Weight loss drugs such as Ozempic have exploded in popularity because they treat obesity so well.
Some of the biggest names in business and entertainment, from Oprah to Elon Musk, have sung their praises, and between 2019 and 2022, the number of nondiabetic adults with prescriptions for them rose from 1.3 million to more than 7 million – an increase of more than 400%.
After Ozempic's rise to fame, several other players raced to enter the market. In 2021, the FDA approved Wegovy, a higher-dose version of semaglutide, to treat obesity. Mounjaro was approved for type 2 diabetes in 2022, and Zepbound, which contains tirzepatide, the same active ingredient as in Mounjaro, was approved in 2023.
But as the popularity of the drugs skyrocketed, so too did issues of accessibility. Barriers to access include cost, availability, and socioeconomic disparities. Because of them, many of those who need them the most can't get the drugs.
Why Has Ozempic Become a Household Name?
After Ozempic (semaglutide) was approved by the FDA in 2017 to treat type 2 diabetes, it wasn't long before the public caught onto one of the drug's key side effects: weight loss.
Ozempic is sold as an injection and is a synthetic version of glucagon-like peptide-1, a hormone the body produces that helps regulate blood sugar, appetite, and digestion. It is in a class of drugs called GLP-1 receptor agonists, also known as GLP-1s.
By 2024, a KFF poll found that 82% of U.S. adults had heard at least a little about GLP‑1s, and about 12% of adults in the U.S. had taken one.
The Cost of Accessing Ozempic
Despite their popularity, the price of GLP‑1 treatments remains high and out of reach for many people without insurance. Even those with insurance may not be able to get approval for coverage under their plan.
In a 2024 survey, about half of all adults who had taken a GLP-1 drug said it was difficult to afford. One in five said it was very difficult. While most insured adults who had taken these drugs said their insurance covered at least part of the cost, even among insured adults, about half said the cost was still difficult to afford.
This is due partly to gaps in insurance coverage. Many insurance companies will cover the drugs as a treatment for diabetes but not for obesity. A 2025 survey found that 57% of employers provided coverage for GLP-1s for diabetes only; only 34% provided coverage for both diabetes and weight loss. That was an increase of over 49%, and 26% in 2023, respectively. Medicare also limited coverage of the drugs to treat diabetes or heart disease but not to treat obesity.
That means that many patients – especially those seeking weight loss treatment – had to pay for the drugs in cash.
Without insurance, a 28‑day supply of brand-name GLP-1s like Ozempic, Wegovy, and Mounjaro costs about $1,000 a month.
To help offset this cost, some players in the industry began to offer the injectables at a lower price directly to consumers, cutting out the middle man entirely.
In early 2025, Eli Lilly and Co. began offering its Zepbound at a price of between $349 and $699 for a one-month supply, depending on dosage. Novo Nordisk has a similar program, offering Wegovy for $499 per month.
But this may still be too costly for many consumers.
Enter compounds. A loophole of sorts allowed pharmacies to sell custom-made versions of the drugs prepared by a pharmacist for as low as $199 a month. The catch? Instead of arriving as a prefilled pen that auto-injects the correct dose, the drugs come in vials, and patients must measure out the correct dosage before they inject themselves.
Compounds also come with health risks, as they're not regulated by the FDA, said HaVy Ngo-Hamilton, PharmD, a clinical pharmacist and senior pharmacy director at BuzzRx.
"There's always a chance that you're not getting exactly what it says on the label," she said. "You may be getting more or less of the active ingredient, and impure ingredients can get into the compounding process and cause harm to you."
Due to the medication shortage, the FDA temporarily allowed companies to sell compounds, but in April, the agency removed semaglutide from its shortage list, making it once again illegal to sell the medication as a compound.
"For all these people who were getting really affordable medications … that option has gone away for them," said Alicia Graham, chief operating officer and co-founder of Claimable, an organization that appeals denied insurance claims on behalf of patients.
Still, some experts in the industry think prices are likely to fall, especially if more indications are added, which Graham said she thinks will happen soon. Emerging research suggested these drugs can be used to treat many different diseases, including polycystic ovary syndrome, nonalcoholic steatohepatitis, and even Alzheimer's disease.
"We're going to see a big expansion of who prescribes [GLP-1s]. … Lots and lots of people are going to be eligible for these medications," Graham said.
The cost of GLP-1s is difficult to predict, but patients overall are going to pay less for brand-name versions than they have previously, said George Huntley, founding member and CEO of the Diabetes Leadership Council and its affiliate, the Diabetes Patient Advocacy Coalition.
"I think the list price of these drugs is about to go up precipitously, and the net price of these drugs are going to drop," he said.
This means that though the price insurers pay for GLP-1s may increase, the end price to consumers will decrease after all discounts or coupons have been applied.
Limited Availability for Ozempic
Beyond costs, the supply of GLP-1s has been anything but consistent.
In early 2024, the number of active drug shortages in the U.S. reached 323, marking an all-time high since tracking began in 2001. Among the drugs listed were GLP-1s, which had been hit by shortages and supply chain issues since March 2022, when the FDA added Wegovy to its shortage list, followed by Ozempic in August.
That shortage lasted until February 2025, when the agency declared that supply met or exceeded national demand. This was also when the FDA said compounds were no longer permitted.
During this nearly three‑year gap, pharmacies scrambled to keep up with increasing demand. A 2023 congressional report found many pre-existing drug shortages were made worse by the COVID-19 pandemic. It also said these shortages were due to "economic drivers, insufficient visibility into supply chains, increased demand and our nation's continued overreliance on foreign suppliers for many of the raw materials used to manufacture critical drugs."
Also, counterfeit Ozempic units surfaced, prompting warnings from the FDA and Novo Nordisk to carefully verify lot and serial numbers.
Social and Economic Disparities
Supply issues aside, access to the medications may also be influenced by a patient's socioeconomic background.
A 2024 study found that nonwhite patients were much less likely to receive GLP‑1 prescriptions, despite many in this population being at higher risk of type 2 diabetes and obesity.
This could lead to a cycle of poorer health and care for the rest of a patient's life. In fact, Huntley said putting patients with prediabetes on GLP-1s for weight loss often prevented them from getting type 2 diabetes altogether.
"It pretty much eliminates type 2 diabetes," he said.
Tirzepatide, which is sold as Mounjaro for diabetes and Zepbound for obesity, has been shown to reduce the risk of developing type 2 diabetes by 94% in adults with prediabetes who are overweight or obese, according to the drug's maker, Eli Lilly and Co.
While this has the biggest effect on patients' quality of life, each patient who isn't diagnosed with diabetes could also save insurance companies thousands. The American Diabetes Association said the average cost of health care for a person with diabetes was $16,752 a year – more than twice the cost of health care for a person without diabetes.
Reduced access could also be due to income. A 2025 study found that higher-income ZIP codes saw more prescriptions, regardless of medical need. And 40% of GLP-1s approved by the FDA for diabetes were prescribed off-label to patients not diagnosed with diabetes. Areas with higher incomes had higher rates of off-label prescriptions, while areas with lower incomes and higher social risk had fewer.
An increase in off-label prescriptions pointed to providers beginning to treat obesity as a disease instead of just a symptom, Huntley said.
"We're beginning to treat [obesity] as a disease, which is great, but we're not actually getting it to the populations that need it the very most, and that is very unfortunate," he said.
Addressing Access and Equity
As of 2025, most insurers offer restricted coverage for GLP-1s, meaning a company may cover only part of the cost or a patient may need a prior authorization for the medicine to be covered. Prior authorization is a review process in which a health care provider or patient needs to get approval from an insurance company before providing or receiving certain medical services.
The process of communicating with an insurance company, submitting information for prior authorization, and appealing the decision can be time-consuming and tedious. A survey published in December 2024 found that 89% of health care providers who prescribed weight loss medications struggled to get prior authorization from insurance companies.
This could cause some doctors to stop prescribing GLP-1s altogether, Graham said: "A lot of practices are saying, 'I just can't afford to prescribe these drugs. I can't afford to appeal [the decisions]. I can't afford to support patients.' "
Medicaid and Medicare have historically covered GLP‑1 medications when prescribed for diabetes or heart disease. But until recently, both programs excluded GLP‑1s when used solely for obesity because of long-standing federal rules that classified weight loss drugs as lifestyle treatments, not medical necessities.
In November 2024, the Biden administration proposed a change, redefining obesity as a chronic disease deserving treatment coverage. The Centers for Medicare and Medicaid Services released a fact sheet outlining plans to require Medicare and Medicaid Part D plans to cover FDA-approved GLP‑1s for obesity treatment.
But in April, the CMS reversed course and decided not to finalize the Biden-era proposal. Under the Trump administration's CMS Director Mehmet Oz and Health and Human Services Secretary Robert F. Kennedy Jr., the agency removed GLP‑1s for obesity treatment from the 2026 Medicare Advantage and Part D rule. The decision excluded obesity use, leaving about 7.5 million people without coverage.
As for prior authorizations, the CMS reported on June 23 that Kennedy and Oz met with industry leaders to "streamline and improve the prior authorization processes for Medicare Advantage, Medicaid Managed Care, Health Insurance Marketplace and commercial plans covering nearly eight out of 10 Americans."
But patients may not have to wait for their insurance or the federal government to decide to cover their medication, especially if a lack of access is due to an insurance denial even though the medication is listed as covered on a patient's plan.
The burden doesn't need to be on the provider, because patients have a right to appeal, Graham said. "In fact, they have more rights to appeal than providers do."
She said this is because federal laws that protect the right to appeal apply to the patient, and the patient is the one listed in the contract they signed for their insurance coverage.
When a doctor submits a prior authorization, Graham said these are often auto-denied using artificial intelligence. But if a patient submits an appeal, it is against the law in the U.S. for AI to be used to review it. And under the Affordable Care Act, patients have the right to escalate their appeals to an external independent review party.
If a patient has employer-provided insurance that does not cover GLP-1s, Huntley said one option is to go directly to the employer and ask for it to be added to their benefits.
"Employees want this medication covered, and it will be a recruitment and retention tool for employers moving forward," he said.
Another option is to join a diabetes advocacy group like the Diabetes Advocacy Group Coalition or the American Diabetes Association. These groups offer support and educational resources, and they also write letters to government bodies such as HHS and CMS on behalf of their members.
"The average person wants to be healthy," Huntley said. "These organizations can amplify their voice in trying to garner support for covering these medications."
