If you live in Kentucky and meet clinical criteria for GLP-1 medications, your chances of actually receiving a prescription are five times higher than if you live in Rhode Island. Same medical need. Same proven medications. Dramatically different access—determined not by health but by geography.
This 5x gap between the highest and lowest prescribing states reveals a fundamental inequity in how GLP-1 medications reach patients. While national headlines focus on drug shortages and celebrity usage, the quieter story is who gets access and who doesn't—and how zip code, income, and gender shape medical treatment.
The State-by-State Reality
Research analyzing prescription data across all 50 states reveals striking variation in GLP-1 prescribing rates. The differences aren't subtle—they represent fundamentally different healthcare environments for patients with identical conditions.
Kentucky's rate of 20.7 prescriptions per 1,000 residents makes it the highest-prescribing state in the nation. Rhode Island, at 3.7 per 1,000, sits at the bottom. That gap—20.7 vs. 3.7—represents a 5.6x difference in prescription rates for the same medications.
| State | Rx per 1,000 | Rank |
|---|---|---|
| Kentucky | 20.7 | #1 (Highest) |
| West Virginia | 18.2 | #2 |
| Tennessee | 16.8 | #3 |
| Alabama | 15.9 | #4 |
| Louisiana | 15.4 | #5 |
| — National Average: ~10 — | ||
| Massachusetts | 5.8 | #46 |
| New York | 6.2 | #45 |
| Vermont | 4.9 | #48 |
| Hawaii | 4.2 | #49 |
| Rhode Island | 3.7 | #50 (Lowest) |
The Pattern Behind the Numbers
The geographic distribution isn't random. Several patterns emerge from the state-level data:
Southern and Appalachian states prescribe more. Kentucky, West Virginia, Tennessee, Alabama, and Louisiana—states with the highest obesity rates in the nation—also have the highest GLP-1 prescription rates. This makes clinical sense: higher disease burden should mean more treatment.
Northeastern states prescribe less. Rhode Island, Vermont, Massachusetts, and New York cluster at the bottom despite having sophisticated healthcare systems and high physician density. Lower obesity rates explain part of this gap, but not all of it.
The correlation isn't perfect. Some high-obesity states (like Mississippi) don't prescribe at rates matching their disease burden. Some lower-obesity states (like Colorado) prescribe more than expected. Regional healthcare culture, insurance markets, and provider practice patterns all contribute.
Why Geography Matters
The factors driving geographic variation illuminate broader issues in healthcare access:
Insurance coverage: State Medicaid policies vary—some cover GLP-1s, many don't
Provider patterns: Regional prescribing cultures differ substantially
Specialist availability: Endocrinologist and obesity medicine specialist density varies
Employer insurance: Regional employer plan designs affect coverage
Patient awareness: Cultural attitudes toward weight loss medication differ by region
Consider two patients with identical BMIs and health conditions. One lives in Louisville, Kentucky; one lives in Providence, Rhode Island. The Louisville patient is five times more likely to receive a GLP-1 prescription—not because they're sicker or medications are more appropriate, but because of where they happen to live.
The Gender Gap
Geography isn't the only axis of disparity. Gender creates equally significant differences in GLP-1 access.
The gender disparity has multiple potential explanations:
Healthcare seeking behavior: Women visit doctors more frequently than men, creating more opportunities for GLP-1 conversations and prescriptions.
Social acceptability: Cultural norms may make weight loss medication use more acceptable for women than men, affecting both patient requests and provider recommendations.
Marketing exposure: GLP-1 marketing and media coverage may reach women more effectively, driving differential awareness and demand.
Provider bias: Physicians may be more likely to discuss weight with female patients than male patients, reflecting broader patterns in how weight is addressed across genders.
The Income Divide
Perhaps the starkest disparity involves income. Patients earning $250,000 or more annually are 72% more likely to use GLP-1 medications compared to lower-income individuals.
This gap reflects multiple barriers:
Insurance coverage: Higher-income individuals more often have employer insurance that covers GLP-1s. Lower-income individuals may have Medicaid (which often excludes coverage) or no insurance at all.
Out-of-pocket costs: Even with insurance, copays and cost-sharing can reach hundreds of dollars monthly. Higher earners can absorb these costs; lower earners cannot.
Cash-pay options: Programs like LillyDirect ($399-549/month for Zepbound) make medications available without insurance—but only to those who can afford several hundred dollars monthly.
Healthcare access: Higher-income individuals more frequently have primary care relationships where GLP-1 conversations might occur.
The Equity Paradox
The income disparity creates a troubling paradox: obesity rates are highest among lower-income populations, but GLP-1 access is lowest in those same groups.
Research consistently shows that obesity prevalence increases as income decreases. Food insecurity, limited access to healthy foods, fewer safe places for physical activity, and other socioeconomic factors contribute to higher obesity rates among lower-income Americans.
If GLP-1 medications represent effective obesity treatment—which evidence confirms they do—then the people who most need them are least able to get them. The 72% income gap means that the burden of untreated obesity concentrates among those already facing socioeconomic disadvantages.
The Public Perception
These disparities shape how the public views GLP-1 medications. When most visible users are celebrities and affluent early adopters, the drugs become associated with privilege rather than medical treatment.
KFF polling revealed widespread skepticism about access:
70% believe GLP-1s are mainly accessible to wealthy people
65% express concerns about medication costs
58% believe insurance coverage is inadequate
Many view GLP-1s as "luxury" treatments rather than necessary medicine
This perception matters because it affects policy debates. If GLP-1s are viewed as lifestyle drugs for the wealthy rather than medical treatments for a chronic disease, political will to expand access diminishes. The disparities themselves reinforce narratives that make closing the gaps harder.
What's Driving Change
Despite current disparities, several factors are gradually improving access:
Employer coverage expansion: More employers are adding GLP-1 coverage under competitive pressure to attract and retain workers. As coverage becomes standard in some sectors, expectations spread.
Direct-to-consumer programs: Manufacturer programs like LillyDirect offer reduced cash-pay prices, creating options outside traditional insurance. While still expensive, $399/month is more accessible than $1,000/month list price.
Compounding alternatives: During shortages, compounding pharmacies provided lower-cost GLP-1 alternatives. While FDA-unapproved and quality-variable, these options expanded access for price-sensitive patients.
Telehealth democratization: Online prescribing services make GLP-1 consultations available regardless of location. Patients in low-prescribing states can access providers more likely to recommend treatment.
Clinical evidence accumulation: As cardiovascular and mortality benefits become established, arguments for insurance coverage strengthen. Evidence-based medicine may eventually overcome coverage resistance.
The Policy Implications
The geographic and demographic disparities highlight policy questions:
Should Medicare cover GLP-1s? Currently prohibited by statute, Medicare coverage would immediately improve access for 65 million Americans—disproportionately helping lower-income seniors currently excluded.
Should Medicaid coverage be standardized? State-by-state variation in Medicaid coverage contributes to geographic disparities. Federal standards could create more uniform access.
How should pricing be addressed? High list prices are the root cause of income-based access gaps. Policy options range from negotiation to importation to reference pricing.
Should anti-discrimination rules apply? If GLP-1 access varies by protected characteristics (gender, potentially race), civil rights frameworks might be relevant to coverage decisions.
What You Can Do
Understanding disparities is useful; navigating them is essential. If you face access barriers:
Explore all coverage options. Check your specific insurance plan's formulary—coverage varies even within the same insurer. Some plans cover certain GLP-1s but not others.
Ask about manufacturer programs. Novo Nordisk and Eli Lilly both offer savings cards, patient assistance programs, and direct-purchase options. Eligibility varies but programs exist.
Consider telehealth providers. Online services may prescribe more readily than local providers in low-prescribing regions. Compare multiple options.
Appeal denials. If insurance denies coverage, appeal with clinical documentation. Prior authorization denials are often reversed on appeal.
Advocate for coverage. Contact employers about plan design, legislators about policy, and insurers about coverage decisions. Access improves when patients demand it.
Location Shouldn't Limit Your Options
Telehealth providers offer GLP-1 access regardless of where you live. Compare your options.
Compare ProvidersThe Bottom Line
The 5x gap between Kentucky and Rhode Island represents more than a statistical curiosity—it reveals how healthcare access depends on factors that have nothing to do with medical need. Add the 60% gender gap and 72% income gap, and a picture emerges of GLP-1 medications as treatments that reach some Americans far more than others.
These disparities aren't inevitable. They result from policy choices, market structures, and healthcare system design. Other countries have found ways to provide more uniform access to medications. The U.S. could do the same—if the political will existed.
For now, patients navigate a system where zip code, gender, and bank account influence whether they receive medications proven to reduce heart attacks, prevent diabetes, and extend life. The science of GLP-1 medications is universal; the access is anything but.
Until that changes, the 5x gap remains not just a number, but a measure of how far we have to go.
Last updated: January 2026. Prescription data from Epic Cosmos research, KFF polling, and state-level healthcare analysis.