Most Affordable Injectable GLP-1 for Diabetes
Exenatide (10 mg pen) is the most affordable injectable GLP-1 receptor agonist for diabetes, with a median National Average Drug Acquisition Cost (NADAC) of $771 per month. 1
Cost Comparison of Injectable GLP-1 Receptor Agonists
According to the 2024 American Diabetes Association Standards of Care, the current costs of injectable GLP-1 receptor agonists are as follows:
| GLP-1 RA | Dosage | Median NADAC (30-day supply) |
|---|---|---|
| Exenatide | 10 mg pen | $771 |
| Exenatide ER | 2 mg pen (weekly) | $793 |
| Dulaglutide | 4.5 mg pen (weekly) | $895 |
| Semaglutide | 1 mg pen (weekly) | $903 |
| Liraglutide | 1.8 mg pen | $1,072 |
Considerations When Selecting a GLP-1 RA
Dosing Frequency
- Daily options: Exenatide (twice daily) and liraglutide (once daily)
- Weekly options: Exenatide ER, dulaglutide, and semaglutide
Efficacy Differences
While cost is important, efficacy should be considered:
- Semaglutide typically provides greater A1C reduction (1.5-1.9%) and weight loss (5-10%) compared to other GLP-1 RAs 2
- Weekly formulations generally provide better fasting glucose control than short-acting agents 3
Administration Considerations
- Exenatide requires twice-daily injections around mealtimes
- Liraglutide requires once-daily injection independent of meals 4
- Weekly options (dulaglutide, semaglutide, exenatide ER) offer convenience with fewer injections
Practical Selection Algorithm
For cost-sensitive patients with no cardiovascular disease:
- Exenatide (10 mg pen) is the most affordable option at $771/month
For patients who prefer fewer injections:
- Exenatide ER (weekly) is the most affordable weekly option at $793/month
For patients with established cardiovascular disease:
- Consider dulaglutide or semaglutide despite higher cost due to proven cardiovascular benefits 3
Common Side Effects and Management
Most GLP-1 RAs share similar side effect profiles:
- Gastrointestinal effects (nausea, vomiting, diarrhea) are most common
- These effects are typically transient and diminish over time
- Starting at lower doses and titrating slowly can improve tolerability 4
Important Caveats
- Prices may vary by location, insurance coverage, and pharmacy discount programs
- Human regular insulin, NPH, and 70/30 NPH/regular products can be purchased at significantly lower costs at select pharmacies 1
- Patient assistance programs from manufacturers may help reduce costs
- When combined with sulfonylureas, dose reduction of the sulfonylurea may be necessary to reduce hypoglycemia risk 4
Remember that while exenatide is the most affordable option based on NADAC pricing, individual patient factors including insurance coverage, dosing preference, and clinical characteristics should be considered when making the final selection.