An analysis presented at the AMCP 2025 Annual Meeting found that using glucagon-like peptide-1 receptor agonists (GLP-1s) for treating type 2 diabetes and obesity may induce side effects that require additional treatments, resulting in increased pharmacy use and costs.
The study used national pharmacy and medical claims to identify those who started a GLP-1 between 2014 and 2024 (cases; n=1.1 million). Cases were matched with controls (n=2.6 million) based on initiation year and quarter, age, gender, continuous coverage, and obesity and/or diabetes diagnosis.
Pharmacy costs remained higher in GLP-1 users than in controls for the three years post-treatment initiation, even when excluding direct GLP-1 drug costs.
Average annual pharmacy costs for GLP-1 users were greater by:
- $1,449 in year one;
- $2,390 in year two;
- $2,812 in year three.
Much of the additional pharmacy costs were related to common gastrointestinal side effects associated with GLP-1s, though utilization increased over a broad range of medication categories.
Compared to controls, the need for additional treatment after GLP-1 initiation was significantly higher for:
- Constipation and diarrhea (by 1.8%; P<0.001);
- Nausea and vomiting (by 7.1%; P<0.001);
- Gastroesophageal reflux disease (GERD; by 5.8%; P<0.001);
- GERD-related respiratory symptoms (by 5.2%; P<0.001).
The rate of side effect-induced treatment increased “substantively” with longer use of GLP-1 therapy. For example, GERD treatment rates were higher in cases than in controls (22%) and increased further with longer GLP-1 use:
- 25% for zero to 12 months of use;
- 28% for 12 to 24 months of use;
- 32% for more than 24 months of use.
“Payers and providers should consider the burden of side effect management when evaluating the suitability of these medications for prospective patients,” the author concluded.
Reference
Coetzer H. Real-world trends in pharmacy utilization among commercially insured individuals treated with glucagon-like peptide-1 (GLP-1) receptor agonists, 2014-2024. Abstract E18. Presented at AMCP 2025; March 31–April 3, 2025; Houston.
