Study analysis · Journal of managed care & specialty pharmacy · 2025
GLP-1 drugs like Ozempic cost 9% more—but don’t cut hospital visits… except for one surprising group.
Ozempic and similar diabetes drugs cost more than other pills and don’t reduce hospital trips for most people, but they do save money on doctor visits for those with obesity.
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 what happened to people who started taking two different diabetes medicines, but it didn’t randomly assign them—it just watched what happened in real life. So we can say the two groups had different costs, but we can’t say one medicine caused those differences because other things (like how healthy people were or what doctors chose) might have influenced it.
What’s the bottom line?
This study looked at two types of diabetes pills: GLP-1 RAs (like Ozempic) and SGLT2is (like Farxiga). It compared how much they cost and how often people went to the hospital.
How strong is this study?
The researchers did a good job matching people who took each medicine so they were similar in age, health, and other factors—that makes the comparison fairer. But because they didn’t randomly assign the medicines, we still can’t be 100% sure the medicine itself caused the cost differences. That’s why we need to be careful not to say one medicine is 'better'—just that it was linked to higher costs in this group.
40 / 100
- COI disclosure+40/40
- Data availabilitydata not shared
- Code availabilitycode not shared
56 / 100
- Randomizationnot randomized
- Blindingblinding unclear
- Control group+15/15
- Sample size (n=44334)+20/20
- 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 567 / 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 with no randomization. Although propensity score matching was used to adjust for observed confounders, unmeasured variables (e.g., lifestyle, adherence, provider bias) could still influence outcomes, preventing definitive causal inference.
Critical COI
Critical conflicts — study credibility is severely compromised
The study was fully funded and conducted by Humana Inc., with all authors being salaried employees or stockholders of the company, and the funder controlled the research design and publication, creating a high risk of bias.
Funders
Conflict Details
Humana Inc.: Salaried employee of Humana Healthcare Research, Inc.
Humana Inc.: Salaried employee of Humana Healthcare Research, Inc.
Humana Inc.: Salaried employee of Humana Healthcare Research, Inc.
Humana Inc.: Salaried employee of Humana Inc., which offers Medicare Advantage health plans
Humana Inc.: Salaried employee of Humana Inc., which offers Medicare Advantage health plans
+7 more conflicts
The study used Humana's proprietary database, all authors are employees or stockholders of the funder, and there is no indication of independent oversight, external review, or data access restrictions. The findings align with potential financial incentives to demonstrate higher costs for GLP-1 RA drugs, which may impact formulary decisions.
Key takeaways
- 01
People on GLP-1 RAs paid 6–9% more for their pills.
- 02
Total costs were 4–6% higher overall.
- 03
But they didn’t go to the hospital or ER more often.
- 04
In obese patients, GLP-1 RAs led to 2.9% lower medical costs (like doctor visits).
- 05
Even though GLP-1 RAs cost more, they didn’t reduce hospital use — except in obese patients, where they may have lowered other medical expenses, possibly due to weight loss or improved health.
Surprising findings
- GLP-1 RA users had 2.9% lower medical costs in the obesity subgroup despite 9.5% higher pharmacy costs.Everyone assumes expensive drugs = higher total costs with no offset. But here, the drug’s side benefits (likely weight loss) reduced doctor visits and tests enough to lower overall medical spending.
- No difference in hospitalizations or ER visits between GLP-1 RA and SGLT2i users—even in patients with heart disease.Clinical trials suggest GLP-1 RAs reduce cardiovascular events, but in real-world Medicare patients, that didn’t translate to fewer hospital stays.
Practical takeaways
If you're over 65 with type 2 diabetes and obesity, ask your doctor if a GLP-1 RA could lower your overall medical bills—even if the pill costs more.
This only applies to obese patients; for others, the higher drug cost isn’t offset. Also, this study only tracked 12 months.
high confidenceMedicare beneficiaries should compare out-of-pocket costs: SGLT2i drugs like Farxiga may be significantly cheaper than GLP-1 RAs like Ozempic.
Cost savings depend on insurance formulary and whether you qualify for low-income subsidies.
medium confidenceWhy this study matters
The $900 Drug Gap
GLP-1 RA users paid 9% more in pharmacy costs—$870 per month vs. $798 for SGLT2i users—driving a 5.7% increase in total health care spending. This cost difference held across all subgroups, including those with heart disease and obesity.
People think expensive diabetes drugs like Ozempic save money by preventing hospitalizations—but this study shows they don’t, at least not for most patients. The higher cost is purely from the drug itself.
Obesity Secret: Lower Medical Costs
Among obese patients, GLP-1 RA users had 2.9% lower medical costs (doctor visits, tests, procedures) despite paying 9.5% more for pills. This suggests weight loss or metabolic improvements reduced other health expenses.
This flips the script: even though the drug is pricier, it might be saving money elsewhere—making it a potential net win for obese patients, which is huge for Medicare beneficiaries.
No Hospital Savings? Here’s Why
Despite claims that GLP-1 RAs reduce complications, the study found zero difference in hospitalizations or ER visits between GLP-1 RA and SGLT2i users—even in high-risk groups like those with heart disease.
This challenges the narrative that these drugs are 'life-saving' in real-world settings for older adults. They help blood sugar and weight—but not acute care use.
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 two types of diabetes pills: GLP-1 RAs (like Ozempic) and SGLT2is (like Farxiga). It compared how much they cost and how often people went to the hospital.
Research results
People on GLP-1 RAs paid 6–9% more for their pills. Total costs were 4–6% higher overall. But they didn’t go to the hospital or ER more often. In obese patients, GLP-1 RAs led to 2.9% lower medical costs (like doctor visits).
What this means - more context
Even though GLP-1 RAs cost more, they didn’t reduce hospital use — except in obese patients, where they may have lowered other medical expenses, possibly due to weight loss or improved health.
This study compares health care resource utilization and costs between Medicare Advantage beneficiaries with type 2 diabetes who initiated GLP-1 RA versus SGLT2i therapy.
Among 22,167 matched pairs, GLP-1 RA users had no difference in hospitalizations or ED visits compared to SGLT2i users, but had 6–9% higher pharmacy costs and 4–6% higher total costs overall. In the obesity subgroup, GLP-1 RA users had 2.9% lower medical costs despite higher pharmacy costs.
Methods Used
Retrospective cohort study using Humana’s Medicare Advantage claims data (2018–2022); 1:1 propensity score matching adjusted for 47 baseline covariates; 12-month follow-up; generalized linear modeling with γ distribution for cost outcomes.
Main Finding
GLP-1 RA initiation was associated with 6–9% higher pharmacy costs and 4–6% higher total health care costs than SGLT2i across all subgroups, with no difference in hospitalizations or ED visits; in the obesity subgroup, medical costs were 2.9% lower for GLP-1 RA users.
Confidence Level
High — large sample (n=44,334), robust propensity score matching, adjustment for confounders, and reporting of effect sizes with 95% CIs.
Study Flags
Red Flags
- •Retrospective design with potential unmeasured confounders
- •Single health plan data limits generalizability
- •Obesity status based on ICD codes, not direct BMI measurements
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 2.9% lower medical costs in the obesity subgroup despite 9.5% higher pharmacy costs.
Everyone assumes expensive drugs = higher total costs with no offset. But here, the drug’s side benefits (likely weight loss) reduced doctor visits and tests enough to lower overall medical spending.
Practical Takeaways
If you're over 65 with type 2 diabetes and obesity, ask your doctor if a GLP-1 RA could lower your overall medical bills—even if the pill costs more.
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 567 / 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 what happened to people who started taking two different diabetes medicines, but it didn’t randomly assign them—it just watched what happened in real life. So we can say the two groups had different costs, but we can’t say one medicine caused those differences because other things (like how healthy people were or what doctors chose) might have influenced it.
Critical conflicts — the funder had full control over study design, data, and analysis. Study credibility is severely compromised. Score capped at 30.
Strengths
- Large sample size (n=44,334)
- Use of propensity score matching to balance 47 baseline covariates
- Adjustment for pre-index costs and comorbidity burden
Weaknesses
- Retrospective design with no randomization
- Blinding status unknown and not assumed
- Potential for unmeasured confounding (e.g., diet, physical activity, adherence)
Methodology
Evidence Keywords
Statistical Reporting
Not medical advice. For informational purposes only. Always consult a healthcare professional. Terms
This study looked at two types of diabetes pills: GLP-1 RAs (like Ozempic) and SGLT2is (like Farxiga). It compared how much they cost and how often people went to the hospital.
Research results
People on GLP-1 RAs paid 6–9% more for their pills. Total costs were 4–6% higher overall. But they didn’t go to the hospital or ER more often. In obese patients, GLP-1 RAs led to 2.9% lower medical costs (like doctor visits).
What this means - more context
Even though GLP-1 RAs cost more, they didn’t reduce hospital use — except in obese patients, where they may have lowered other medical expenses, possibly due to weight loss or improved health.
This study compares health care resource utilization and costs between Medicare Advantage beneficiaries with type 2 diabetes who initiated GLP-1 RA versus SGLT2i therapy.
Among 22,167 matched pairs, GLP-1 RA users had no difference in hospitalizations or ED visits compared to SGLT2i users, but had 6–9% higher pharmacy costs and 4–6% higher total costs overall. In the obesity subgroup, GLP-1 RA users had 2.9% lower medical costs despite higher pharmacy costs.
Methods Used
Retrospective cohort study using Humana’s Medicare Advantage claims data (2018–2022); 1:1 propensity score matching adjusted for 47 baseline covariates; 12-month follow-up; generalized linear modeling with γ distribution for cost outcomes.
Main Finding
GLP-1 RA initiation was associated with 6–9% higher pharmacy costs and 4–6% higher total health care costs than SGLT2i across all subgroups, with no difference in hospitalizations or ED visits; in the obesity subgroup, medical costs were 2.9% lower for GLP-1 RA users.
Confidence Level
High — large sample (n=44,334), robust propensity score matching, adjustment for confounders, and reporting of effect sizes with 95% CIs.
Study Flags
Red Flags
- •Retrospective design with potential unmeasured confounders
- •Single health plan data limits generalizability
- •Obesity status based on ICD codes, not direct BMI measurements
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 2.9% lower medical costs in the obesity subgroup despite 9.5% higher pharmacy costs.
Everyone assumes expensive drugs = higher total costs with no offset. But here, the drug’s side benefits (likely weight loss) reduced doctor visits and tests enough to lower overall medical spending.
Practical Takeaways
If you're over 65 with type 2 diabetes and obesity, ask your doctor if a GLP-1 RA could lower your overall medical bills—even if the pill costs more.
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 567 / 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 what happened to people who started taking two different diabetes medicines, but it didn’t randomly assign them—it just watched what happened in real life. So we can say the two groups had different costs, but we can’t say one medicine caused those differences because other things (like how healthy people were or what doctors chose) might have influenced it.
Critical conflicts — the funder had full control over study design, data, and analysis. Study credibility is severely compromised. Score capped at 30.
Strengths
- Large sample size (n=44,334)
- Use of propensity score matching to balance 47 baseline covariates
- Adjustment for pre-index costs and comorbidity burden
Weaknesses
- Retrospective design with no randomization
- Blinding status unknown and not assumed
- Potential for unmeasured confounding (e.g., diet, physical activity, adherence)
Methodology
Evidence Keywords
Statistical Reporting
Scoring
How strong is this study?
The researchers did a good job matching people who took each medicine so they were similar in age, health, and other factors—that makes the comparison fairer. But because they didn’t randomly assign the medicines, we still can’t be 100% sure the medicine itself caused the cost differences. That’s why we need to be careful not to say one medicine is 'better'—just that it was linked to higher costs in this group.
40 / 100
- COI disclosure+40/40
- Data availabilitydata not shared
- Code availabilitycode not shared
56 / 100
- Randomizationnot randomized
- Blindingblinding unclear
- Control group+15/15
- Sample size (n=44334)+20/20
- 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 567 / 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 with no randomization. Although propensity score matching was used to adjust for observed confounders, unmeasured variables (e.g., lifestyle, adherence, provider bias) could still influence outcomes, preventing definitive causal inference.
Critical COI
Critical conflicts — study credibility is severely compromised
The study was fully funded and conducted by Humana Inc., with all authors being salaried employees or stockholders of the company, and the funder controlled the research design and publication, creating a high risk of bias.
Funders
Conflict Details
Humana Inc.: Salaried employee of Humana Healthcare Research, Inc.
Humana Inc.: Salaried employee of Humana Healthcare Research, Inc.
Humana Inc.: Salaried employee of Humana Healthcare Research, Inc.
Humana Inc.: Salaried employee of Humana Inc., which offers Medicare Advantage health plans
Humana Inc.: Salaried employee of Humana Inc., which offers Medicare Advantage health plans
+7 more conflicts
The study used Humana's proprietary database, all authors are employees or stockholders of the funder, and there is no indication of independent oversight, external review, or data access restrictions. The findings align with potential financial incentives to demonstrate higher costs for GLP-1 RA drugs, which may impact formulary decisions.
Standing
The people behind it
The researchers who wrote the study this analysis is built on.
Authored by
7 researchersIf this is your work, this is how we attribute it on Fit Body Science. Insiya B. Poonawalla is listed as the lead author.