Rise in Off-Label GLP-1 Prescribing Highlights Need for Equitable Access

Based on an all-payer US claims-based dataset, significantly high rates of off-label glucagon-like peptide-1 (GLP-1) receptor agonist prescribing were uncovered throughout the year 2022, according to data published in the American Journal of Medicine Open.¹ Findings from this review support further approaches to increasing equitable access of these medications, especially in underserved communities.

“Prescriptions for GLP-1 RAs have increased appreciably in the US over the last several years,” wrote authors of the study. “In addition, wide-spread marketing of the weight-loss benefits of these drugs has spurred media attention highlighting differences in use and access between over-resourced and under-resourced populations.”

According to an Axios report, more than 2% of the US population is currently taking GLP-1s for a variety of reasons, resulting in almost a 600% jump in the use of this medication class since 2019.² Originally approved to treat patient outcomes among those with type 2 diabetes (T2D), GLP-1s have since been approved for weight-loss.¹ Since the explosion of their use among patients with T2D or obesity, there are now 7 available GLP-1 options on the US market to treat either condition.³

The researchers' goal was to uncover the association of off-label GLP-1 prescribing with various patient characteristics. | image credit: mbruxelle / stock.adobe.com

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However, with an obesity prevalence of over 40% among US adults,⁴ there is evidence that these medications are being used off-label to improve various obesity-related outcomes. This off-label use is especially apparent because many of the approved GLP-1s do not encompass both T2D and obesity, rather one or the other. Moreover, this off-label prescribing amid increased obesity rates and GLP-1 use has also shown to perpetuate socioeconomic disparities.

“Whether [these disparities exist] in those taking GLP-1 RAs off-label remains to be determined,” they wrote.¹ “We sought to examine off-label prescribing of GLP-1 RAs approved for T2D across the US through the lens of race, ethnicity, and social determinants of health.”

To understand off-label GLP-1 prescribing and its associated disparities, researchers conducted a retrospective analysis featuring multiple data sources regarding patients with prescriptions for GLP-1 RAs approved for T2D. The analysis, however, only included data spanning from January 1-December 31, 2022. Sifting through prescription drug data, off-label prescribing was noted if researchers uncovered prescriptions without an ICD-10 code for T2D.

Their main goal was to uncover the association of off-label GLP-1 prescribing with various patient characteristics. Researchers predicted higher-income communities, rather than those that are historically underserved, would exhibit significantly higher rates of off-label prescribing, possibly due to varying financial means to seek these medications.

“The primary aim was to identify correlations between county-level GLP-1 RA off-label prescription rates and health disparity variables (race, ethnicity, median household income, and social vulnerability) within the US,” continued the authors.¹ “Our hypothesis was that higher rates of off-label prescribing would be present in counties that had higher percentages of White [and] non-Hispanic residents, higher median household income, and lower social vulnerability.”

The analysis included a total of 3,688,430 GLP-1 prescriptions spanning across 2783 of the 3143 US counties.^1,5 GLP-1 prescriptions accounted for 0.15%-0.85% of each county’s population. The median off-label prescription rates per US county was 37.7%, while on-label prescriptions showed a median of 62.3% among included counties.

Finally, for sociodemographic characteristics among counties, residents were 84.6% White, 2.5% Black, 0.7% Asian, 0.3% American Indian or Alaska Native, <0.1% Native Hawaiian or Pacific Islander, 1.5% other races, and 4.6% of 2 or more races. The median household income was $61,286 while the mean social vulnerability index (SVI)—higher numbers translating to higher rates of vulnerability—was 0.51.

Using a hierarchical clustering on principle components method, researchers identified the clusters of counties across the US that exhibited the highest and lowest rates of off-label prescribing. Indeed, the highest rate (51.6%) of off-label GLP-1 prescribing occurred in a cluster of counties in Hawaii with a median income of over $92,000. The lowest off-label prescribing rates occurred in a cluster of counties with American Indian reservations. Those rates were 31.2% among counties with a significantly lower median household income of $52,437.

“Using a national claims-based dataset, we observed a high rate of off-label GLP-1 RA prescriptions in 2022, with notable heterogeneity across US counties and few clear population-level drivers,” the authors wrote.¹ “In our analysis, nearly 40% of GLP-1 RA prescriptions were off-label. In another recent study, first time prescriptions for GLP-1 RAs grew from 4% in the first half of 2018 to 24% in the first half of 2023, with off-label prescriptions growing from 9% to 33% over the same time periods.”

Amid increased rates of GLP-1 prescriptions as well as diabetes and obesity prevalence, experts are not expecting off-label prescribing to slow down anytime soon. As these occurrences continue to increase, patients will continue to seek GLP-1 medications for conditions they do not have. And while areas with greater median incomes will be able to access these off-label prescriptions more often than underserved communities, experts believe significant disparities are further being uncovered in the context of equitable GLP-1 access.

“This retrospective analysis of an all-payer US claims-based dataset found high rates of off-label GLP-1 RA prescribing in 2022,” they concluded.¹ “These findings could help to inform population health strategies focused on equitable access to GLP-1 RAs.”

READ MORE: Diabetes Resource Center

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References

1. Spinelli KJ, Oakes AH, Chiu ST, et al. Health disparity clusters of off label prescriptions for glucagon-like peptide 1 receptor agonists. Am J Med Open. 2025;13:100100. https://doi.org/10.1016/j.ajmo.2025.100100

2. Reed T. Just how many Americans are taking GLP-1s now. Axios. May 27, 2025. Accessed August 21, 2025. https://www.axios.com/2025/05/27/american-glp1-use-weight-loss-increasing

3. GLP-1 agonists. Cleveland Clinic. July 3, 2023. Accessed August 21, 2025. https://my.clevelandclinic.org/health/treatments/13901-glp-1-agonists

4. Emmerich SD, Fryar CD, Stierman B, et al. Obesity and severe obesity prevalence in adults: United States, August 2021–August 2023. NCHS Data Brief, no 508. Hyattsville, MD: National Center for Health Statistics. 2024. doi: https://dx.doi.org/10.15620/cdc/159281

5. O’Connor B. I visited every county in the U.S.—and yes, there’s a club for that. Cornell University. March 28, 2023. Accessed August 21, 2025. https://alumni.cornell.edu/cornellians/every-county/