Which GLP-1 (Glucagon-Like Peptide-1) receptor agonist, such as semaglutide (Ozempic) or liraglutide (Victoza), is becoming more affordable for adult patients with type 2 diabetes and comorbid conditions like hypertension or hyperlipidemia?

GLP-1 Receptor Agonist Cost Trends

I cannot provide specific information about which GLP-1 receptor agonist is decreasing in cost in a particular date, as the evidence provided does not contain current pricing data or cost trend information for specific time periods.

What the Evidence Shows About GLP-1 Cost-Effectiveness

GLP-1 receptor agonists remain expensive medications with poor cost-effectiveness ratios across all formulations. 1

Cost-Effectiveness Data (2024)

As first-line therapy:

• Oral GLP-1 RA vs. metformin: $875,000 per quality-adjusted life-year (QALY) 1
• Injectable GLP-1 RA: More costly and less effective than both metformin and SGLT2 inhibitors 1

As add-on therapy:

• GLP-1 RA vs. sulfonylureas (added to metformin): $807,000 per QALY 1
• GLP-1 RA vs. NPH insulin (added to metformin plus sulfonylurea): $2,072,000 per QALY 1
• Exenatide vs. glyburide (added to metformin): $353,522.78 per QALY 1

Clinical Guideline Recommendations Despite Cost

The American Diabetes Association (2024-2025) recommends GLP-1 RAs based on clinical benefit, not cost:

• Preferred over insulin for patients without insulin deficiency 1
• Recommended for advanced CKD (eGFR <30 mL/min/1.73 m²) due to lower hypoglycemia risk and cardiovascular benefits 1
• Preferred for patients with MASLD/MASH and obesity 1

However, cost barriers must be addressed:

• Clinicians should routinely assess financial obstacles 1
• For patients with cost-related barriers, consider lower-cost alternatives (metformin, sulfonylureas, thiazolidinediones, human insulin) 1
• No generic GLP-1 RAs are currently available 1

Important Caveats

All cost-effectiveness analyses show:

• Results are highly sensitive to drug pricing assumptions 1
• None of the newer GLP-1 RAs fall below the $150,000 per QALY willingness-to-pay threshold 1
• SGLT2 inhibitors demonstrate better cost-effectiveness than GLP-1 RAs in most scenarios 1, 2

For patients requiring a third oral agent added to metformin and sulfonylurea, SGLT2 inhibitors are preferred over GLP-1 RAs from both clinical and cost-effectiveness perspectives. 2

Practical Approach for Cost-Conscious Prescribing

When cost is a primary concern:

1. Start with metformin as first-line therapy 1
2. Add sulfonylureas or thiazolidinediones as second-line agents 1
3. Consider SGLT2 inhibitors over GLP-1 RAs when adding a third agent 2
4. Reserve GLP-1 RAs for patients with specific indications (advanced CKD, MASLD, or when cardiovascular benefits outweigh costs) 1

Discuss medication costs directly with patients when selecting between SGLT2 inhibitors and GLP-1 RAs. 1