Familiar names in this category of injectable and oral medications are Ozempic and Wegovy. Other GLP-1 agonists include dulaglutide (Trulicity), liraglutide (Saxenda and Victoza), exenatide (Bydueron and Byetta), semaglutide (Rybelsus), and tirzepatide (Mounjaro).
In 2024, spending on GLP-1 agonists significantly increased, reaching $49.3 billion. This increase is a notable portion of the total US prescription drug spending. GLP-1 agonists are now the fastest-growing drug segment in the US market (Pharmaceutical Executive, May 13, 2025).
I have a disclaimer regarding the additional benefits of GLP-1 medications that have recently been published in studies. The studies involve preliminary data that require further investigation in larger randomized controlled trials to confirm the reported benefits of GLP-1 agonists in these recent smaller studies.
Semaglutide (Ozempic) controls blood sugar levels, aids in weight loss, and potentially reduces cardiovascular events such as myocardial infarction (heart attack). The mechanism of action of GLP-1 agonists is to stimulate, through the GLP-1 receptor, the beta cells in the pancreas. Beta cells produce insulin, which causes the cells in our body to absorb glucose from the circulating blood. Glucose is a primary energy source for cellular function. This process lowers the glucose level in the blood. GLP-1 receptor agonists promote weight loss by suppressing appetite, enhancing satiety (the feeling of fullness), and delaying gastric emptying.
GLP-1 agonists may help brain health by reducing inflammation in the brain, which could contribute to a lower risk of neurocognitive disorders like Alzheimer’s and dementia. There are GLP-1 receptors in all types of brain cells, and they exhibit neuroprotective properties. GLP-1 agonist drugs address the dysfunctions of all brain cell types in Alzheimer’s disease (AD) and are postulated to be a potential cure for dementia. Dulaglutide (Trulicity) has the most significant entry into brain cells, at 61.8%, among the available GLP-1 agonists. A randomized, placebo-controlled study involving 8,828 study patients showed a substantial benefit to cognition. The next step would be to study dulaglutide versus standard AD medications, such as memantine (Namenda) (J Clin Med. 2024 Jun 26;13(13):3729).
I have read multiple articles on “Ozempic Babies.” The postulate is that weight loss associated with semaglutide (Ozempic) may improve pregnancy odds for some women. Another theory is that GLP-1 may interfere with birth control medication. There is growing interest in the administration of GLP-1 in women who are obese and/or have polycystic ovary disease. Polycystic ovary disease is a hormonal disorder common among women of reproductive age. It’s characterized by irregular or absent periods, excess androgen levels (male hormones), and/or polycystic ovaries (ovaries with multiple small cysts). Data from small studies suggest preconception GLP-1 use may help improve pregnancy odds in this patient population. In a meta-analysis and systematic review published in BMC Endocrine Disorders in 2023, researchers found that, among 840 women with PCOS across 11 randomized controlled trials, the use of GLP-1 was associated with an improvement in the rate of spontaneous pregnancy. There were no significant differences in the total pregnancy rate or IVF (in vitro fertilization) pregnancy rate between those prescribed a GLP-1 receptor agonist (RA) vs. those not prescribed a GLP-1 RA.
GLP-1 medications may decrease heart arrhythmia events in patients who are obese and diabetic. This cohort of patients has a high risk for atrial fibrillation (AF) and was seen in diabetic and obese atrial fibrillation patients. The patients in the study may have received a procedure called ablation. An ablation is a procedure in which the electrophysiologist maps the heart in patients with atrial fibrillation and destroys the fibrillatory areas with a laser, thereby blocking the aberrant conduction pathway. GLP-1 RA medications used in this patient population significantly lowered the risk of atrial fibrillation-related events for patients with diabetes, atrial fibrillation (AF), and obesity, with a particular benefit observed for those with severe obesity (TRANSFORM-AF study, Heart Rhythm 2025; April 24-27, 2025; San Diego). The premise of this study is that obese patients with AF may see a benefit when a GLP-1 agonist medication is added to the conventional therapy of a rate-controlling medication like metoprolol succinate (Toprol XL) and an anticoagulant like apixaban (Eliquis).
Those of you who have quit smoking know that weight gain can be a common occurrence. Treating nicotine addiction with glucagon-like peptide one receptor agonists (GLP-1 agonists) was associated with less weight gain compared with other smoking cessation treatments such as nicotine patches and varenicline (Chantix). Results of a new review suggested that GLP-1 agonists may serve as a safe adjunctive therapy for smoking cessation, especially in patients who are more prone to relapsing due to weight gain, such as women and obese patients. The review included three randomized controlled trials that enrolled 410 smokers, 207 of whom received a GLP-1 receptor agonist (RA). The studies were conducted in the United States (2021), Denmark (2022), and Switzerland (2023). The study periods ranged from 6 to 26 weeks. The US study compared exenatide (2 mg weekly) with placebo plus nicotine patch and counseling. The Danish study also investigated exenatide 2 mg weekly but compared the drug with a placebo plus cognitive-behavioral therapy. The Swiss research compared dulaglutide (1.5 mg weekly) with placebo plus varenicline (Chantix), a partial agonist at nicotinic receptors.
The answer to what makes airplanes fly is the same answer to what will get the prescription for a GLP-1 agonist into the patient’s hands: money and a fantastic health insurance plan. I have worked endlessly to find ways to help patients afford their medications. The GLP-1 agonists have excellent patient outcomes. If a patient has to ask themselves, “Do I eat or do I fill my prescription?” then, more often than not, the patient will not fill their prescription at the pharmacy. This growing problem is being addressed, but most GLP-1 agonists will require prior authorization from the patient’s insurance company.
For seniors, hopefully, there will be some options to reduce the costs of GLP-1s. There’s ongoing bipartisan support for reforming the prior authorization process, particularly in Medicare Advantage plans. A proposed bill is the Improving Seniors’ Timely Access to Care Act of 2024, H.R. 8702 in the House of Representatives and S. 4532 in the Senate. The Centers for Medicare & Medicaid Services (CMS) is also actively working on prior authorization reforms, with a final rule expected to ease administrative burdens on physicians and save practices an estimated $15 billion over the next decade. Individual states are working on reforms to reduce barriers to prior authorization.
The Ozempic, Zebound, Rybelsus, and Mounjaro medications are lifesaving for people with diabetes and obesity. The cardioprotective properties, weight loss, and blood glucose control can be significant. GLP-1 medications are considered first-line treatments for diabetes and obesity. For the appropriate patient, the barrier is most often the monthly copays and costs without insurance coverage. Healthcare’s mission must be to ensure that patients are prescribed evidence-based and guideline-based medications, such as GLP-1s, with the additional goal of ensuring affordability for optimal outcomes.
Be safe and happy flying.
