Access to GLP-1 Drugs Unequal for US Patients With Obesity

Fewer than 3% of eligible people with obesity in the United States receive prescriptions to glucagon-like peptide-1 (GLP-1) receptor agonists, with differences in access seen by sex, race/ethnicity, and where the patients live, new real-world data suggest.

The study, led by Chungsoo Kim, PharmD, PhD (Yale School of Medicine, New Haven, CT), was published as a research letter this week in JAMA.

Senior author Yuan Lu, ScD (Yale School of Medicine), told TCTMD that the data confirm—on a large scale—that “the adoption of this new medication [class] is really slow in clinical practice.”

Yet even within this larger phenomenon of low uptake, “we clearly identify some groups that are left behind,” she added.

Lu said it will be important to continue to track these trends over time. GLP-1 drugs are being studied across a multitude of disease states, not only cardiometabolic conditions like diabetes and obesity but also sleep apnea, atrial fibrillation, and heart failure. “So we’re also looking into patient subgroups that are demonstrating benefits in the trial to see what the adoption [is like] in real life,” she reported.

We clearly identify some groups that are left behind. Yuan Lu

For the current study, Kim and colleagues turned to the Epic Cosmos Dataset, which contains 277 million electronic health records from more than 280 US healthcare systems. They identified 39 million adults without type 2 diabetes who had either a body mass index (BMI) ≥ 30 kg/m2 or a BMI of ≥ 27 kg/m2 plus at least one obesity-related comorbidity.

Just 887,110 (2.3%) of these individuals received a prescription for semaglutide or tirzepatide between July 2020 and October 2024. Patients prescribed a GLP-1 drug tended to be younger than those not given one of the medications (mean 47.3 vs 51.9 years) and had higher BMI (mean 39.0 vs 34.2; P < 0.001 for both comparisons).

Men were approximately 60% less likely to get a prescription than were women (1.2% vs 3.0%). Non-Hispanic white patients were the most likely to be prescribed a GLP-1 receptor agonist (2.4%), with significantly lower rates seen among non-Hispanic Black (2.3%), Hispanic (1.8%), and non-Hispanic Asian patients (1.7%).

People who lived in the most socially vulnerable areas based on factors like poverty and housing quality were less likely to get a GLP-1 script (1.9% vs 2.6% in those in the least vulnerable areas), as were those who lived in rural areas (1.5% vs 2.4% of those in cities).

While prescription rates grew over the years, the greatest increases were seen in metropolitan and less socially vulnerable areas. Notably, drug shortages did not appear to play a role in the sex, racial/ethnic, or socioeconomic disparities.

“These findings highlight the need to monitor evolving prescribing patterns and explore strategies that ensure equitable access to these therapies as the evidence, policy, and reimbursement landscape evolves,” the investigators conclude, noting that the disparities likely reflect barriers at the system and patient levels, where eligibility, insurance coverage, and financial factors could be prohibitive.

Yet the problem does not appear to be at the clinician level—patients prescribed a GLP-1 receptor agonist had, on average, five clinical encounters in the year prior to receiving their prescriptions. “Physician bias in prescribing: that would not be a major [barrier],” Yu confirmed. Financial factors like whether an individual patient’s insurance will cover the drug or whether they can afford to pay out of pocket are a larger driver, she said.