Tirzepatide was first approved for use in the US in May 2022, when it received an indication for adult patients with type 2 diabetes.1 Indications for chronic weight management and sleep apnea quickly followed over the next 2-plus years.2,3 The dual glucagon-like peptide-1 receptor agonist and glucose-dependent insulinotropic polypeptide receptor agonist has been praised for its safety and efficacy,4,5 while also being called out for its cost.6,7
A recent article published in Annals of Internal Medicine examined trends in the use of tirzepatide vs other glucose-lowering medications and weight-lowering medications,8 with the authors explaining that ongoing evaluation of these medications is necessary to keep patients and providers informed with the most up-to-date data.
Personalized Care Key as Tirzepatide Use Expands Rapidly
For an in-depth interview with John M. Ostrominski, MD, fellow in cardiovascular medicine and obesity medicine, Brigham and Women’s Hospital and Harvard Medical School, and first author of the Annals of Internal Medicine article, “Trends in Utilization of Glucose- and Weight-Lowering Medications After Tirzepatide Approval in the United States," click over to "Personalized Care Key as Tirzepatide Use Expands Rapidly."
In this episode of Managed Care Cast, Ostrominski speaks to the results that he and his team saw, with implications that “underscore the need and importance of personalized and shared decisions around treatment.”
In this first part of a recent interview with The American Journal of Managed Care® (AJMC®), UT Southwestern Medical Center’s Jaime Almandoz, MD, MBA, speaks to the Annals of Internal Medicine findings, which are the results of a study that investigated tirzepatide uptake trends by examining commercial claims data for January 1, 2021, to December 31, 2023.
This transcript has been lightly edited for clarity; captions were auto-generated.
Transcript
What are the most important takeaways from this article for clinicians working in obesity medicine, type 2 diabetes, and metabolic health?
This study highlights the rapid and significant uptake of tirzepatide across populations with and without type 2 diabetes, within 18 months of its approval. Among adults with type 2 diabetes, tirzepatide comprised over 12% of all glucose-lowering medications by the end of 2023. In individuals without diabetes, it quickly became the most commonly used weight-loss medication, surpassing semaglutide. These findings reinforce that new and emerging incretin-based therapies are transforming care paradigms, not just because of their effectiveness for reducing body weight and blood sugars, but because they're being embraced widely in clinical practice.
How do the findings presented align, or conflict, with what you are seeing in clinical practice?
The observed trends are very, very much aligned with what we're seeing clinically. Demand for incretin-based therapies, particularly tirzepatide, has grown tremendously. Patients are increasingly informed about how these medications work and are actively requesting them, often by name. Clinicians are also more comfortable prescribing them due to the strong data on both weight reduction and cardiometabolic improvements. However, access and affordability remain significant barriers. Many of the patients with obesity or cardiometabolic issues who would benefit from treatment face insurance denials or high out-of-pocket costs, which can prevent initiation or lead to discontinuation.
It's a never-ending thing where you spend most of your days trying to convince people that your patients need evidence-based care. It's a thing. Price is also a thing. We live in the real world, and so we can't be too naive, but also we've just got to keep fighting.
Are there gaps or limitations in the article for readers and experts to consider?
While the study provides excellent insights into prescription trends among commercially insured adults, its generalizability is limited. It doesn't capture Medicaid, uninsured, or other publicly insured populations where obesity and diabetes burdens are disproportionately high. Dispensing data reveal valuable trends in prescribing, but we need additional information on clinical outcomes, adherence, or long-term effectiveness. We also lack data on reasons for discontinuation or barriers to access, which are critical for informing policy and coverage decisions. Finally, the study period ends in December 2023, which is just a month after tirzepatide’s FDA approval for weight management.2 Longer-term data on this population is really needed.
References
1. FDA approves Lilly’s Mounjaro (tirzepatide) injection, the first and only GIP and GLP-1 receptor agonist for the treatment of adults with type 2 diabetes. News release. Eli Lilly; May 13, 2022. Accessed April 22, 2025. https://investor.lilly.com/news-releases/news-release-details/fda-approves-lillys-mounjarotm-tirzepatide-injection-first-and
2. FDA approves new medication for chronic weight management. News release. FDA; November 8, 2023. Accessed April 22, 2025. https://www.fda.gov/news-events/press-announcements/fda-approves-new-medication-chronic-weight-management
3. Joszt L. Weight loss drug tirzepatide now approved for sleep apnea in adults with obesity. AJMC. December 20, 2024. Accessed April 22, 2025. https://www.ajmc.com/view/weight-loss-drug-tirzepatide-now-approved-for-sleep-apnea-in-adults-with-obesity
4. Santoro C. Tirzepatide and semaglutide improve weight loss, cardiovascular conditions, but deemed too expensive. AJMC. March 14, 2025. Accessed April 22, 2025.https://www.ajmc.com/view/tirzepatide-and-semaglutide-improve-weight-loss-cardiovascular-conditions-but-deemed-too-expensive
5. Shaw M. Top GLP-1 agonists balance weight loss efficacy, safety. AJMC. January 6, 2025. Accessed April 22, 2025. https://www.ajmc.com/view/top-glp-1-agonists-balance-weight-loss-efficacy-safety
6. Griauzde DH, Carter EW, Oshman L, et al. Understanding insurance coverage policies for incretin mimetics for weight management. Am J Manag Care. Published online January 28, 2025. https://www.ajmc.com/view/understanding-insurance-coverage-policies-for-incretin-mimetics-for-weight-management
7. Shao WL. Contributor: how can the US health care system affordably and fairly expand GLP-1 access for the millions of people who need it? AJMC. March 5, 2025. Accessed April 22, 2025. https://www.ajmc.com/view/contributor-how-can-the-us-health-care-system-affordably-and-fairly-expand-glp-1-access-for-the-millions-of-people-who-need-it-
8. Shaw M. Tirzepatide surges, overtakes older drugs in diabetes, obesity care. AJMC. April 14, 2025. Accessed April 22, 2025. https://www.ajmc.com/view/tirzepatide-surges-overtakes-older-drugs-in-diabetes-obesity-care
