ARTICLE: GLP-1 Receptor Agonist Prescriptions Among People With and Without Serious Mental Illness
AUTHORS: Emma E McGinty, Pradhyumna Wagle, Gail L Daumit
JOURNAL: JAMA Psychiatry. 2026 Sep 2:e262667. doi: 10.1001/jamapsychiatry.2026.2667. Online ahead of print.
Abstract
People with serious mental illnesses (SMIs), including schizophrenia, bipolar disorder, and major depressive disorder (MDD), experience 10 to 20 years premature mortality driven by high prevalence of cardiovascular risk factors.1,2 Glucagon-like peptide-1 (GLP-1) receptor agonists are transforming cardiovascular risk prevention and could have high impact in this population, but prescribing patterns are unknown. We examined GLP-1 prescriptions among adults with vs without SMI from 2018 to 2024 using national insurance claims.
Methods: We used Inovalon Insights Real-World Data including deidentified medical and pharmaceutical claims for commercial, Medicare Advantage (MA), and Medicaid Managed Care beneficiaries in all 50 US states. The sample included adults aged 18 years or older and continuously enrolled in a single insurance type in a given calendar year from 2018 to 2024. SMI included schizophrenia, bipolar disorder, or MDD (eAppendix 1 in Supplement 1), assigned hierarchically in the order listed. Person-year level measures included any GLP-1 prescription, measured using National Drug Codes (eAppendix 2 in Supplement 1); GLP-1–indicating condition diagnosis (diabetes, obesity, sleep apnea, overweight plus co-occurring chronic condition) (eAppendix 3 and eAppendix 4 in Supplement 1)3; modified Elixhauser comorbidity index, excluding the GLP-1–indicating conditions measured separately; and age, sex, and state.
We compared the proportion of adults with and without SMI receiving any GLP-1 prescription from 2018 to 2024 in the overall sample and the subset with a GLP-1 indication. We then used multivariate logistic regression with predictive margins to calculate the adjusted predicted proportions of people with and without SMI receiving a GLP-1 prescription overall and by SMI diagnosis, GLP-1–indicating condition, and insurance type from 2018 to 2024. Models adjusted for SMI diagnosis, GLP-1 indication, comorbidity index, insurance type, sex, age, year, and state. The Weill Cornell Medicine institutional review board approved the study and waived informed consent because the data were deidentified. We followed the STROBE reporting guideline for cross-sectional studies. Statistical analysis was performed from August 2025 to May 2026 using Stata 18.5 (StataCorp). Two-sided P < .05 was considered statistically significant.
Results: The sample included 104 315 456 adults. Among the 14 187 676 with SMI, 14.0% had schizophrenia, 20.8% had bipolar disorder, and 65.2% had MDD. Mean (SD) age was similar among adults with (44.9 [18.4] years) and without (43.0 [17.9] years) SMI. More adults with SMI were female (66.2% vs 51.3%). Among people with SMI, 48.8% had commercial insurance, 11.7% had MA, and 43.4% had Medicaid Managed Care compared with 67.3%, 6.5%, and 28.3% among those without SMI. Prevalence of diabetes (among those with SMI: 22.4% vs those without SMI: 11.5% ), obesity (42.9% vs 21.8%), sleep apnea (17.0% vs 6.3%), and overweight plus another chronic condition (16.9% vs 8.7%) was higher among people with SMI. All differences were statistically significant.
During 2018 to 2024, 5.4% of people with and 2.1% without SMI received any GLP-1 prescription (results not shown). More adults with SMI and a GLP-1–indicating condition received any GLP-1 prescription (2.3% in 2018, 13.7% in 2024) relative to their counterparts without SMI (1.8% in 2018, 11.1% in 2024), with one exception (Figure 1). Among adults with diabetes, a lower proportion of those with schizophrenia (3.4% in 2018, 19.4% in 2024) received any GLP-1 relative to adults without SMI (4.5% in 2018, 23.1% in 2024).
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