The State of GLP-1 Usage in the U.S. (Presented By Talent Wave)

What are We Spending? Who is Spending it?

Trying to make sense of GLP-1 usage in America today can feel a bit overwhelming with all of the headlines. There are multiple molecules, multiple indications, multiple doses, and a range of payment channels, all contributing to a fast-moving, fragmented picture. Still, there’s no denying it: GLP-1s have been one of the hottest topics in healthcare for the past 24 months. From boardrooms to barbershops, everyone has a take on Ozempic, Wegovy, or Mounjaro.

So I wanted to hit pause, set a baseline, and give a clear snapshot of where we are now and where we might be heading over the next five years. While the headlines may be dominated by tons and tons of new indications/benefits, this article focuses strictly on the branded commercial market, excluding the ever-growing world of compounded GLP-1s, which some estimates suggest may inflate total spend by 10% to 30% according to some experts. What follows is a breakdown of U.S. spend, projected growth, who’s actually using these drugs, and who’s footing the bill. My aim: to ground the hype in data and give readers a clearer view of one of the most consequential therapeutic trends of our time.

The U.S. Pharmacy Market: Setting the Stage

To understand the scale of GLP-1 spending, you have to first zoom out and look at the total pharmacy drug spend in the U.S., a market that’s been growing at a steady 10% annual clip over the past few years. If current trends hold, prescription drug spending could top $800 billion by 2025, a staggering figure that would represent nearly 3% of total U.S. GDP, which is expected to reach almost $28 trillion by year’s end.

In recent years, much of that growth has been driven by the rise of high-cost specialty drugs for rare diseases and complex conditions. But now, GLP-1s are flipping the script and grabbing an outsized share of attention and spending due to their expanding role in weight management. We’re witnessing unprecedented demand for these drugs, driven not just by cultural momentum, but by the clear and measurable clinical benefits of weight loss. Health plans are increasingly sounding the alarm on earnings calls and P&T committee meetings, recognizing that as GLP-1s gain new FDA indications whether for sleep apnea, heart failure, or NASH, they’re not just a clinical breakthrough; they’re a budgetary force that will at some point break our balance sheets.

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How These Drugs Work (Mechanism of Action)

GLP-1 receptor agonists work by mimicking a naturally occurring hormone in the body called glucagon-like peptide-1 (GLP-1). This hormone is released from the gut after eating and helps regulate blood sugar levels, appetite, and digestion. When you take a GLP-1 medication like Ozempic, Wegovy, Mounjaro, or Zepbound, it binds to GLP-1 receptors in multiple areas of the body, including the pancreas, brain, and gastrointestinal tract. This leads to increased insulin secretion, reduced glucagon release, and slower gastric emptying, which together help lower blood sugar and blunt post-meal spikes.

Having given some of the mechanisms of action above, many patients especially those taking GLP-1s for obesity report they see an increase in their appetite regulation. GLP-1 drugs signal satiety, reduce cravings, and make patients feel full sooner and longer after meals. In higher doses, they can significantly reduce caloric intake without requiring patients to consciously restrict their eating. This causes substantial and sustained weight loss for many individuals, often without the rebound associated with past weight loss drugs. For this reason, it has become a very effective treatment for folks who have struggled with their weight for decades, sending Ozempic in TikTok folklore. 

Potential Upcoming Indications

Currently the GLP-1 drugs are approved for Type 2 diabetes and obesity in the US which impact an estimated 37 million americans and 127 million americans respectively. Although obesity only represents about 33% of the revenue in the US and Type 2 represents about 66% of the revenue, the compounded annual growth rate (CAGR) for obesity is over 30% while type 2 diabetes is in the high teens.  Below I want to take a look at the size of some of the future markets that they are exploring for these drugs but obviously there will be heavy overlap given the comorbidities we see with Type 2 diabetes and obesity with some of the future indications. 

Sleep Apnea

GLP-1s are under investigation for treating sleep apnea, a disorder characterized by interrupted breathing during sleep. Estimated 25 million adults.

Diabetic Nephropathy

Research is ongoing to assess the efficacy of GLP-1s in managing diabetic nephropathy, a kidney disease resulting from diabetes. Estimated 8 million individuals with diabetes are affected by kidney disease.

Non-Alcoholic Steatohepatitis (NASH)

GLP-1s are being studied for NASH, a severe form of non-alcoholic fatty liver disease that can lead to liver cirrhosis. Estimated 16 million adults.

Cardiovascular Disease

Given their potential cardiovascular benefits, GLP-1s are under consideration for reducing cardiovascular events in high-risk populations. Estimated 30 million adults with diagnosed heart disease.

Alzheimer's Disease

Preliminary studies are exploring the role of GLP-1s in slowing cognitive decline associated with Alzheimer's disease. Estimated 6 million individuals.

Addiction Management

GLP-1s are being investigated for their potential to reduce cravings and substance use in addiction disorders. Estimated 20 million adults with substance use disorders.

Polycystic Ovary Syndrome (PCOS)

Research is assessing the effectiveness of GLP-1s in managing PCOS, a hormonal disorder common among women of reproductive age. Estimated 5 million women.

Osteoarthritis

Studies are examining whether GLP-1s can alleviate symptoms or slow the progression of osteoarthritis. Estimated 32 million adults.

Inflammatory Bowel Disease (IBD)

 The potential anti-inflammatory effects of GLP-1s are being explored in the context of IBD, including Crohn's disease and ulcerative colitis. Estimated 3 million adults.

Depression

Research is underway to determine if GLP-1s can have antidepressant effects or improve mood disorders. Estimated 17 million adults experience major depressive episodes annually.

Current US Spend

Digging into the 2024 financial earnings, the GLP-1 drug market in the United States has surpassed blockbuster territory. In 2024 alone, Americans spent an estimated $40 billion on GLP-1 medications, with nearly all of that revenue going to just two companies: Novo Nordisk and Eli Lilly. Novo brought in approximately $23.1 billion from its portfolio of GLP-1s, including Ozempic, Wegovy, Rybelsus, and the legacy product Victoza. Eli Lilly, meanwhile, generated about $17.6 billion from its own GLP-1 lineup (Mounjaro, Zepbound, and Trulicity). These drugs are used to treat type 2 diabetes and obesity, and in many cases, both, with dual reimbursement pathways and rapidly expanding indications mentioned above.

What’s remarkable is that these figures do not include the growing share of patients obtaining GLP-1s through compounding pharmacies. Due to higher prices as manufacturers recoup investment and persistent supply shortages, a growing number of Americans have turned to compounded versions of semaglutide and tirzepatide typically sourced through telehealth clinics and local compounders. Estimates suggest as many as 10-30% of GLP-1 users may be accessing these off-brand versions, but since these aren't tracked through traditional pharma sales channels, they remain invisible in the official market size figures. That means the real financial footprint of GLP-1s in the U.S. could be several billion dollars larger than what current revenue data shows.

Who is Using These Drugs

One of the catalysts for writing this article was a text message from a couple of former colleagues who are/were in the space. We were discussing some of the discussion points related to this hot topic in healthcare. We started asking ourselves, who are the biggest users of the GLP-1 drugs as a way to begin discussing which type of healthcare stakeholders could benefit from potential savings. Looking at the KFF data from last year and the chart from that report below, indicates that many of the users are in the 18 and older crowd with the Medicare population making up less than 10% which is insightful on the demographic of users.