Most adults who qualify for a GLP-1 for obesity never get one. In a national analysis of Epic health records covering 39 million eligible adults, only 2.3% were prescribed semaglutide or tirzepatide for obesity between June 2021 and October 2024 (Kim et al., JAMA, 2025 (external link)). That low number isn't spread evenly. Prescribing was lower for Hispanic (1.8%) and Asian (1.7%) patients than for White patients (2.4%), lower in the most socially vulnerable areas (1.9%) than the least (2.6%), and lower in rural areas (1.5%) than in cities (2.4%).
Where the gaps show up
Insurance is a big part of it. A Cleveland Clinic study of 50,678 adults with obesity found that only 8.0% were ever prescribed an anti-obesity medication and 4.4% filled a prescription. Patients on Medicaid or Medicare, Black and Hispanic patients, and people in the most deprived neighborhoods were less likely to get a prescription, and Hispanic patients and those on Medicaid or Medicare were also less likely to fill one (Gasoyan et al., Diabetes, Obesity and Metabolism, 2024 (external link)).
Coverage doesn't close every gap. In the Veterans Health Administration, where drug coverage is uniform, Black and Asian veterans still had 26% and 34% lower odds of a GLP-1 prescription than White veterans (Stein et al., Health Affairs Scholar, 2026 (external link)). But one study points the other way: in a university staff HMO at Yale, where everyone had the same coverage and the same clinics, there were no racial, ethnic or socioeconomic differences in prescribing (Chen et al., Journal of General Internal Medicine, 2025 (external link)). Taken together, the studies suggest that how care is organized and paid for matters a great deal, and that where it's uniform, gaps can shrink.
What drives the differences
- Your employer. As our guide on employer self-funded plan decisions explains, whether GLP-1s are covered often comes down to your employer's choice, and bigger employers are far more likely to cover them. In KFF's 2025 survey, 43% of firms with 5,000 or more workers covered GLP-1s for weight loss, compared with 16% of firms with 200 to 999 workers (KFF 2025 Employer Health Benefits Survey (external link)).
- Paying out of pocket during gaps. Even when coverage comes through eventually, prior authorization delays or temporary denials often mean paying yourself or using a manufacturer program such as LillyDirect or NovoCare for a while. Not everyone can.
- Finding a prescriber. Primary care access varies by region and insurance type, and places with few clinicians who manage obesity medications create a bottleneck even for people who have coverage. The rural numbers above fit that pattern.
- Time and paperwork. Prior authorization, appeals and formulary research (see our guide on checking your formulary) take time, persistence and comfort with bureaucracy, and not everyone has those to spare.
- Older patterns of unequal care and trust. For some communities, the GLP-1 gap is the latest version of long-standing differences in access to care and trust in it.
What's being done, and what you can do
Researchers are tracking these patterns in national data, the VA and single health systems, like the studies above. Some patient advocacy organizations use this kind of data in policy arguments (see the role of patient advocacy organizations).
On your own, you can share your experience (see sharing your story), support organizations that work on equity in obesity care, and raise coverage gaps with your employer or with lawmakers. The Yale finding is a useful point to bring up: when coverage and care are the same for everyone, the prescribing gap can disappear.
Study findings above are attributed to their authors and were located via PubMed.
This article is general education, not medical, legal, or insurance advice. Coverage rules, appeal rights, and policy details vary by plan and location and change over time. Confirm specifics with your plan, prescriber, or a qualified advisor.