{ "study": { "slug": "medicare-part-d-glp1-spending", "title": "GLP-1 drugs now cost Medicare Part D $24.57 billion a year", "standfirst": "GLP-1 drugs cost Medicare Part D $24.57 billion in 2024 — 10.8% of the entire program's drug spending on just 1.3% of its prescriptions. Ozempic alone, at $12.38 billion, is the second-costliest drug in Part D; Mounjaro and Trulicity push the class past $24 billion.", "desk": "care-quality", "article_type": "Original Research", "published": "2026-06-12", "issue": 56, "doi": "10.5072/fonteum/medicare-part-d-glp1-spending-2026", "url": "https://fonteum.com/research/medicare-part-d-glp1-spending", "methodology_version": "part-d-glp1/v1" }, "data_as_of": "2026-04-04", "datasets": [ { "slug": "cms-part-d-prescribers", "name": "CMS Medicare Part D Prescribers", "publisher": "CMS — Medicare Part D Prescribers, by Provider and Drug", "upstream_url": null } ], "key_findings": [ { "number": "$24.57B", "finding": "in Medicare Part D drug cost for the GLP-1 class in 2024 — 10.8% of the program's $226.74 billion total, on 19.6 million prescription claims", "dataset": "cms-part-d-prescribers" }, { "number": "$12.38B", "finding": "for Ozempic alone, making it the second-costliest single drug in all of Part D, behind only the blood thinner Eliquis", "dataset": "cms-part-d-prescribers" }, { "number": "98.9%", "finding": "of GLP-1 class cost comes from just four brands — Ozempic, Mounjaro, Trulicity, and Rybelsus", "dataset": "cms-part-d-prescribers" }, { "number": "$1,254", "finding": "average Part D cost per GLP-1 claim — roughly eight times the $153 average across all Part D prescriptions", "dataset": "cms-part-d-prescribers" } ], "faqs": [ { "q": "How much does Medicare Part D spend on GLP-1 drugs?", "a": "In 2024, Medicare Part D spent $24.57 billion on GLP-1 receptor agonists — the class that includes Ozempic, Mounjaro, and Trulicity. That is 10.8% of the program's entire $226.74 billion drug bill, delivered on 19.6 million prescription claims, about 1.3% of all Part D claims." }, { "q": "Is Ozempic the most expensive drug in Medicare Part D?", "a": "No — it is the second-costliest. Ozempic cost Part D $12.38 billion in 2024, behind only the blood thinner Eliquis at $19.88 billion. Ozempic alone accounts for half of all GLP-1 spending in the program and about 5.5% of total Part D drug cost." }, { "q": "Does Medicare cover Ozempic and Mounjaro?", "a": "Medicare Part D covers these drugs when prescribed for type 2 diabetes, their FDA-approved on-label use in the program. The $24.57 billion total reflects that diabetes coverage. By federal statute, Part D does not cover drugs used only for weight loss, which is why their weight-loss-labeled siblings barely appear." }, { "q": "Why are GLP-1 drugs so expensive per prescription?", "a": "GLP-1 drugs are brand-only injectables with no generic competition, so each fill carries a high list price. The average GLP-1 claim cost Part D about $1,254 in 2024 — roughly eight times the $153 average across all Part D prescriptions, which are dominated by cheap generics." }, { "q": "Does Medicare cover Wegovy or Zepbound for weight loss?", "a": "Not for weight loss alone. Section 1860D-2 of the Social Security Act excludes agents used for weight loss from Part D coverage. Neither Wegovy nor Zepbound appears among the 50 costliest Part D drugs in 2024. Wegovy gained a cardiovascular-risk indication in 2024 that can support coverage in specific cases." }, { "q": "Which GLP-1 drugs drive the spending?", "a": "Four brands carry 98.9% of the class. Ozempic ($12.38 billion) and Mounjaro ($5.83 billion) lead, followed by Trulicity ($4.79 billion) and the oral semaglutide Rybelsus ($1.31 billion). Older GLP-1 drugs such as Victoza and Byetta together make up the remaining 1.1%." }, { "q": "Can I reproduce these GLP-1 spending figures?", "a": "Yes. Every number aggregates the CMS Medicare Part D Prescribers public-use file for data year 2024, read from frozen materialized views. The GLP-1 set is defined by generic name. The exact SQL is in the reproducibility block below and traces to a specific federal snapshot dated 2026-04-04." } ], "citation": { "apa": "Fonteum Research. (2026, June 12). GLP-1 drugs now cost Medicare Part D $24.57 billion a year. Fonteum Research, Issue 56. https://doi.org/10.5072/fonteum/medicare-part-d-glp1-spending-2026", "url": "https://fonteum.com/research/medicare-part-d-glp1-spending" }, "reproducible_sql": "-- GLP-1 drugs in Medicare Part D, 2024 — fully reproducible query.\n--\n-- Source: CMS Medicare Part D Prescribers, \"by Provider and Drug\".\n-- Snapshot: cms-part-d-prescribers / data year 2024 / CMS release 2026-04-04.\n-- Base: public.cms_part_d_prescribers (~28.0M prescriber × drug rows).\n-- Reads: the five frozen materialized views created by\n-- supabase/migrations/20260612150000_part_d_prescribing_research_views.sql.\n-- These views aggregate the 28M-row base table ONCE (the base table is\n-- too large to GROUP BY inside an 8s request), so every figure below is\n-- bounded and reproducible. The GLP-1 slice is computed in the overview\n-- view as a FILTER over generic_name; the per-brand rows are read from\n-- the costliest-drugs view.\n--\n-- Every headline figure in the study resolves to one of the rows below.\n\n-- 1. Program totals + the GLP-1 class slice (single overview row):\nSELECT\n total_drug_cost, -- $226,740,902,131 program total\n total_claims, -- 1,479,628,807 program claims\n glp1_cost, -- $24,567,586,107 GLP-1 class cost\n glp1_claims, -- 19,591,489 GLP-1 class claims\n round(100.0 * glp1_cost / total_drug_cost, 2) AS glp1_cost_pct, -- 10.84%\n round(100.0 * glp1_claims / total_claims, 2) AS glp1_claims_pct, -- 1.32%\n round(glp1_cost::numeric / glp1_claims, 2) AS glp1_cost_per_claim, -- $1,253.99\n round(total_drug_cost::numeric / total_claims, 2) AS program_cost_per_claim -- $153.24\nFROM public.part_d_prescribing_overview_mv;\n\n-- The GLP-1 class is defined exactly as in the view: generic_name in\n-- ('Semaglutide','Tirzepatide','Dulaglutide','Liraglutide',\n-- 'Exenatide','Exenatide Microspheres','Lixisenatide','Semaglutide (Oral)')\n-- (the GLP-1 receptor agonists), summed over data_year = 2024.\n\n-- 2. The GLP-1 brands that surface in the 50 costliest Part D drugs:\nSELECT rank, brand_name, generic_name, claims, cost,\n round(cost::numeric / claims, 2) AS cost_per_claim\nFROM public.part_d_top_drugs_by_cost_mv\nWHERE generic_name IN ('Semaglutide','Tirzepatide','Dulaglutide','Liraglutide',\n 'Exenatide','Exenatide Microspheres','Lixisenatide','Semaglutide (Oral)')\nORDER BY cost DESC;\n-- 2 Ozempic Semaglutide 9,930,484 $12,375,986,475 $1,246 <- 2nd costliest drug overall\n-- 4 Mounjaro Tirzepatide 4,694,896 $5,825,295,741 $1,241\n-- 7 Trulicity Dulaglutide 3,816,376 $4,786,817,612 $1,254\n-- 33 Rybelsus Semaglutide (Oral) 899,704 $1,309,259,751 $1,455\n-- The four named brands = $24,297,359,579 = 98.9% of the $24.57B class total;\n-- the remaining 1.1% is older GLP-1s (Victoza, Byetta, etc.) below the top 50.\n\n-- 3. Wegovy / Zepbound absence check — neither appears in the 50 costliest drugs\n-- (Part D excludes weight-loss-only agents per SSA §1860D-2(e)(2)):\nSELECT count(*) AS weight_loss_glp1_in_top50\nFROM public.part_d_top_drugs_by_cost_mv\nWHERE brand_name IN ('Wegovy','Zepbound'); -- 0", "license": "U.S. Government Works (federal sources; 17 U.S.C. §105)", "generated_by": "Fonteum — https://fonteum.com", "notes": "Aggregate, source-traced figures frozen to the snapshot above. Reproduce by running reproducible_sql against the cited federal dataset; no per-entity records are included." }