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Background <p>Despite the proven effectiveness of glucagon-like peptide-1 receptor agonists (GLP-1 RAs) and sodium glucose transporter-2 inhibitors (SGLT2-Is) for the treatment of a variety of conditions, the complexity of factors that influence access and utilization patterns is poorly understood.</p> Objective <p>Using data from the 2017–2023 Medical Expenditure Panel Survey (MEPS), this study quantified GLP-1 RA/SGLT2-I utilization, expenditure, and off-label prescribing—defined as any prescription not linked to an FDA-approved indication—diabetes, chronic kidney disease, obesity, or cardiovascular disease—and estimated the determinants.</p> Design <p>Survey-weighted logistic and generalized linear regression models, adjusted for demographic, insurance, time, and clinical characteristics, quantified these outcomes.</p> Key Results <p>Between 2017 and 2023, use of GLP-1 RAs/SGLT2-Is rose from 0.42 to 4.45% and from 8.50 to 31.36% among adults with an FDA-approved condition. Compared to Whites and those with high income, a college education, and private insurance, Blacks (OR = 0.78, CI = 0.62, 0.99), Hispanics (OR = 0.74, CI = 0.58, 0.94), middle-income (OR = 0.73, CI = 0.62,0.85) and low-income (OR = 0.73, CI = 0.61, 0.86) earners, publicly insured (OR = 0.79, CI = 0.55, 0.82), uninsured (OR = 0.53, CI = 0.31, 0.92), and those with low education (OR = 0.67, CI = 0.53, 0.85) were less likely to utilize GLP-1 RAs or SGLT2-Is. Simultaneously, per-prescription spending increased nearly 50%. Off-label utilization fell from 27 to 12%. Comparatively, off-label utilization was higher among females (OR = 1.56, CI = 1.08, 2.25), but lower among Blacks (OR = 0.92, CI = 0.53, 0.96), Hispanics (OR = 0.55, CI = 0.31, 0.95), and those with only a high school (OR = 0.66, CI = 0.43, 0.99) or less than high school (OR = 0.46, CI = 0.23, 0.90) education.</p> Conclusions <p>The use of GLP-1 RA and SGLT2-I increased between 2017 and 2023, especially among individuals with approved diagnoses. At the same time, the average per-prescription cost increased by nearly 50%, creating barriers to access among low-income/education individuals. Given their clinical benefits, policy efforts should focus on equitable access, cost containment, and guidance on off-label prescribing.</p>

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Trends in GLP-1 Receptor Agonist and SGLT2-Inhibitor Utilization and Expenditure Between 2017–2023: Demographic, Income, and Insurance Associations

  • 期刊论文

  • 发表日期：

    2026年4月15日

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  • Molly Jacobs,
  • Qianqian Fang,
  • Charles Ellis

摘要

Background

Despite the proven effectiveness of glucagon-like peptide-1 receptor agonists (GLP-1 RAs) and sodium glucose transporter-2 inhibitors (SGLT2-Is) for the treatment of a variety of conditions, the complexity of factors that influence access and utilization patterns is poorly understood.

Objective

Using data from the 2017–2023 Medical Expenditure Panel Survey (MEPS), this study quantified GLP-1 RA/SGLT2-I utilization, expenditure, and off-label prescribing—defined as any prescription not linked to an FDA-approved indication—diabetes, chronic kidney disease, obesity, or cardiovascular disease—and estimated the determinants.

Design

Survey-weighted logistic and generalized linear regression models, adjusted for demographic, insurance, time, and clinical characteristics, quantified these outcomes.

Key Results

Between 2017 and 2023, use of GLP-1 RAs/SGLT2-Is rose from 0.42 to 4.45% and from 8.50 to 31.36% among adults with an FDA-approved condition. Compared to Whites and those with high income, a college education, and private insurance, Blacks (OR = 0.78, CI = 0.62, 0.99), Hispanics (OR = 0.74, CI = 0.58, 0.94), middle-income (OR = 0.73, CI = 0.62,0.85) and low-income (OR = 0.73, CI = 0.61, 0.86) earners, publicly insured (OR = 0.79, CI = 0.55, 0.82), uninsured (OR = 0.53, CI = 0.31, 0.92), and those with low education (OR = 0.67, CI = 0.53, 0.85) were less likely to utilize GLP-1 RAs or SGLT2-Is. Simultaneously, per-prescription spending increased nearly 50%. Off-label utilization fell from 27 to 12%. Comparatively, off-label utilization was higher among females (OR = 1.56, CI = 1.08, 2.25), but lower among Blacks (OR = 0.92, CI = 0.53, 0.96), Hispanics (OR = 0.55, CI = 0.31, 0.95), and those with only a high school (OR = 0.66, CI = 0.43, 0.99) or less than high school (OR = 0.46, CI = 0.23, 0.90) education.

Conclusions

The use of GLP-1 RA and SGLT2-I increased between 2017 and 2023, especially among individuals with approved diagnoses. At the same time, the average per-prescription cost increased by nearly 50%, creating barriers to access among low-income/education individuals. Given their clinical benefits, policy efforts should focus on equitable access, cost containment, and guidance on off-label prescribing.