Prescription Access Crisis: 40% of GLP-1 RA Rx Are Unfilled

An alarming 40% of orders for glucagon-like peptide-1 receptor agonists (GLP-1RAs) went unfilled between January 2018 and September 2022, according to a new study from the University of Colorado Health (UCHealth) system, with patients citing soaring costs, insurance roadblocks, and potential prejudicial prescribing behavior because of race as access barriers.¹ In addition, despite a higher prevalence of diabetes and obesity among racial and ethnic minority groups and for individuals who have obesity and not diabetes, the impact from lack of access has the potential to be more significant.

Chief among the new study’s findings, published in JAMA Health Forum, is that uninsured individuals paid upwards of $900 per month in 2024 for a GLP-1 RA prescription fill—the reported average retail price.² Overall, the outcomes of interest were GLP-1 RA prescriptions filled within 90 days, out-of-pocket costs per fill for a 30-day supply, and potential differences by race, ethnicity, and drug indication, all among patients with insurance. The drug indications were diabetes only, obesity only, diabetes and obesity, or neither.

UCHealth electronic health record data were linked to eligibility and medical and pharmacy claims data from the Colorado All-Payer Claims Database for patients who had at least 1 GLP-1 RA order between January 2018 and September 2022. These patients also had to have continuous Medicare enrollment or commercial insurance coverage for the year before and the 3 months after the date of record.

Among the 6094 patients, the mean (SD) age was 60.9 years (12.7), 53.7% were women, and non-Hispanic White was the most common race/ethnicity (72.3%), followed by Hispanic (19.4%), non-Hispanic Black (5.8%), and non-Hispanic Asian (2.5%). There were 9848 GLP-1 RA orders in total, 60.1% (n = 5915) of which were filled. Patients were stratified by age (younger than 50, 50-59, 60-69, and 70 years and older), insurance type (Traditional Medicare, Medicare Advantage, or commercial), and sex.

Compared with non-Hispanic White patients, non-Hispanic Black and Hispanic patients had lower fill rates overall (60.9% vs 55.3% vs 58.4%, respectively). A higher fill rate was seen for patients diagnosed with diabetes and obesity (64.6%); the lowest fill rate was for patients with obesity alone (37.2%). For diabetes alone, the fill rate was 47.5%.

The mean out-of-pocket cost was $71.90 ($163.69) for each filled GLP-1 RA prescription, and this dropped to $41.15 for non-Hispanic Black patients and $63.69 for Hispanic patients. For non-Hispanic White patients, the mean cost was $78.37. Again, the patients diagnosed with diabetes and obesity had the best results, having out-of-pocket costs totaling $70.32 vs $134.04 for individuals diagnosed with obesity only.

Of the variations seen among their results, the study authors implicated potential causes being insurance coverage, use of different approved GLP-1 RAs—during the study period, exenatide twice daily and once weekly, lixisenatide once daily, liraglutide once daily, dulaglutide once weekly, semaglutide once weekly, and oral semaglutide once daily were approved³—and patients having different cost thresholds they would not exceed.

“[Out-of-pocket] costs for patients with obesity alone were nearly 2 times those for patients with diabetes,” the study authors wrote, “likely reflecting less comprehensive insurance coverage for this indication.”

Their results should be interpreted with caution, they added, as their data came from just 1 health system and they did not consider reasons for nonadherence. It’s also possible that patients paid cash for their prescriptions instead of going through their insurance carrier.

“Policymakers should explore options to improve equitable access to GLP-1RAs,” they concluded.

References

1. Sarpatwari A, Soto MJ, Ganguli I, Sloan CE, Goss F, Sinaiko AD. Glucagon-like peptide-1 receptor agonist order fills and out-of-pocket costs by race, ethnicity, and indication. JAMA Health Forum. 2025;6(10):e254258. doi:10.1001/jamahealthforum.2025.4258
2. Williams E, Rudowitz R, Bell C. Medicaid coverage of and spending on GLP-1s. Kaiser Family Foundation. November 4, 2024. Accessed October 13, 2025. https://www.kff.org/medicaid/issue-brief/medicaidcoverage-of-and-spending-on-glp-1s/
3. Trujillo JM, Nuffer W, Smith BA. GLP-1 receptor agonists: an updated review of head-to-head clinical studies. Ther Adv Endocrinol Metab. 2021;12:2042018821997320. doi:10.1177/2042018821997320