Trends in the utilization, expenditure and costs of noninsulin glucose-lowering drugs in the Medicaid population: Steady increases in glucagon-like peptide-1 receptor agonist and sodium-glucose transporter-2 inhibitor use, prices and expenditure

Aims: This study aimed to analyse changes in the utilization, expenditure and average cost of noninsulin glucose-lowering drugs (GLDs) between 2008 and 2023. Methods: This was a retrospective observational study of 2008-2023 data from the National Medicaid State Drug Utilization database. Drug utilization and annual Medicaid reimbursement amounts were calculated for all included medications. Average reimbursement/prescription costs were used to represent average prices. The Mann-Kendall test and Sen's slope estimator were used to evaluate trend significance and estimate median annual changes with 95% confidence intervals (CIs).Results: Findings showed a significant increase in the total annual utilization (z = 4.997, Sen's slope: 2.53 million [95% CI: 2.26-2.95 million]), reimbursement amounts (z = 4.997, Sen's slope: $679 million [95% CI: $389 million-$1.04 billion]) and average prices (z = 3.467, Sen's slope: $13.24 [95% CI: $5.97-$21.53]) of the included drugs between 2008 and 2023 (all P < .001; Mann-Kendall test). Metformin dominated the market, accounting for 53% of the prescriptions, followed by sulfonylureas (20.5%). Medicaid spent $2.8 billion on metformin and $1.2 billion on sulfonylureas. This is relatively low compared to expenditure on other medications, such as glucagon-like peptide-1 (GLP-1) receptor agonists, which reached $35.5 billion. There was a notable shift toward the use of GLP-1 receptor agonists and sodium-glucose transporter-2 inhibitors, accompanied by a significant increase in their average cost and Medicaid spending on these drugs. Conclusions: Metformin and sulfonylureas have remained the most prescribed and affordable noninsulin GLDs. However, there has been a shift toward greater utilization of GLP-1 receptor agonists and sodium-glucose transporter-2 inhibitors.