The GLP-1 Access Gap: Mapping Who Can Actually Afford America’s Miracle Weight-Loss Drugs

Published 1/6/2026

Author: Andrew Reed, Assoc. Director, The Health Management Academy

Key Takeaways

• GLP-1 drugs like Ozempic, Wegovy, Zepbound, and Mounjaro are now available across a wide cash-pay range, from roughly $150 to $450 per month, depending on drug, dose, and format.

• As many as 48 million Americans who want to lose weight expect to start a GLP-1 drug in 2026.

• Even after recent price cuts, most states still face double-digit income burdens at mid-to high-tier prices, with annual out-of-pocket costs often exceeding $3,000 per year and reaching $4,000 or more at injectable maintenance prices.

• States with the highest income burdens also have the highest obesity rates – notably Mississippi, West Virginia, and Louisiana, where rates top 40%.

• More than 40% of U.S. adults have obesity, underscoring enormous demand for effective weight-loss treatments.

• Americans still pay 2-4× more for GLP-1s than peers in Europe ($83–$144/month).

• Social divides persist: 73% of women and 61% of men feel pressure to lose weight; men cite health (58%), and women cite appearance (70%) as their top reasons for weight loss.

• 70% of Americans believe GLP-1s are only accessible to the wealthy.

The Miracle Drug Most Americans Can’t Afford

Ozempic has become nearly synonymous with modern weight loss. GLP-1 medications like Ozempic, Wegovy, Zepbound, and Mounjaro are being hailed as breakthrough treatments, reshaping how Americans think about managing weight and metabolic health.

Yet a major obstacle remains: cost. Despite widespread demand, affordability and insurance coverage lag far behind medical efficacy. The Trump administration’s recent Most Favored Nation (MFN) pricing deal, announced in November 2025, represented the first major effort to close that gap, anchoring widely discussed consumer prices around $350 per month for many injectable GLP-1 through manufacturer self-pay programs.

Since that announcement, manufacturers have gone further, introducing lower-priced starter-dose and oral options that push monthly cash prices below $300, and in some cases below $200. Though lower-priced starter doses as low as $149 are typically only used temporarily and are not representative of ongoing treatment costs. While this marks meaningful progress, even these reduced rates remain out of reach for many middle and lower-income households, particularly in states with the highest obesity rates.

The Geography of the GLP-1 Divide

The story of GLP-1 access is not just about cost – it’s about geography. When viewed on a map, the disparities are unmistakable. The very states that bear the nation’s heaviest burden of obesity are also the ones where GLP-1 medications consume the largest share of income.

In states like Mississippi, West Virginia, and Arkansas, annual GLP-1 costs at commonly prescribed injectable prices can still represent more than 12% of median per capita income, roughly double the national average. These same states report obesity rates near or above 40%, among the highest in the country. By contrast, residents in wealthier states such as Massachusetts, Connecticut, and California face income burdens below 8%, alongside some of the lowest obesity rates in the nation.

Across much of the South and Midwest, the combination of high obesity prevalence, lower wages, and limited insurance coverage creates what could be described as “GLP-1 deserts” – regions where access is constrained not just by price, but by insurance exclusions and state-level policy decisions.

What’s the True Cost of a Miracle?

For anyone exploring GLP-1s for weight loss, the first surprise often comes with the price tag. Even under the new self-pay pricing, Zepbound from Eli Lilly now ranges in cost from $299 to $449 per month, depending on dosage.

Ozempic and Wegovy from Novo Nordisk are currently priced at $349 per month for injectable maintenance dosing, with limited-time introductory injectable offers as low as $199 per month for the first two months and oral Wegovy currently available at $149 per month for lower doses. Some higher-dose options can still reach $499/month out of pocket (e.g. Ozempic 2mg).

Under the MFN framework, Medicare and Medicaid programs are expected to access select GLP-1s at approximately $245 per month, though coverage for weight-loss-only use remains limited or excluded in many states.

Even with these cost reductions, accessibility remains a concern. A monthly expense of $200–$350 still translates to $2,400–$4,200 per year – a sharp drop from previous annual costs exceeding $12,000, but still far from affordable for many Americans.

Americans Pay a Steep Price Penalty

While GLP-1 drugs have transformed weight management in the U.S., their affordability remains far worse than in much of the world. Across Europe and other developed nations, comparable medications are priced dramatically lower, making access far more attainable for patients seeking treatment.

According to the Peterson-KFF Health System Tracker, [UPDATED] even with recent U.S. price reductions, Americans often still pay more for GLP-1s than patients in peer nations, particularly for injectable formulations. In Switzerland, Ozempic costs around $144, while patients in Germany pay roughly $103, and those in Sweden about $96. Wegovy, Mounjaro, and Rybelsus follow similar international trends, with monthly prices in countries such as France ($83), the United Kingdom ($93), and the Netherlands ($103–$444) often remaining below U.S. levels.

How Much Does It Cost to Lose a Pound?

It’s helpful to bring these prices to life by discussing them in terms of how much it costs to lose a pound of body weight. We can use an estimate of 15% body weight loss over the course of 12 months as a foundation for some simple calculations. Results will vary from patient to patient, of course, but an annual weight loss of 15% has been shown to be a common outcome when using these drugs properly.

Because GLP-1 pricing now varies by drug, dose, formulation, and whether a patient is in an introductory or maintenance phase, it’s helpful to consider a range of current prices. At approximately $350 per month ($4,200 per year), which reflects typical injectable maintenance dosing, an individual starting at 240 pounds would lose about 36 pounds over 12 months, translating to roughly $116.67 per pound lost. By contrast, lower-priced oral formulations or temporary starter-dose offers — generally ranging from $150 to $200 per month — reduce annual costs to $1,800–$2,400, bringing the cost per pound closer to $50–$70.

Dividing $4,200 by 36 pounds leaves us with an average annual per-pound cost of $116.67. So, is that affordable? It all depends on context. In a high-income state like Connecticut or Massachusetts, it could be. In lower-income states like Mississippi, Louisiana, and West Virginia, not so much – but it depends on the price tag people are willing to put on feeling or looking “healthier”.

Insurance Gaps Only Serve to Reinforce Inequality

Access to GLP-1 medications is also shaped by the uneven landscape of insurance coverage. Many private insurers will approve these drugs when prescribed for diabetes management but exclude them when used primarily for weight loss. Coverage can vary widely depending on an individual’s employer, plan type, and state regulations.

The data lay this out: only 19% of firms with 200 or more workers include coverage for GLP-1 agonists when used for weight-loss in their largest health plan in 2025. Coverage rises to 43% among firms with 5,000 or more workers.

Recent pricing changes have not resolved this gap. Lower cash prices do not guarantee insurance coverage, and in some cases, including Medicaid programs, weight-loss-only coverage has narrowed rather than expanded. ​​For example, California’s Medi-Cal program ended coverage of GLP-1 medications prescribed solely for weight loss effective January 1, 2026, regardless of manufacturer price reductions.

The Human Side of the GLP-1 Divide

Numbers only tell part of the story. To better understand the human side of the GLP-1 divide, The Health Management Academy surveyed 1,827 Americans in November 2025 to capture the real-world impact of the GLP-1 divide, highlighting the emotional, social, and financial toll it takes across different incomes and between men and women.

Social Pressure and Perception

The pressure to lose weight is nearly universal, but not evenly distributed. Nearly three-quarters of women (73%) say they feel social pressure to slim down, compared with 61% of men. Despite media narratives that often frame GLP-1 drugs as empowering, over half of women (52%) and more than a third of men (37%) believe users are judged negatively, seen as “taking the easy way out”. Only a small minority, fewer than 10%, say usage of GLP-1s is viewed positively.

Who’s Using GLP-1s and Why

According to the survey, 1 in 10 adults currently use a GLP-1 medication, and a further 42% say they’ve seriously considered starting treatment. The motivations differ sharply by gender. Men overwhelmingly cite health-related reasons (58%), while women are far more likely to pursue GLP-1s for appearance-based goals (70%).

Affordability and Access

Perhaps the most striking finding is the financial barrier. The majority of respondents said they could afford to spend $100 or less per month on a GLP-1 medication, with nearly one-quarter capping out at $50 or less. Only about 3% said they could realistically pay over $250 per month, still far below even the current maintenance prices of roughly $350.

Income patterns show that even among earners earning over $150,000 annually, few felt comfortable spending more than $250 monthly. Across all income groups, cost barriers remain the limiting factor, signaling that cost continues to dictate access more than medical need.

When asked what they’d be willing to give up to afford a GLP-1 prescription, 38% said dining out or takeout, 24% said travel or leisure, and 22% said streaming subscriptions. Only 10% said they would make no trade-offs at all. 

Respondents were clear about who they think these medications are really for. More than 70% believe GLP-1s are accessible only to higher-income Americans, and over half say they’re limited to those with good insurance. Just 15% believe they’re accessible to “anyone who needs them”.

How Many Americans Expect to Use GLP-1s in 2026?

Among the 58% of adults who say they want to lose weight, nearly one-third (32%) expect to start a prescription GLP-1 drug in 2026, which translates to an estimated 48 million American adults — including 9% who say they definitely will and 23% who say they probably will. At the same time, the desire is far from universal: 24% say they might or might not start treatment, while 31% say they probably or definitely will not. Another 13% say they have not yet considered GLP-1 medications.

While demand for GLP-1 drugs appears to be accelerating, uncertainty around affordability, insurance coverage, and long-term access continues to shape whether interest translates into actual treatment. For many Americans who want to lose weight, the desire to start a GLP-1 drug in 2026 exists in theory, but remains contingent on whether the economic barriers to access can be overcome.

Access Limitations Define America’s Weight-Loss Divide

More than 22 states now report adult obesity rates above 35%, and in several, including Mississippi, Louisiana, and West Virginia, rates approach or exceed 40%. Yet these same states also rank near the bottom for per capita income, pushing their GLP-1 income burden ratios above 12%, according to our analysis. In practical terms, that means the typical individual in Mississippi would need to spend roughly one-eighth of their annual income to maintain continuous GLP-1 treatment, a cost so steep it would likely require cutting back on essentials or major lifestyle expenses just to afford it.

This imbalance lies at the heart of the GLP-1 access crisis. Clinical eligibility does not translate to real-world access. The people who could benefit most from these medications are often those least able to afford them, perpetuating a cycle in which geography, income, and health outcomes remain tightly intertwined.

From a public health perspective, these disparities have far-reaching implications. Limited access to GLP-1s in low-income and high-obesity regions threatens to widen existing health inequities, particularly in rates of diabetes, cardiovascular disease, and mobility-related conditions. Without targeted policy interventions, such as expanded insurance coverage or income-based subsidy programs, the benefits of GLP-1 medications may continue to accrue disproportionately to higher-income populations, leaving behind the very communities most affected by obesity.

Affordability and access remain the dividing lines between those who can benefit from these medications and those who cannot. Individuals in higher-income states, or those with employer plans that include robust pharmaceutical coverage, have a realistic path to treatment. Meanwhile, lower-income households, often located in regions with the highest obesity rates, face costs that place GLP-1s still firmly out of reach.

Methodology

To examine where Americans can realistically afford GLP-1 drugs for weight loss, The Health Management Academy conducted a state-by-state analysis combining income, pricing, and coverage data with an original national survey.

Data Sources:

• Income: Median per capita annual income by state was sourced from the U.S. Census Bureau.

• Coverage: Medicaid coverage policies for GLP-1 medications were obtained from KFF.org.

• Employer Benefits: Data on employer-provided coverage for GLP-1 agonists came from the KFF 2025 Employer Health Benefits Survey.

• International GLP-1 pricing comparisons: Peterson-KFF Health System Tracker.

• Weight-loss outcome assumptions (15% average reduction in body weight over 12 months) were based on results from the STEP 1 and SURMOUNT 1 clinical trials.

Cost Burden Analysis: To calculate the income burden faced in each state, we compared the average monthly out-of-pocket price of GLP-1 medications (pricing assumptions reflect a blended cash-pay range of approximately $150–$450 per month, with $350 used as a common injectable reference point rather than a universal baseline) to each state’s per capita annual income. This ratio represents the percentage of income required to maintain a full year of GLP-1 treatment, revealing where affordability challenges are most severe. Pricing figures are up to date as of January 2026.

Survey Data: A national survey of 1,827 U.S. adults was conducted in November 2025 to understand perceptions and experiences surrounding GLP-1 access and affordability. Respondents had an average age of 42.6 years and were 54.4% female, 45.1% male, and 0.5% nonbinary, representing all 50 states and the District of Columbia.

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