Background

In 2025, Avalere Health conducted a retrospective Medicare claims analysis of glucagon-like peptide-1 (GLP-1) drug utilization (including single and dual agent GLP-1s). While use of GLP-1s has increased substantially in recent years with the approval of additional indications, Medicare is statutorily prohibited from covering weight loss drugs, including GLP-1s when prescribed solely for the treatment of obesity. To better understand changes in GLP-1 use, Avalere Health evaluated prescribing patterns and measured utilization of GLP-1s among beneficiaries enrolled in standalone Prescription Drug Plans (PDPs) between 2021 and 2023.

Findings

Avalere Health found that from 2021 to 2023, providers (defined based on National Provider Identifiers [NPIs]) increasingly prescribed GLP-1 drugs to beneficiaries, but use was almost entirely limited to drugs approved for a Type 2 diabetes indication. GLP-1 drugs indicated for weight loss are not covered by Medicare Part D plans and there was very limited utilization of those products among beneficiaries. Between 2021 and 2023 the number of:

• GLP-1 claims (i.e., drug fills) increased from 3.2 million to 5.5 million
• Beneficiaries with one or more GLP-1 claims increased from 714,000 to 1.2 million
• Providers prescribing GLP-1s to Medicare beneficiaries in standalone PDPs increased from 164,000 to 277,000.

There was also an increase in the average number of GLP-1 claims per prescribing provider, increasing from 16.2 claims per provider in 2021 to 22.5 in 2023. This increase was largely driven by the increase in the average number of beneficiaries per provider with at least 1one GLP-1 claim, which increased from 4.4 beneficiaries in 2021 to 5.4 in 2023. The average number of claims per beneficiary remained constant at 4.5 per year.

Figure 1. GLP-1 Claims, Beneficiaries with GLP-1 Claims, and NPIs Prescribing GLP-1s in PDPs, 2021–2023

The GLP-1 findings are especially notable when compared to patterns for all pharmacy claims among GLP-1-prescribing providers. Avalere Health found that the average number of beneficiaries per provider remained relatively constant, while total Part D drug claims decreased between 2021 and 2023. On average, the total number of Part D drug claims decreased by 24% in 2023 compared to 2021 among GLP-1-prescribing providers, despite a 39% increase in GLP-1 drug claims during the same period. Consequently, GLP-1s made up a growing proportion of these providers’ total Part D prescriptions, increasing from 3.2% in 2021 to 5.9% in 2023.

Future Coverage and Access Implications for GLP-1s

GLP-1 drugs remain a key area of focus for policymakers as emerging indications and growing patient demand have prompted policy proposals to expand patient access. These proposals represent notable shifts in longstanding coverage restrictions for weight loss drugs under Medicare. In early 2025, the Centers for Medicare and Medicaid Services (CMS) proposed expanding coverage of anti-obesity medications, such as GLP-1s, for treatment of obesity under Medicare Part D; this proposal was not finalized.

More recently, CMS announced the Better Approaches to Lifestyle and Nutrition for Comprehensive hEalth (BALANCE) Model, which aims to test whether CMS-negotiated expanded coverage of GLP-1s for weight management will improve or maintain quality of care while reducing or maintaining Medicare and Medicaid expenditures. At the same time, access to GLP-1s will also be influenced by broader drug pricing reforms, such as the Medicare Drug Price Negotiation Program and the proposed Guarding U.S. Medicare Against Rising Drug Costs (GUARD) Model.

Methodology

Avalere Health utilized 100% Medicare Part D drug event data, accessed via a research collaboration with Inovalon, Inc. and governed by a research-focused CMS Data Use Agreement. The population included was limited to Medicare beneficiaries enrolled in a standalone Part D plan with at least 1 GLP-1 drug claim between 2021 and 2023. The prescribing providers were identified based on the NPI referenced on each GLP-1 drug claim.