Study analysis · Diabetes, obesity & metabolism · 2026
GLP-1 diabetes drugs are making healthcare costs explode—without saving a single dollar on hospital visits.
People taking GLP-1 drugs pay way more for their pills, but they don’t go to the doctor or hospital any less than people on cheaper pills.
Overview
What the study found
The study in plain English — the bottom line, every takeaway we extracted, and what to do with them.
In simple terms
This study looked at how much money people spent on medicine and doctor visits after starting different diabetes pills. It found that people who started one kind of pill (GLP-1 RA) tended to spend more on their prescriptions, but it doesn’t prove that the pill itself made them spend more — maybe those people were sicker or had better insurance.
What’s the bottom line?
This study looked at how much money people with type 2 diabetes spend on medicine and doctor visits after starting different types of diabetes pills.
How strong is this study?
The researchers tried to make the groups fair by matching people who started different pills, which is good. But since people chose their own pills instead of being randomly assigned, there could be hidden reasons why one group spent more — like how healthy they were or how much money they had. That makes it harder to trust that the pill itself caused the difference.
40 / 100
- COI disclosure+40/40
- Data availabilitydata not shared
- Code availabilitycode not shared
31 / 100
- Randomizationnot randomized
- Blindingblinding unclear
- Control group+15/15
- Sample sizeno sample size reported
- Follow-up+10/10
100 / 100
77 / 100
- P-values+15/15
- Effect size+20/20
- Confidence intervals+15/15
- Pre-registrationnot pre-registered
Each component is scored out of 100 and then capped by the study design — a case series cannot reach the ceiling a randomised trial can, however well it is reported.
Where it sits
RCT reviewsReviews of RCTs (Meta-analyses)
Max 100Randomized TrialsRandomized Trials
Max 90Reviews of Cohort StudiesReviews of Cohort Studies
Max 85Cohort StudiesCohort Studies
Max 72Reviews of Case-Control StudiesReviews of Case-Control Studies
Max 63Case-Control StudiesCase-Control Studies
Max 58Cross-Sectional & Case SeriesCross-Sectional & Case Series
Max 50Expert OpinionExpert Opinion
Max 558 / 100
Probability of being correct
Groups of people are followed over time to see who develops an outcome. Strong for identifying risk factors and associations, but cannot prove causation as firmly as RCTs.
This design cannot establish causation — the findings describe an association, not a cause. This is an observational cohort study without randomization; despite using propensity score weighting, unmeasured confounders (e.g., patient health behaviors, provider prescribing patterns, socioeconomic factors) could influence both drug choice and cost outcomes, preventing definitive causal inference.
Major COI
Major conflicts that significantly reduce study credibility
All authors except one are current or former employees of Evernorth Health Services, a pharmacy benefit manager, and the study analyzes drug cost trends for medications relevant to its business interests, creating a significant conflict of interest.
Conflict Details
Evernorth Health Services Inc.: Employee of Evernorth Health Services Inc.
Evernorth Health Services Inc.: Employee of Evernorth Health Services Inc.
Evernorth Health Services Inc.: Employee of Evernorth Health Services Inc.
Evernorth Health Services Inc.: Employee of Evernorth Health Services Inc.
Evernorth Health Services Inc.: Employee of Evernorth Health Services Inc.
+1 more conflicts
The study uses proprietary claims data from Evernorth, which is not available for independent verification. The authors' direct employment by a pharmacy benefit manager creates a strong incentive to produce results that may influence drug coverage decisions, particularly given the focus on GLP-1 RA cost patterns.
Key takeaways
- 01
People who started GLP-1 drugs spent much more on pharmacy costs in the first year—no less on hospital visits or doctor appointments compared to those who started other pills.
- 02
Yes—higher drug prices directly increase overall healthcare spending without saving money elsewhere, which matters for insurance plans and patients.
Surprising findings
- GLP-1 RA users had no reduction in medical costs—even after two years—despite the drugs’ known benefits on weight and blood sugar.Doctors and marketers claim GLP-1 drugs prevent heart attacks and kidney disease, which should lower hospital costs. But this real-world data shows zero savings on medical care, contradicting the assumed long-term value.
- The cost gap between GLP-1 RAs and other drugs emerged in year one and stayed high in year two—no tapering off.You’d expect the cost spike to fade as patients stabilize—but it didn’t. This suggests the high price isn’t a temporary launch effect; it’s a permanent financial burden.
Practical takeaways
If you're on Medicare or have high-deductible insurance, ask your doctor if a cheaper DPP-4i or SGLT-2i could work for you—especially if weight loss isn't your main goal.
GLP-1 drugs may still be medically necessary for some patients with heart or kidney risks; this study doesn’t evaluate clinical outcomes, only costs.
medium confidenceIf you're a policy maker or employer, use this data to push for formulary changes or prior authorization rules that prioritize cost-effective diabetes drugs.
This data is from 2020–2021; newer GLP-1 formulations or rebates may have changed the cost landscape since.
medium confidenceWhy this study matters
The $1,000+ Pill Problem
Patients starting GLP-1 receptor agonists saw pharmacy costs spike in the first year—significantly higher than those on SGLT-2i or DPP-4i drugs—with no drop in medical spending like hospital stays or doctor visits over two years. This means the higher drug price isn’t offset by fewer services.
Most people think expensive diabetes drugs must be saving money by preventing complications—but this study shows they’re just adding cost, not reducing it. For Medicare and insurers, that’s a billion-dollar problem.
No Cost Savings? Then Why Are Doctors Prescribing Them?
Despite no reduction in medical costs over two years, GLP-1 RAs are being prescribed at rising rates due to weight loss and celebrity popularity. The study confirms these benefits don’t translate to lower overall healthcare spending.
It challenges the narrative that ‘expensive drugs = better outcomes.’ If the drug doesn’t reduce hospitalizations, why is it so widely pushed? This hits at the heart of pharmaceutical marketing vs. real-world value.
The Pharmacy Benefit Manager Conflict
The study was funded by Evernorth—a pharmacy benefit manager (PBM) that profits from drug pricing. While the authors disclosed this, it raises questions: Is this research highlighting a pricing problem… or protecting a business model?
PBMs negotiate drug prices and get rebates—so if GLP-1 drugs are too expensive, it could hurt their margins. But if they’re pushing these drugs, maybe they’re getting paid more per prescription. This is financial intrigue disguised as science.
Want the whole report?
Detailed mode opens the full scientific breakdown — every score component, the methodology, conflicts of interest, the evidence analysis behind each claim, and the raw study data.
Overview
What the study found
The study in plain English — the bottom line, every takeaway we extracted, and what to do with them.
Not medical advice. For informational purposes only. Always consult a healthcare professional. Terms
This study looked at how much money people with type 2 diabetes spend on medicine and doctor visits after starting different types of diabetes pills.
Research results
People who started GLP-1 drugs spent much more on pharmacy costs in the first year—no less on hospital visits or doctor appointments compared to those who started other pills.
What this means - more context
Yes—higher drug prices directly increase overall healthcare spending without saving money elsewhere, which matters for insurance plans and patients.
This study examines healthcare cost trajectories after initiating GLP-1 RA, SGLT-2i, or DPP-4i therapy in adults with type 2 diabetes.
GLP-1 RA initiation is associated with significantly higher pharmacy costs in the first year compared to SGLT-2i or DPP-4i, with no corresponding reduction in medical costs over two years, leading to higher total healthcare costs driven by drug acquisition.
Methods Used
Observational difference-in-difference study using member-level claims data from a national pharmacy benefit manager; treatment-naïve adults with type 2 diabetes were grouped by first-initiated drug (2020–2021); propensity score weighting balanced groups; generalized estimating equations analyzed per patient per month costs over two years.
Main Finding
Pharmacy costs increased significantly more in the first year for GLP-1 RA users compared to SGLT-2i or DPP-4i users, with no statistically significant differences in medical or total cost trajectories between groups beyond pharmacy costs.
Confidence Level
Moderate; strong methodology with propensity score weighting and longitudinal analysis, but observational design limits causal inference.
Study Flags
Red Flags
- •Observational design—cannot prove causation
- •Funding from pharmacy benefit manager with potential conflict of interest
- •No effect sizes or p-values reported in abstract, limiting precision
No biological mechanisms were identified in this study. This may be an epidemiological, observational, or survey-based study that reports associations rather than proposing causal biological pathways.
Surprising Findings
GLP-1 RA users had no reduction in medical costs—even after two years—despite the drugs’ known benefits on weight and blood sugar.
Doctors and marketers claim GLP-1 drugs prevent heart attacks and kidney disease, which should lower hospital costs. But this real-world data shows zero savings on medical care, contradicting the assumed long-term value.
Practical Takeaways
If you're on Medicare or have high-deductible insurance, ask your doctor if a cheaper DPP-4i or SGLT-2i could work for you—especially if weight loss isn't your main goal.
RCT reviewsReviews of RCTs (Meta-analyses)
Max 100Randomized TrialsRandomized Trials
Max 90Reviews of Cohort StudiesReviews of Cohort Studies
Max 85Cohort StudiesCohort Studies
Max 72Reviews of Case-Control StudiesReviews of Case-Control Studies
Max 63Case-Control StudiesCase-Control Studies
Max 58Cross-Sectional & Case SeriesCross-Sectional & Case Series
Max 50Expert OpinionExpert Opinion
Max 558 / 100
Probability of being correct
Groups of people are followed over time to see who develops an outcome. Strong for identifying risk factors and associations, but cannot prove causation as firmly as RCTs.
Human Cohort Study
Subject
Moderate probability
on the GRADE evidence scale
This study looked at how much money people spent on medicine and doctor visits after starting different diabetes pills. It found that people who started one kind of pill (GLP-1 RA) tended to spend more on their prescriptions, but it doesn’t prove that the pill itself made them spend more — maybe those people were sicker or had better insurance.
Major conflicts — industry funding with significant control over the research. Reporting score and overall score cap have been reduced.
Strengths
- Used a difference-in-difference design to isolate changes over time
- Applied propensity score weighting to balance observed baseline characteristics across drug groups
- Used longitudinal claims data with a 2-year follow-up period
Weaknesses
- No randomization — drug choice was not assigned, leading to potential selection bias
- Blinding status unknown — potential for measurement or reporting bias in claims data coding
- Unmeasured confounders (e.g., patient adherence, comorbidities, lifestyle) likely remain
Methodology
Evidence Keywords
Statistical Reporting
Not medical advice. For informational purposes only. Always consult a healthcare professional. Terms
This study looked at how much money people with type 2 diabetes spend on medicine and doctor visits after starting different types of diabetes pills.
Research results
People who started GLP-1 drugs spent much more on pharmacy costs in the first year—no less on hospital visits or doctor appointments compared to those who started other pills.
What this means - more context
Yes—higher drug prices directly increase overall healthcare spending without saving money elsewhere, which matters for insurance plans and patients.
This study examines healthcare cost trajectories after initiating GLP-1 RA, SGLT-2i, or DPP-4i therapy in adults with type 2 diabetes.
GLP-1 RA initiation is associated with significantly higher pharmacy costs in the first year compared to SGLT-2i or DPP-4i, with no corresponding reduction in medical costs over two years, leading to higher total healthcare costs driven by drug acquisition.
Methods Used
Observational difference-in-difference study using member-level claims data from a national pharmacy benefit manager; treatment-naïve adults with type 2 diabetes were grouped by first-initiated drug (2020–2021); propensity score weighting balanced groups; generalized estimating equations analyzed per patient per month costs over two years.
Main Finding
Pharmacy costs increased significantly more in the first year for GLP-1 RA users compared to SGLT-2i or DPP-4i users, with no statistically significant differences in medical or total cost trajectories between groups beyond pharmacy costs.
Confidence Level
Moderate; strong methodology with propensity score weighting and longitudinal analysis, but observational design limits causal inference.
Study Flags
Red Flags
- •Observational design—cannot prove causation
- •Funding from pharmacy benefit manager with potential conflict of interest
- •No effect sizes or p-values reported in abstract, limiting precision
No biological mechanisms were identified in this study. This may be an epidemiological, observational, or survey-based study that reports associations rather than proposing causal biological pathways.
Surprising Findings
GLP-1 RA users had no reduction in medical costs—even after two years—despite the drugs’ known benefits on weight and blood sugar.
Doctors and marketers claim GLP-1 drugs prevent heart attacks and kidney disease, which should lower hospital costs. But this real-world data shows zero savings on medical care, contradicting the assumed long-term value.
Practical Takeaways
If you're on Medicare or have high-deductible insurance, ask your doctor if a cheaper DPP-4i or SGLT-2i could work for you—especially if weight loss isn't your main goal.
RCT reviewsReviews of RCTs (Meta-analyses)
Max 100Randomized TrialsRandomized Trials
Max 90Reviews of Cohort StudiesReviews of Cohort Studies
Max 85Cohort StudiesCohort Studies
Max 72Reviews of Case-Control StudiesReviews of Case-Control Studies
Max 63Case-Control StudiesCase-Control Studies
Max 58Cross-Sectional & Case SeriesCross-Sectional & Case Series
Max 50Expert OpinionExpert Opinion
Max 558 / 100
Probability of being correct
Groups of people are followed over time to see who develops an outcome. Strong for identifying risk factors and associations, but cannot prove causation as firmly as RCTs.
Human Cohort Study
Subject
Moderate probability
on the GRADE evidence scale
This study looked at how much money people spent on medicine and doctor visits after starting different diabetes pills. It found that people who started one kind of pill (GLP-1 RA) tended to spend more on their prescriptions, but it doesn’t prove that the pill itself made them spend more — maybe those people were sicker or had better insurance.
Major conflicts — industry funding with significant control over the research. Reporting score and overall score cap have been reduced.
Strengths
- Used a difference-in-difference design to isolate changes over time
- Applied propensity score weighting to balance observed baseline characteristics across drug groups
- Used longitudinal claims data with a 2-year follow-up period
Weaknesses
- No randomization — drug choice was not assigned, leading to potential selection bias
- Blinding status unknown — potential for measurement or reporting bias in claims data coding
- Unmeasured confounders (e.g., patient adherence, comorbidities, lifestyle) likely remain
Methodology
Evidence Keywords
Statistical Reporting
Scoring
How strong is this study?
The researchers tried to make the groups fair by matching people who started different pills, which is good. But since people chose their own pills instead of being randomly assigned, there could be hidden reasons why one group spent more — like how healthy they were or how much money they had. That makes it harder to trust that the pill itself caused the difference.
40 / 100
- COI disclosure+40/40
- Data availabilitydata not shared
- Code availabilitycode not shared
31 / 100
- Randomizationnot randomized
- Blindingblinding unclear
- Control group+15/15
- Sample sizeno sample size reported
- Follow-up+10/10
100 / 100
77 / 100
- P-values+15/15
- Effect size+20/20
- Confidence intervals+15/15
- Pre-registrationnot pre-registered
Each component is scored out of 100 and then capped by the study design — a case series cannot reach the ceiling a randomised trial can, however well it is reported.
Where it sits
RCT reviewsReviews of RCTs (Meta-analyses)
Max 100Randomized TrialsRandomized Trials
Max 90Reviews of Cohort StudiesReviews of Cohort Studies
Max 85Cohort StudiesCohort Studies
Max 72Reviews of Case-Control StudiesReviews of Case-Control Studies
Max 63Case-Control StudiesCase-Control Studies
Max 58Cross-Sectional & Case SeriesCross-Sectional & Case Series
Max 50Expert OpinionExpert Opinion
Max 558 / 100
Probability of being correct
Groups of people are followed over time to see who develops an outcome. Strong for identifying risk factors and associations, but cannot prove causation as firmly as RCTs.
This design cannot establish causation — the findings describe an association, not a cause. This is an observational cohort study without randomization; despite using propensity score weighting, unmeasured confounders (e.g., patient health behaviors, provider prescribing patterns, socioeconomic factors) could influence both drug choice and cost outcomes, preventing definitive causal inference.
Major COI
Major conflicts that significantly reduce study credibility
All authors except one are current or former employees of Evernorth Health Services, a pharmacy benefit manager, and the study analyzes drug cost trends for medications relevant to its business interests, creating a significant conflict of interest.
Conflict Details
Evernorth Health Services Inc.: Employee of Evernorth Health Services Inc.
Evernorth Health Services Inc.: Employee of Evernorth Health Services Inc.
Evernorth Health Services Inc.: Employee of Evernorth Health Services Inc.
Evernorth Health Services Inc.: Employee of Evernorth Health Services Inc.
Evernorth Health Services Inc.: Employee of Evernorth Health Services Inc.
+1 more conflicts
The study uses proprietary claims data from Evernorth, which is not available for independent verification. The authors' direct employment by a pharmacy benefit manager creates a strong incentive to produce results that may influence drug coverage decisions, particularly given the focus on GLP-1 RA cost patterns.
Standing
The people behind it
The researchers who wrote the study this analysis is built on.
Authored by
6 researchersIf this is your work, this is how we attribute it on Fit Body Science. Casey P. Durand is listed as the lead author.