial insurance negotiations.

Compounded semaglutide. During the FDA-declared shortage of Ozempic and Wegovy (2022–2024), compounding pharmacies legally produced semaglutide at significantly lower prices. The FDA ended the shortage designation in early 2025, restricting compounding, but the episode demonstrated patient demand for lower-cost alternatives.

Limitations

GLP-1 spending figures from JAMA Network Open represent gross spending before manufacturer rebates. Net spending after rebates is lower, though the exact discount is not publicly disclosed. Additionally, spending projections are inherently uncertain and depend on patent litigation outcomes, FDA approval decisions, and insurance coverage policy changes.

References

1. Tsipas S, et al. Spending on Glucagon-Like Peptide-1 Receptor Agonists in the US, 2018–2023. JAMA Network Open. 2025. https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2832114

2. KFF. Poll: 1 in 8 Adults Say They Are Currently Taking a GLP-1 Drug. kff.org. November 2025. https://www.kff.org/public-opinion/poll-1-in-8-adults-say-they-are-currently-taking-a-glp-1-drug-for-weight-loss-diabetes-or-another-condition-even-as-half-say-the-drugs-are-difficult-to-afford/

3. Centers for Medicare & Medicaid Services. Medicare Part D Spending by Drug, 2023. data.cms.gov. https://data.cms.gov/summary-statistics-on-use-and-payments/medicare-medicaid-spending-by-drug/medicare-part-d-spending-by-drug

4. KFF. TrumpRx: What's the Value for Customers? kff.org. February 2026. https://www.kff.org/patient-consumer-protections/trumprx-whats-the-value-for-customers/

5. NYU. Weighing the Social Costs of Weight Loss Drugs. nyu.edu. 2024. https://www.nyu.edu/about/news-publications/news/2024/august/weight-loss-drugs.html

6. Cornell University. Ozempic is Changing the Foods Americans Buy. news.cornell.edu. December 2025. https://news.cornell.edu/stories/2025/12/ozempic-changing-foods-americans-buy

This article was reviewed by the RxGuide Editorial Team. All spending data is sourced from peer-reviewed publications and publicly available government datasets. This content is for informational purposes only and does not constitute medical or financial advice.