Who Still Uses Liraglutide in 2026, and Why

Every head-to-head trial says the same thing. Weekly semaglutide beats daily liraglutide on weight. Weekly semaglutide beats it on A1C. Tirzepatide beats both. A 2026 network meta-analysis of 24 randomized trials put liraglutide 3.0 mg last for weight loss among the active treatments it compared [1].

So why did about 47,000 Medicare beneficiaries fill a generic liraglutide prescription in 2025 [2]?

Because effectiveness is not the only variable, and for a lot of Americans it is not even the binding one. This article walks through the four real reasons liraglutide is still being dispensed, using federal data rather than opinion.

This is not medical advice. It describes coverage, prices and labels. It does not tell you which drug to take.

How many people are actually still on liraglutide?

CMS publishes what Medicare Part D and state Medicaid programs pay for, drug by drug. The picture is clear.

In calendar 2025, generic liraglutide accounted for 195,236 Medicare Part D claims across 47,040 beneficiaries, totaling $92.1 million. In the first quarter of 2026 alone it accounted for 44,056 claims across 28,101 beneficiaries. Brand Victoza, by comparison, served 3,532 beneficiaries for its two-pen pack and 3,278 for its three-pen pack across all of 2025 [2].

That is not a drug disappearing. That is a drug where almost everyone moved to the generic.

The direction over time is just as clear. In 2023, before generics, Medicare Part D spent about $1.32 billion on brand Victoza. In 2024, the first generic year, brand spending fell to about $281 million and generic liraglutide picked up $48 million. Victoza three-pack beneficiaries fell from 142,213 to 62,754 in a single year [3].

On the Medicaid side, which does cover some weight-management drugs, states paid $38.4 million for Saxenda across 33,533 claims in 2024, down from $129.5 million in 2023, plus $31.0 million for generic liraglutide in its first partial year [4].

Reason one: it is the only GLP-1 with a generic

This is the single biggest reason, and it is a legal fact rather than a clinical one.

There is no generic Ozempic. There is no generic Wegovy. There is no generic Mounjaro or Zepbound. There is generic liraglutide, referencing both Victoza and Saxenda, from several manufacturers.

What that means in practice is substitution. When a prescription is written and a therapeutically equivalent generic exists, a pharmacy in most states can dispense it without going back to the prescriber. For every other GLP-1 on the US market, there is nothing to substitute with, so the brand price is the only price.

The gap is measurable in federal data. The National Average Drug Acquisition Cost is CMS’s survey of what US retail pharmacies actually pay wholesalers. In the file effective August 19, 2026, generic liraglutide was priced at $32.00 per mL for the three-pen carton (verified 2026-09-14), which works out to roughly $288 for a 30-day supply at the 1.8 mg diabetes dose. Brand Victoza was $87.81 per mL, about $790 for the same 30 days. Four weekly doses of Wegovy 2.4 mg came to roughly $1,306, four of Mounjaro 5 mg to roughly $1,077, and a 1 mg Ozempic pen, which holds four doses, to roughly $996 [5]. (Those are 28-day equivalents against liraglutide’s 30, so the weekly drugs are if anything understated here. All per-carton and per-month figures in this section are calculated by this site from CMS’s published per-mL rates and the labeled dosing; NADAC itself publishes only a per-mL price.)

Those are acquisition costs, not what a patient pays. But a cash price has to clear an acquisition cost, and that is why generic liraglutide keeps showing up as the cheapest GLP-1 on discount-card comparisons. What a patient actually pays is a much wider band: on the same day, cash and discount-card prices for a month of the diabetes generic ran from about $63 a pen with a SingleCare card to a GoodRx average retail price of $924 for a three-pen carton, and for the weight-management generic from about $372 to about $1,240 a carton depending on pharmacy and ZIP code [16][17].

At the weight-management dose the gap narrows. The generic five-pen carton was $47.69 per mL, about $715 for 30 days at 3 mg daily, against roughly $1,306 for four weekly doses of Wegovy [5]. Cheaper, but not the order-of-magnitude difference some people expect.

Reason two: some plans cover it when they will not cover the newer drugs

Formularies are not clinical rankings. They are negotiated lists, and a drug with generic competition behaves differently on them than a single-source brand.

Medicare Part D is the clearest case. It covers liraglutide for type 2 diabetes, which is why the Victoza-referenced generic appears in Part D claims at all. It has historically excluded drugs used only for weight loss, which is why Saxenda does not appear in Part D data while it does appear in Medicaid data [2][4].

Commercial plans vary enormously and this site cannot tell you what yours does. What the data shows is that liraglutide has survived formulary review in plans where the newer drugs did not, often as a step-therapy requirement: try the generic first, and if it does not work, the plan will consider the brand.

The American Diabetes Association’s 2026 Standards of Care also give liraglutide reasons to stay on a formulary beyond price. It is listed among the GLP-1 drugs with demonstrated cardiovascular benefit, among those with kidney endpoint benefit in cardiovascular outcome trials driven by albuminuria, and among those needing no dose adjustment for reduced kidney function, unlike exenatide and lixisenatide [6].

Reason three: children and teenagers

This one gets overlooked, and it is a real clinical reason rather than an economic one.

Victoza is labeled for type 2 diabetes in pediatric patients aged 10 years and older [7]. That indication rests on the Ellipse trial, which randomized 134 patients aged 10 to under 17, all on metformin with or without basal insulin, to liraglutide up to 1.8 mg daily or placebo. A1C fell 0.64 percentage points on liraglutide and rose 0.42 on placebo, an estimated treatment difference of 1.06 percentage points at 26 weeks that widened to 1.30 at 52 weeks [8].

Saxenda is labeled for chronic weight management in patients aged 12 years and older who weigh more than 60 kg and have obesity [9]. That rests on the SCALE Teens trial.

Both floors are lower than much of the class. When a pediatric endocrinology clinic needs an approved option for a 12-year-old, liraglutide is often the drug with a label that covers the patient in front of them.

There is one gap worth naming. The SCALE Kids trial tested liraglutide in children aged 6 to under 12 and reported positive results in 2024, but there is no FDA approval for that age group. The Saxenda label still starts at 12.

Reason four: it is what some people can tolerate, or afford to continue

This one is more complicated than the marketing on either side suggests.

The tolerability case for liraglutide is weaker than people assume. In STEP 8, gastrointestinal side effects were reported by 82.7% of the liraglutide group and 84.1% of the semaglutide group, which is essentially the same. What differed was who stayed: 27.6% of the liraglutide arm left the trial against 13.5% of the semaglutide arm [10]. The 2026 network meta-analysis reached a similar conclusion, finding liraglutide carried higher risks of any adverse event and of discontinuation due to adverse events than the newer drugs [1].

So “liraglutide is gentler” is not supported by the head-to-head evidence, and this site will not claim it.

What is real is the practical argument some patients make: a drug you can stay on for years at a price you can sustain may do more for you than a more effective drug you can afford for six months. Obesity treatment guidelines describe these medicines as long-term therapies. A daily drug you keep taking is a different proposition from a weekly drug your insurer stops covering in January.

A New England Journal of Medicine Perspective published in January 2026 by researchers at Harvard’s Program on Regulation, Therapeutics and Law made a version of this argument at the policy level, framing generic liraglutide as an underused route to affordable GLP-1 therapy and describing a potential cycle in which uptake pulls in more manufacturers, prices fall further, and access widens [11].

Is liraglutide actually a good diabetes drug, independent of price?

On the diabetes side the evidence is stronger than the weight-loss ranking suggests, and it comes from a trial Novo Nordisk did not fund.

GRADE was a National Institutes of Health study that randomized 5,047 US adults with type 2 diabetes of under 10 years’ duration, already on metformin, to add insulin glargine, glimepiride, liraglutide or sitagliptin, and followed them a mean of 5.0 years. Glargine and liraglutide were the two most effective at keeping A1C under 7%, at 26.5 and 26.1 events per 100 participant-years respectively, against 30.4 for glimepiride and 38.1 for sitagliptin. Severe hypoglycemia was lowest with sitagliptin at 0.7% and liraglutide at 1.0%. Liraglutide produced the most weight loss and the most gastrointestinal side effects of the four [12].

A companion paper found no meaningful differences between the four arms in kidney outcomes, neuropathy, major cardiovascular events or death, though a broader “any cardiovascular disease” analysis favored liraglutide with a hazard ratio of 0.7 (95% CI 0.6 to 0.9) against the other three combined, with confidence intervals not adjusted for multiple comparisons [13].

Five years, five thousand people, independent funding. That is a stronger evidence base than most drugs have, and it is why liraglutide never fell off diabetes formularies the way it fell off weight-management marketing.

What is happening to the brands?

Slowly, they are being retired. The FDA drug shortage database, in an entry revised August 25, 2026, lists brand Saxenda as limited availability with the note that the product will be available until discontinuation in January 2027, and both Victoza package sizes as limited availability because of a shipping delay, with the estimated duration listed as to be determined. The same entry lists the Teva-distributed authorized generic as available [14].

For most patients that matters less than it sounds. The generic is the product nearly everyone is already getting, and it is approved, marketed and unaffected by a brand discontinuation notice.

So should you be on it?

That is not a question this article can answer, and it is not one an article should. What it can do is lay out what the trade-off actually is.

Liraglutide loses on effectiveness. STEP 8 put average weight loss at 6.4% against 15.8% for weekly semaglutide over 68 weeks [10]. It loses on convenience, being a daily injection rather than a weekly one. It does not clearly win on side effects.

It wins on one thing: it is the only drug in this class where a generic exists, which means it is the only one where price competition is doing anything at all. Medicare Part D spending per generic liraglutide claim fell from $772.57 in 2024 to $471.98 in 2025 to $433.77 in the first quarter of 2026, as the number of manufacturers reporting claims rose from two to five [2][3].

Whether that matters for you depends on your coverage, your budget, your age, how you tolerated what you have tried, and what your prescriber thinks. Take this article to that conversation rather than instead of it.

Sources

1. Pałka W et al. Analysis of the efficacy and safety of liraglutide, semaglutide, and tirzepatide for the treatment of overweight and obesity: a systematic review and network meta-analysis. Journal of Endocrinological Investigation, 2026
2. Medicare Quarterly Part D Spending by Drug — liraglutide rows, CMS, retrieved 2026-09-14
3. Medicare Part D Spending by Drug, calendar year 2024 — liraglutide rows, CMS
4. Medicaid Spending by Drug, calendar year 2024 — liraglutide and Saxenda rows, CMS
5. NADAC (National Average Drug Acquisition Cost) 2026 — liraglutide, Victoza, Saxenda, Wegovy, Ozempic, Mounjaro and Zepbound records, CMS
6. 9. Pharmacologic Approaches to Glycemic Treatment: Standards of Care in Diabetes—2026. Diabetes Care 49(Suppl 1):S183–S215
7. VICTOZA (liraglutide) injection — prescribing information, DailyMed
8. Tamborlane WV et al. Liraglutide in Children and Adolescents with Type 2 Diabetes (Ellipse). New England Journal of Medicine, 2019
9. SAXENDA (liraglutide) injection, solution — prescribing information, DailyMed, revised 02/2026
10. STEP 8 Randomized Clinical Trial — JAMA, January 2022
11. Gondi S, Kesselheim AS, Rome BN. Generic Liraglutide — Overlooked but Not Forgotten. New England Journal of Medicine, 2026;394(2):107-110
12. GRADE Study Research Group. Glycemia Reduction in Type 2 Diabetes — Glycemic Outcomes. New England Journal of Medicine, 2022
13. GRADE Study Research Group. Glycemia Reduction in Type 2 Diabetes — Microvascular and Cardiovascular Outcomes. New England Journal of Medicine, 2022
14. FDA Drug Shortages — Liraglutide Injection, current shortage record, retrieved 2026-09-14
15. 8. Obesity and Weight Management for the Prevention and Treatment of Diabetes: Standards of Care in Diabetes—2026. Diabetes Care 49(Suppl 1):S166–S182
16. Liraglutide (Victoza) and Liraglutide (Saxenda) prices — GoodRx, retrieved 2026-09-14
17. Liraglutide prices — SingleCare, retrieved 2026-09-14