{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,5]],"date-time":"2026-06-05T07:59:45Z","timestamp":1780646385479,"version":"3.54.1"},"reference-count":27,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2026,3,11]],"date-time":"2026-03-11T00:00:00Z","timestamp":1773187200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,3,11]],"date-time":"2026-03-11T00:00:00Z","timestamp":1773187200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Health Services Research"],"published-print":{"date-parts":[[2026,4]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To assess the extent of off\u2010label glucagon\u2010like peptide\u20101 receptor agonist (GLP\u20101) prescribing among individuals without diabetes in Medicare Part D.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Study Setting and Design<\/jats:title>\n                    <jats:p>This cross\u2010sectional study included Medicare Part D beneficiaries who initiated GLP\u20101s. We used a difference\u2010in\u2010differences event\u2010study design with insulin initiators as a control group to interpret time trends in prescribing without diabetes evidence.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Data Sources and Analytic Sample<\/jats:title>\n                    <jats:p>We identified beneficiaries initiating semaglutide or tirzepatide between 2019 and 2023 using a 20% sample of Part D event data. Nondiabetic use was defined as the absence of a diabetes diagnosis or a prescription history of diabetes medications within 1\u2009year before or after 6\u2009months of the first GLP\u20101 fill.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Principal Findings<\/jats:title>\n                    <jats:p>Among 126,263 new GLP\u20101 users, 9.0% were prescribed without diabetes, rising to 13.8% in 2023. This practice was more common among younger, female beneficiaries with obesity. From 2021 to 2023, the share of initiators without diabetes evidence increased by 13.3 percentage points (95% CI, 12.9\u201313.6), beyond changes observed among insulin initiators.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>This growth underscores the substantial budgetary implications for Medicare, particularly amid ongoing policy discussions around expanding coverage of GLP\u20101s for weight management.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/1475-6773.70098","type":"journal-article","created":{"date-parts":[[2026,3,12]],"date-time":"2026-03-12T03:27:52Z","timestamp":1773286072000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["The Use of Glucagon\u2010Like Peptide 1 Agonists Among Non\u2010Diabetics: Evidence From Medicare Part D"],"prefix":"10.1111","volume":"61","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1464-9017","authenticated-orcid":false,"given":"Minji","family":"Kim","sequence":"first","affiliation":[{"name":"Department of Health Policy and Management Johns Hopkins Bloomberg School of Public Health  Baltimore Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kieran","family":"Allsop","sequence":"additional","affiliation":[{"name":"Department of Economics Johns Hopkins Krieger School of Arts and Sciences  Baltimore Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9317-5306","authenticated-orcid":false,"given":"Joseph F.","family":"Levy","sequence":"additional","affiliation":[{"name":"Department of Health Policy and Management Johns Hopkins Bloomberg School of Public Health  Baltimore Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,3,11]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.japh.2023.10.002"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2024.10333"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2032183"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1093\/asj\/sjad211"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2024.57232"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamahealthforum.2024.2026"},{"issue":"360","key":"e_1_2_9_8_1","first-page":"1","article-title":"Prevalence of Obesity and Severe Obesity Among Adults: United States, 2017\u20132018","author":"Hales C. M.","year":"2020","journal-title":"NCHS Data Brief"},{"key":"e_1_2_9_9_1","unstructured":"Office of the Assistant Secretary for Planning and Evaluation \u201cMedicare Coverage of Anti\u2010Obesity Medications \u201dIssue Brief No. HP\u20102024\u201025 (US Department of Health and Human Services November 2024)."},{"key":"e_1_2_9_10_1","unstructured":"Kaiser Family Foundation \u201cMedicaid Coverage of and Spending on GLP\u20101s \u201dNovember 4 2024 https:\/\/www.kff.org\/medicaid\/issue\u2010brief\/medicaid\u2010coverage\u2010of\u2010and\u2010spending\u2010on\u2010glp\u20101s\/."},{"key":"e_1_2_9_11_1","unstructured":"Kaiser Family Foundation \u201cCostly GLP\u20101 Drugs Are Rarely Covered for Weight Loss by Marketplace Plans \u201dPress Release June 12 2024 https:\/\/www.kff.org\/affordable\u2010care\u2010act\/press\u2010release\/costly\u2010glp\u20101\u2010drugs\u2010are\u2010rarely\u2010covered\u2010for\u2010weight\u2010loss\u2010by\u2010marketplace\u2010plans\/."},{"key":"e_1_2_9_12_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamahealthforum.2025.0905"},{"key":"e_1_2_9_13_1","doi-asserted-by":"publisher","DOI":"10.7326\/M24\u20100019"},{"key":"e_1_2_9_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajmo.2025.100100"},{"key":"e_1_2_9_15_1","doi-asserted-by":"publisher","DOI":"10.1017\/S1744133124000306"},{"key":"e_1_2_9_16_1","doi-asserted-by":"crossref","unstructured":"S. D.Pearson C. M.Whaley andS. K.Emond \u201cAffordable Access to GLP\u20101 Obesity Medications: Strategies to Guide Market Action and Policy Solutions \u201dInstitute for Clinical and Economic Review April 9 2025 https:\/\/icer.org\/wp\u2010content\/uploads\/2025\/04\/Affordable\u2010Access\u2010to\u2010GLP\u20101\u2010Obesity\u2010Medications\u2010_\u2010ICER\u2010White\u2010Paper\u2010_\u201004.09.2025.pdf.","DOI":"10.57264\/cer-2025-0083"},{"key":"e_1_2_9_17_1","unstructured":"L. A.Wreschnig \u201cMedicare Coverage of GLP\u20101 Drugs \u201dCRS in Focus No. IF12758 (Congressional Research Service September 9 2024) https:\/\/www.congress.gov\/crs\u2010product\/IF12758."},{"key":"e_1_2_9_18_1","doi-asserted-by":"publisher","DOI":"10.2337\/dsi24\u20100002"},{"key":"e_1_2_9_19_1","doi-asserted-by":"publisher","DOI":"10.1111\/dom.14512"},{"key":"e_1_2_9_20_1","unstructured":"Brigham and Women's Hospital \u201cDiagnosis Codes Suitable for Researching Obesity Using Claims\u2010Based Databases \u201dMarch 17 2022 https:\/\/www.brighamhealthonamission.org\/2022\/03\/17\/diagnosis\u2010codes\u2010suitable\u2010for\u2010researching\u2010obesity\u2010using\u2010claims\u2010based\u2010databases\/."},{"key":"e_1_2_9_21_1","doi-asserted-by":"publisher","DOI":"10.1377\/hlthaff.2024.00356"},{"key":"e_1_2_9_22_1","doi-asserted-by":"publisher","DOI":"10.1007\/s12325\u2010025\u201003340\u20102"},{"key":"e_1_2_9_23_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2025.29842"},{"key":"e_1_2_9_24_1","doi-asserted-by":"publisher","DOI":"10.15620\/cdc\/159281"},{"key":"e_1_2_9_25_1","doi-asserted-by":"publisher","DOI":"10.18553\/jmcp.2024.30.1.34"},{"key":"e_1_2_9_26_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2024.28092"},{"key":"e_1_2_9_27_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2025.15841"},{"key":"e_1_2_9_28_1","unstructured":"J.Cubanski \u201cA Current Snapshot of the Medicare Part D Prescription Drug Benefit \u201dKaiser Family Foundation October 9 2024 https:\/\/www.kff.org\/medicare\/issue\u2010brief\/a\u2010current\u2010snapshot\u2010of\u2010the\u2010medicare\u2010part\u2010d\u2010prescription\u2010drug\u2010benefit\/."}],"container-title":["Health Services Research"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/1475-6773.70098","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/1475-6773.70098","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/1475-6773.70098","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,5]],"date-time":"2026-06-05T07:01:53Z","timestamp":1780642913000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/1475-6773.70098"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3,11]]},"references-count":27,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2026,4]]}},"alternative-id":["10.1111\/1475-6773.70098"],"URL":"https:\/\/doi.org\/10.1111\/1475-6773.70098","archive":["Portico"],"relation":{},"ISSN":["0017-9124","1475-6773"],"issn-type":[{"value":"0017-9124","type":"print"},{"value":"1475-6773","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3,11]]},"assertion":[{"value":"2025-09-04","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-02-25","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-03-11","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e70098"}}