Patients on GLP-1s Increasingly Carry Diagnoses for New Indications

More than half of patients currently on glucagon-like peptide-1 (GLP-1) receptor agonist therapy have a diagnosis tied to a newly approved or investigational indication for the drug class, a finding with direct implications for payer coverage design and long-term health care spending, according to new analysis from Trilliant Health published June 11, 2026.¹

The study examined a national all-payer claims cohort of patients on GLP-1s from 2018 through 2024 and evaluated co-occurring diagnoses across 10 emerging indication categories: polyendocrine metabolic ovarian syndrome, obstructive sleep apnea (OSA), nonalcoholic fatty liver disease (NAFLD) or nonalcoholic steatohepatitis (NASH), major depressive disorder (MDD), chronic kidney disease (CKD), heart failure, substance use disorder, alcohol use disorder, binge eating disorder or other eating disorders, and Alzheimer disease or dementia. Across that span, the volume of patients on GLP-1s grew by 635.6%, with the steepest acceleration following the 2021 approval of semaglutide (Wegovy; Novo Nordisk) for chronic weight management.²

What the Co-Occurrence Data Reveal

Among established patients, 51.3% had at least 1 diagnosis associated with an emerging or recently approved indication; of this group, 30.8% had 1, 13.8% had 2, 5.0% had 3, 1.4% had 4, and 0.4% had 5 or more conditions.¹ OSA was the most prevalent co-occurring condition at 25.5%, followed by MDD at 18.2%, CKD at 10.6%, and NAFLD or NASH at 10.3%. Binge eating disorder and other eating disorders represented the least common co-occurrence, at 0.5%.

“While some of these indications have received regulatory approval, others remain in phase 3 investigation or are prescribed off-label based on earlier-stage evidence,” the report’s authors wrote.

These co-occurrence rates carry particular weight given the scale of the underlying populations:

• An estimated 83.7 million US adults, or approximately 32.4% of the adult population, had OSA in 2024
• Approximately 21 million adults experienced at least 1 MDD episode in 2021, representing 8.3% of the U.S. adult population
• An estimated 37 million adults, or 1 in 10, have CKD

How Approved Indications Have Expanded

The regulatory arc spans more than 2 decades. Semaglutide (Ozempic; Novo Nordisk) received approval for glycemic control in 2017,³ and cardiovascular (CV) outcomes trials, including LEADER for liraglutide (NCT01179048) and SUSTAIN 6 for semaglutide (NCT01720446), established the class’s ability to reduce major adverse CV events in high-risk patients with type 2 diabetes (T2D).¹ Obesity indications followed, with semaglutide (Wegovy) in 2021² and tirzepatide (Zepbound; Eli Lilly) in 2023.⁴

In December 2024, tirzepatide received FDA approval for moderate to severe OSA in adults with obesity, the first pharmacologic approval for that indication.⁵ Semaglutide (Ozempic; Novo Nordisk) gained FDA approval for adults with comorbid T2D and CKD in January 2025 to address CV and kidney disease risks based on the FLOW trial (NCT03819153), which demonstrated a 24% reduction in the primary kidney disease progression end point versus placebo.⁶ In August 2025, semaglutide (Wegovy) received accelerated FDA approval for metabolic dysfunction-associated steatohepatitis (MASH) with moderate to advanced fibrosis.⁷ Two phase 3 trials demonstrated improvements in quality of life, exercise capacity, and myocardial stress biomarkers with semaglutide in patients with obesity-related heart failure with preserved ejection fraction, and Novo Nordisk resubmitted Wegovy for that indication in early 2025, with an FDA decision that has since been delayed.¹

What This Means for Coverage Policy

The findings arrive as payers are navigating cost and access calculations for GLP-1 therapies. Fewer than one-third of large employers covered GLP-1s for obesity in 2023, and many insurers that do provide coverage have imposed prior authorization (PA) requirements.^8,9 Research has also proposed a prior authorization Friction Index to help payers identify where utilization management workflows create avoidable delays without necessarily broadening coverage criteria.¹⁰

As the FDA-approved indication list continues to grow, the share of patients on GLP-1s with a clinically defensible basis for coverage will expand accordingly, and with it, the aggregate cost exposure for payers and self-funded employers, according to the Trilliant Health authors. They also argue that traditional utilization controls are unlikely to contain the resulting spending trajectory and that the policy and economic case for accelerating price competition, generic entry, and biosimilar development will grow in direct proportion to how broadly these therapies are ultimately prescribed.¹

References

1. Patton K, Miller A. More than half of GLP-1 patients have a diagnosis associated with a newly approved or investigational indication. Trilliant Health. June 11, 2026. Accessed June 11, 2026. https://www.trillianthealth.com/market-research/studies/more-than-half-of-glp-1-patients-have-a-diagnosis-associated-with-a-newly-approved-or-investigational-indication

2. Inserro A. FDA clears semaglutide for weight loss when used with diet, exercise. AJMC^®. June 4, 2021. Accessed June 11, 2026. https://www.ajmc.com/view/fda-clears-semaglutide-for-weight-loss-when-used-with-diet-exercise

3. Caffrey M. FDA panel gives nod to once-weekly semaglutide for type 2 diabetes. AJMC. October 18, 2017. Accessed June 11, 2026. https://www.ajmc.com/view/fda-panel-gives-nod-to-once-weekly-semaglutide-for-type-2-diabetes

4. Joszt L. FDA approves diabetes drug tirzepatide for chronic weight management. AJMC. November 8, 2023. Accessed June 11, 2026. https://www.ajmc.com/view/fda-approves-diabetes-drug-tirzepatide-for-chronic-weight-management

5. Joszt L. Weight loss drug tirzepatide now approved for sleep apnea in adults with obesity. AJMC. December 20, 2024. Accessed June 11, 2026. https://www.ajmc.com/view/weight-loss-drug-tirzepatide-now-approved-for-sleep-apnea-in-adults-with-obesity

6. Munz K. FDA expands semaglutide use for CV, kidney risks in T2D, CKD. AJMC. January 28, 2025. Accessed June 11, 2026. https://www.ajmc.com/view/fda-expands-semaglutide-use-for-cv-kidney-risks-in-t2d-ckd

7. Klein H. FDA approves semaglutide for MASH with fibrosis. AJMC. August 18, 2025. Accessed June 11, 2026. https://www.ajmc.com/view/fda-approves-semaglutide-for-mash-with-fibrosis

8. Son M, Edwards AM, Burns B. Contributor: yearly trends in coverage rates for GLP-1 RAs in weight loss. AJMC. May 29, 2025. Accessed June 11, 2026. https://www.ajmc.com/view/contributor-yearly-trends-in-coverage-rates-for-glp-1-ras-in-weight-loss

9. McCormick B. Gaps in persistence, coverage limit GLP-1 impact in obesity. AJMC. April 14, 2026. Accessed June 11, 2026. https://www.ajmc.com/view/gaps-in-persistence-coverage-limit-glp-1-impact-in-obesity

10. Sisodia A. Reducing GLP-1 prior authorization friction: a managed care playbook. Am J Manag Care. 2026;32(6).