If you've paid attention to health news over the past two years, you might assume everyone who wants a GLP-1 medication has one. Ozempic has become a household name. Celebrities discuss their weight loss openly. Shortages made national news. Surely these drugs are everywhere.
The reality tells a different story. According to research published using Epic Cosmos data—representing 39 million clinically eligible American adults—only 887,110 people (2.3%) had received a GLP-1 prescription for weight management. That means 97.7% of Americans who meet clinical criteria for these medications aren't getting them.
This is the most important GLP-1 statistic you've probably never seen. While market capitalization numbers grab headlines and celebrity weight loss drives social media engagement, the treatment gap reveals an ongoing public health crisis hidden in plain sight.
What Does "Clinically Eligible" Mean?
The 39 million figure comes from applying standard medical criteria for GLP-1 prescriptions. Generally, patients qualify if they have:
BMI ≥ 30 (obesity), OR
BMI ≥ 27 (overweight) with at least one weight-related condition such as:
Type 2 diabetes, hypertension, dyslipidemia, cardiovascular disease, sleep apnea, fatty liver disease, or other obesity-related comorbidities
Using these criteria, approximately 39 million American adults qualify for GLP-1 medications based on their medical records. Some estimates put the broader eligible population even higher—100 million or more when including those who might benefit but haven't been formally diagnosed with comorbidities.
The 2.3% treatment rate means that for every person taking a GLP-1 for weight management, roughly 43 qualified people are not. Despite the drugs' proven efficacy and the clinical evidence supporting their use, the vast majority of potential beneficiaries remain untreated.
The Five Barriers Blocking Access
Understanding why 97.7% of eligible patients aren't receiving treatment requires examining the obstacles between patients and prescriptions.
The Geographic Divide
The treatment gap isn't uniform across the country. Where you live dramatically affects your likelihood of receiving a GLP-1 prescription.
| State | Rx Rate per 1,000 | Comparison |
|---|---|---|
| Kentucky (Highest) | 20.7 | Baseline |
| West Virginia | 18.2 | 12% lower |
| Tennessee | 16.8 | 19% lower |
| National Average | ~10 | 52% lower |
| New York | 6.2 | 70% lower |
| Rhode Island (Lowest) | 3.7 | 82% lower |
Kentucky's prescription rate is five times higher than Rhode Island's. A patient with identical BMI and health conditions is dramatically more likely to receive treatment depending on which state line they happen to live on.
These disparities reflect differences in insurance coverage policies, provider practice patterns, state regulations, and cultural attitudes toward weight management medications. They also suggest that the treatment gap could narrow significantly if barriers were addressed uniformly.
The Demographic Disparities
Geography isn't the only dividing line. Who you are significantly affects your access to GLP-1 medications.
Income creates even starker divisions. Patients earning $250,000 or more annually are 72% more likely to use GLP-1 medications than lower-income individuals. This reflects both insurance coverage differences and ability to pay out-of-pocket when coverage is denied.
The income disparity has shaped public perception. KFF polling found that 70% of Americans believe GLP-1 medications are only accessible to wealthy people. For medications addressing a condition that disproportionately affects lower-income populations, this represents a significant equity failure.
Gender gap: Women 60% more likely to receive Rx than men
Income gap: High earners ($250K+) 72% more likely than lower income
Geographic gap: 5x difference between highest and lowest states
Public perception: 70% believe access limited to wealthy
The Insurance Coverage Problem
Insurance coverage—or its absence—is the single largest driver of the treatment gap. The landscape is frustratingly inconsistent:
Medicare: Does not cover GLP-1 medications for obesity (weight loss indication). Coverage is available for type 2 diabetes indication, creating an incentive to pursue diabetes-related prescriptions even when weight management is the primary need. Proposed legislation would change this, but passage remains uncertain.
Medicaid: Coverage varies dramatically by state. Some state Medicaid programs cover obesity medications; many do not. This creates gaps precisely among populations most likely to have obesity and related health conditions.
Employer insurance: Coverage depends entirely on plan design. Estimates suggest 40-50% of employer plans now offer some GLP-1 coverage, but with significant restrictions (prior authorization, step therapy, quantity limits) that reduce effective access.
Individual/ACA plans: Coverage varies by insurer and plan level. Many exclude obesity medications entirely as "lifestyle" treatments.
What Closing the Gap Would Mean
If the 97.7% of untreated eligible patients received GLP-1 medications, the public health implications would be enormous. Modeling studies project:
Cardiovascular events prevented: 500,000+
New diabetes cases avoided: 2+ million
Deaths prevented: 300,000+
Healthcare cost savings: $50-100 billion annually
These projections extrapolate from SELECT trial results (20% cardiovascular risk reduction, 73% diabetes prevention, 19% mortality reduction) across the full eligible population. Even if real-world results prove more modest than trial findings, the potential impact remains transformative.
Signs of Progress
The situation isn't static. Several developments suggest the treatment gap may begin narrowing:
Manufacturing expansion: The $70+ billion invested by Eli Lilly and Novo Nordisk in manufacturing will eventually increase supply, reducing shortage-driven access barriers.
Oral formulations: The December 2025 approval of oral Wegovy may reduce hesitancy among patients uncomfortable with injections, potentially expanding the willing patient pool.
Employer coverage growth: Under pressure from employees and facing evidence of healthcare cost savings, more employers are adding GLP-1 coverage to their health plans.
LillyDirect and similar programs: Direct-to-consumer programs that bypass traditional pharmacy channels at reduced prices (Lilly offers Zepbound vials at $399-549/month to anyone, including those on Medicare/Medicaid) create new access pathways.
Policy momentum: Multiple pieces of federal legislation propose Medicare coverage for obesity medications. While passage is uncertain, political attention to the issue is increasing.
What You Can Do
If you believe you might benefit from GLP-1 medications but haven't explored your options, several pathways exist:
Check your insurance: Coverage may exist even if you're not aware of it. Contact your insurer directly to ask about GLP-1 coverage for obesity or weight management.
Talk to your doctor: Many providers don't proactively discuss weight management medications. Raising the topic yourself may open a conversation that wouldn't otherwise happen.
Explore manufacturer programs: Both Novo Nordisk and Eli Lilly offer savings programs, patient assistance programs, and direct-purchase options that can dramatically reduce costs for eligible patients.
Consider telehealth: Online providers specializing in weight management often have streamlined processes for evaluation, prescription, and medication access.
Know your options: Multiple GLP-1 medications exist, and different options may have different coverage under your insurance. If one drug isn't covered, another might be.
Don't Be Part of the 97.7%
Explore your options with trusted providers who can help navigate insurance, costs, and access pathways.
Compare ProvidersThe Bottom Line
The 97.7% treatment gap represents one of the great disconnects in modern medicine: treatments proven to reduce heart attacks, prevent diabetes, and extend life remain inaccessible to the vast majority of people who could benefit from them.
This isn't a problem of science—the evidence is overwhelming. It's a problem of systems: insurance design, healthcare economics, provider behavior, and societal attitudes about weight. Until these systems change, tens of millions of Americans will continue living without access to treatments that could transform their health.
The headlines focus on $1 trillion market caps and celebrity transformations. But the real story of GLP-1 medications lies in that stark number: 97.7%. Almost everyone who could benefit isn't benefiting. And that's a problem worth solving.
Last updated: January 2026. Statistics from Epic Cosmos research, KFF polling, and peer-reviewed publications.