Study highlights significant barriers to access for weight-loss medications for some groups

Access to weight-loss drugs is not always fair: ©Natalia - stock.adobe.com

Glucagon-like peptide-1 (GLP-1) receptor agonists, initially developed to manage diabetes, have rapidly gained popularity as effective weight-loss medications. Since the U.S. Food & Drug Administration approved these drugs for weight management in 2021, their use has soared among the public and celebrities alike. However, a study led by researchers at Boston University School of Public Health found significant disparities in access to these treatments.

Published in JAMA Network Open, the study analyzed national insurance claims data for over 97,000 commercially insured U.S. adults with obesity but without diabetes. The findings highlight stark inequities in who obtains prescriptions for semaglutide, influenced by factors such as insurance type, job industry, gender, and concurrent medication use.

Among non-diabetic individuals with obesity, those with point-of-service or preferred provider organization insurance coverage were more likely to access semaglutide than those with health management organization or exclusive provider organization plans. Women, individuals employed in the financial and real estate sectors, and those taking antidepressants or hormone-related medications also had higher rates of access compared to their counterparts.

“The paradigm for treating people with obesity has often been to recommend lifestyle changes, and then if they develop diabetes or another metabolic condition, to treat them with metformin, insulin, or GLP-1 drugs,” Andrew Stokes, senior author and associate professor of global health at Boston University. “However, emerging evidence suggests that due to biological resistance to weight loss and systemic external barriers, achieving sustainable lifestyle change can be challenging.”

Barriers to treatment

The study underscores systemic barriers preventing many from accessing GLP-1 medications for obesity. Currently, only 25% of employers offer insurance coverage for these drugs for weight management, despite most covering them for diabetes. Even when coverage is available, restrictive policies such as step therapy and prior authorization requirements further limit access.

Geography also plays a role. People living in the Northeast U.S. were more likely to start semaglutide than those in other regions. Additionally, individuals with the highest body mass index values (40 or above) were most likely to access the medication. This trend raises concerns about physicians restricting GLP-1 prescriptions to the most severe cases of obesity, despite FDA approval for use in individuals with BMIs of 30 or higher, or 27 with a comorbidity.

“There is a need for policymakers to recognize that factors unrelated to whether an individual has a medical necessity for treatment can affect whether or not a person is likely to receive these medications,” said lead author Meghan Podolsky, research fellow at Boston University. “Increasing access will require addressing the significant barriers to care, such as treatment cost, site of care, and the policies that insurance plans can implement.”

The study’s authors say they hope that their findings will inform policy changes to broaden insurance coverage for GLP-1 drugs across diverse demographic and socioeconomic groups. Katherine Hempstead, senior policy officer at the Robert Wood Johnson Foundation, emphasized the broader implications: “The substantial barriers to access to GLP-1s reflect existing inequities and poor alignment of incentives in our health care system. Research is needed to help illustrate the size and nature of access gaps so that we can design better coverage policies.”

The research team plans to continue studying inequities in GLP-1 access, including differences by race, ethnicity, and socioeconomic status.