Endocrine/Metabolic Therapies

Top medications by spend and largest year-over-year changes

Table 1 lists the top 10 endocrine and metabolic medications by Vizient client spend, highlighting market share and anticipated price adjustments. GLP-1 agents, semaglutide and tirzepatide remained the leading driver in spend, making up approximately 4.21% of the spend in this category reflecting the ongoing growth in both diabetes and obesity care.

Between Q1 2022 and Q2 2025, IQVIA data show tirzepatide use accelerating past semaglutide by late 2023 and maintaining strong growth through 2025. This marks a transition in GLP-1 market leadership, with tirzepatide now dominant by dispensed volume (Figure 1).

The shift reflects expanded indications—tirzepatide for obesity and semaglutide for cardiovascular risk—broadening access and coverage. Compounded products are excluded, likely underestimating total volume, especially for semaglutide during earlier shortages. The FDA resolved the semaglutide shortage in February 2025.

Key contributors to Vizient client spend include bone agents and growth hormone therapies. Romosozumab (Evenity) continues gaining traction in osteoporosis care, while denosumab use grows with the aging population. With biosimilars from Sandoz, Fresenius Kabi, and Celltrion expected, denosumab pricing and total spend are projected to decline.

Somatropin spending rose due to both higher utilization and price increases, while SGLT2 inhibitors such as empagliflozin and dapagliflozin show steady adoption as their role in diabetes and heart failure expands.

Endocrine and metabolic drugs represent 10.8% of total purchases, with price growth expected to ease from 3.8% in 2025 to 1.8% in 2026, driven by moderating GLP-1 prices. Dapagliflozin (Farxiga) is projected to decline by 10%, reflecting the impact of Inflation Reduction Act provisions.

GLP-1s: Market expansion drives budget pressures

GLP-1 therapies have become central to endocrine and metabolic management. Use now extends beyond diabetes and obesity, with new label expansions—including CV risk reduction for semaglutide and MASH indications—driving broader adoption. Tirzepatide’s obesity approval has accelerated growth (Figure 1).

FDA restrictions on compounding have reduced lower-cost alternatives, increasing the impact of brand pricing on payers and health systems. Spending pressure now stems more from rising eligible populations and longer treatment durations across multiple indications.

Key strategies to manage spend:

• Indication-specific coverage (e.g., ASCVD, CKD, MASH)
• Outcomes-based reauthorization
• Steer fills to system-owned retail or specialty pharmacies
• Pharmacist-led GLP-1 clinics for titration, adherence, and lab management

Looking ahead, Medicare coverage expansions and IRA price negotiations in 2027 will shape long-term costs, making 2026–2027 critical for aligning utilization, site-of-fill, and contracting strategies.

Evolving insulin dynamics: Pricing and supply considerations

Insulin remains vital across acute and outpatient care, but the market is shifting fast. Pricing declines driven by competition and policy changes are reducing spend even as demand stays steady, while long-acting supply shortages add new operational challenges.

Short-acting insulins—including aspart, glargine, and lispro—have seen steep average sales price (ASP) drops: aspart >50%, glargine >30%, and lispro >40% (Table 2). These trends reflect biosimilar and authorized generic competition, manufacturer discounting, and Inflation Reduction Act policies such as the $35 monthly cap. Together, these factors have driven sharp market value erosion despite stable or rising utilization.