J Gen Intern Med. 2026 Apr 15. doi: 10.1007/s11606-026-10408-4. Online ahead of print.
ABSTRACT
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.
PMID:41984414 | DOI:10.1007/s11606-026-10408-4