Health Equity and GLP-1 Access: A Review of the Disparities Literature
Among eligible patients with T2D and obesity, GLP-1 prescribing rates: 18.4% for non-Hispanic White patients, 9.6% for non-Hispanic Black patients. A systematic review of prescribing disparities, the insurance structural barrier, and what clinical trial enrollment data shows about representation.
GLP-1 receptor agonists represent a meaningful treatment advance for obesity and its comorbidities — but access to them is not distributed equitably. A growing body of research documents disparities in GLP-1 prescribing, adherence, and outcomes by race, ethnicity, insurance status, and geography. Here's what the literature shows.
Prescribing Disparities
Multiple analyses of insurance claims and EHR data find substantial racial and ethnic disparities in GLP-1 prescribing rates among eligible patients. A 2024 JAMA Health Forum analysis of 450,000 adults with type 2 diabetes and obesity found:
| Group | GLP-1 Prescribing Rate Among Eligible Patients |
|---|---|
| Non-Hispanic White | 18.4% |
| Hispanic/Latino | 11.2% |
| Non-Hispanic Black | 9.6% |
| Asian American | 13.8% |
These disparities persisted after adjustment for income, insurance type, and comorbidity burden — suggesting factors beyond insurance access, including prescriber behavior, clinical interaction quality, and patient-provider communication, contribute.
The Insurance Barrier
Insurance coverage is the primary structural barrier. Medicare Part D only began the demonstration coverage program in July 2026. Medicaid coverage for GLP-1 weight loss medications varies by state — 16 states cover GLP-1s for obesity specifically, 34 do not as of mid-2026. Commercial insurance coverage has expanded but often requires step therapy, prior authorization, and BMI documentation that creates administrative friction disproportionately affecting patients in resource-limited clinical settings.
Adherence and Outcome Disparities
Among patients who initiate GLP-1 treatment, adherence disparities also emerge. A retrospective cohort study of 48,000 patients found 12-month GLP-1 adherence rates of 72% in commercial insurance vs. 54% in Medicaid — controlling for clinical characteristics. Cost-sharing differences are the primary proposed mechanism; secondary factors include transportation to follow-up appointments and time off work for clinic visits.
Lower-cost compounded semaglutide has been argued as an equity tool — making GLP-1 treatment accessible to patients who cannot afford brand-name pricing. The FDA's proposed compounding restrictions (503B guidance, comment period closed June 2026) have generated specific equity criticism on these grounds. The counterargument from the FDA and brand manufacturers: compounded formulations lack the manufacturing quality standards of approved drugs, potentially creating safety disparities for the already-underserved populations they're intended to help.
Clinical Trial Representation
The pivotal STEP and SURMOUNT trials enrolled predominantly White, commercially insured North American and European participants. The STEP-1 trial population was 68.3% White, 10.4% Black, 17.1% Hispanic/Latino. Clinical trial efficacy in diverse real-world populations cannot be assumed to replicate trial results exactly — the interaction between ethnicity, genetic background, microbiome, baseline metabolic profile, and GLP-1 response is not fully characterized.
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Sources
- Eberly LA, et al. "Racial and Ethnic Disparities in GLP-1 Receptor Agonist Prescribing." JAMA Health Forum. 2024.
- Feldman CH, et al. "Insurance Coverage and GLP-1 Adherence." J Gen Intern Med. 2025.
- Wilding JPH, et al. "STEP-1 trial demographic supplement." NEJM. 2021.
- Kaiser Family Foundation. "State Medicaid Policies for GLP-1 Obesity Treatment Coverage." Updated June 2026.