Unequal Access to GLP-1 Medications: The Stark Reality for Obesity Care in the U.S.

Introduction:

Despite their game-changing role in obesity and cardiometabolic disease management, GLP-1 receptor agonists remain out of reach for the vast majority of eligible Americans. A recent study analyzing data from over 277 million electronic health records reveals that fewer than 3% of qualifying patients with obesity received these therapies. Even more concerning are the stark disparities based on sex, race, socioeconomic status, and geography. The problem, however, appears rooted not in clinical inertia but in systemic access barriers.

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The Study: A National Lens on Prescribing Trends

Published in JAMA in May 2025, the research by Chungsoo Kim, PharmD, PhD, and colleagues at Yale School of Medicine, analyzed over 39 million U.S. adults with obesity but no type 2 diabetes using the Epic Cosmos Dataset, one of the largest collections of EHR data in the nation.

• Eligibility Criteria: Adults with BMI ≥30 kg/m² or BMI ≥27 kg/m² with one obesity-related comorbidity.

• Study Window: July 2020 to October 2024.

• GLP-1 Agents Tracked: Semaglutide (Wegovy) and Tirzepatide (Zepbound).

Key Findings:

• Only 2.3% (887,110) of eligible patients received a GLP-1 prescription.

• Those prescribed were generally younger (mean 47.3 years) and had a higher BMI (mean 39.0 kg/m²) than those not treated.

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Disparities in Access: Who Is Being Left Behind?

The study uncovered consistent and troubling disparities in prescribing patterns:

1. Gender Disparities

• Women were 2.5 times more likely to be prescribed a GLP-1 agonist than men (3.0% vs 1.2%).

2. Racial and Ethnic Inequities

• Non-Hispanic White: 2.4%

• Non-Hispanic Black: 2.3%

• Hispanic: 1.8%

• Non-Hispanic Asian: 1.7%
  The lower rates among racial and ethnic minorities suggest systemic barriers beyond provider bias, including insurance coverage, affordability, and awareness.

3. Socioeconomic and Geographic Gaps

• Patients in rural regions: 1.5%

• Patients in urban regions: 2.4%

• Those in highly vulnerable socioeconomic areas: 1.9%

• Those in less vulnerable areas: 2.6%

The growth in prescription rates over time was concentrated in metropolitan, affluent areas, with minimal gains in rural or socially disadvantaged communities.

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Not a Physician Problem—It’s a System Problem

Interestingly, clinician access was not the limiting factor. Patients who eventually received a GLP-1 prescription had, on average, five clinical encounters in the preceding year, suggesting that provider interaction alone does not account for the underutilization.

Instead, cost and insurance coverage emerged as key drivers of disparity. The high out-of-pocket price of GLP-1 drugs—often exceeding $1,000 per month—and inconsistent insurance approvals create formidable barriers, especially for marginalized groups.

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Beyond Obesity: Expanding Clinical Promise of GLP-1s

GLP-1 receptor agonists have demonstrated benefit not only in weight loss and glycemic control but also in cardiovascular outcomes, heart failure, atrial fibrillation, and even obstructive sleep apnea. As evidence grows, equitable access becomes not just a health equity issue but a cardiovascular prevention imperative.

Learn more about GLP-1 clinical applications in obesity and cardiometabolic health from the American Diabetes Association and the American Heart Association.

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Conclusion: Call to Action

The glaring gap in GLP-1 utilization reflects deep-rooted systemic inequities, not clinical oversight. As policy evolves and new data emerge, stakeholders—health systems, payers, policymakers, and pharma—must prioritize strategies to expand affordability, coverage, and geographic reach.

Ensuring fair access to life-changing therapies like GLP-1s is not just a matter of good medicine—it’s a matter of health justice.

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Key Takeaways for Clinicians

• Fewer than 3% of eligible U.S. patients with obesity received GLP-1 drugs from 2020 to 2024.

• Significant disparities were seen by sex, race/ethnicity, and geography, independent of provider access.

• Men, minority groups, rural dwellers, and socioeconomically vulnerable populations had markedly lower access.

• Cost and insurance coverage, not physician bias, are the primary barriers.

• As GLP-1 agents show benefit across multiple cardiometabolic diseases, ensuring equitable access is vital to maximizing their public health impact.