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

Published 11/17/2025

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

Key Takeaways

• GLP-1 drugs like Ozempic, Wegovy, Zepbound, and Mounjaro will soon cost around $350/month under TrumpRx pricing for those without insurance coverage.

• Even after price cuts, most states face double-digit income burdens, with annual out-of-pocket costs exceeding $4,000 for the uninsured.

• States with the highest income burdens also have the highest obesity rates – notably Mississippi, West Virginia, and Louisiana, where both 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, represents the first major effort to close that gap, cutting average monthly prices for drugs like Ozempic, Wegovy, Mounjaro, and Zepbound to roughly $350. While the policy marks meaningful progress from past list prices exceeding $1,000 per month, even the new 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 represent more than 12% of the 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 the drugs’ clinical promise is offset by economic inaccessibility.

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. Anyone looking into GLP-1s for weight loss is often met with sticker shock. Even under the new TrumpRx pricing agreement, Zepbound from Eli Lilly now averages $346 per month out of pocket, with prices ranging between $299 and $449.

Comparable medications such as Mounjaro are priced similarly, while Ozempic and Wegovy from Novo Nordisk will be available for $350 per month.

Under the new Most Favored Nation (MFN) framework, Medicare and Medicaid beneficiaries will have access to these drugs at a discounted price of $245 per month.

Even with these sizeable cost reductions, accessibility remains a concern. A monthly expense of $350 translates to $4,200 per year – a sharp drop from the previous list prices exceeding $12,000 annually, but still far from accessible for many Americans. Earlier estimates placed typical U.S. GLP-1 costs between $700 and $800 per month, underscoring that though prices have improved, meaningful financial barriers persist.

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, even under the new TrumpRx framework, U.S. prices for GLP-1 drugs – around $350 per month – remain several times higher than those paid in peer nations. 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) consistently well below American 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.

Let's assume it costs $350 per month, equating to $4,200 per year, to purchase GLP-1 in this example. Then, if we imagine an individual who started the year weighing 240 pounds, we know they will have lost 36 pounds using their twelve-month supply of a GLP-1.

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.

This creates a compounding inequity: higher-income workers are more likely to hold insurance plans with robust pharmaceutical benefits, meanwhile lower-income employees – often in jobs without comprehensive coverage – must pay out of pocket. As a result, those with the greatest need for GLP-1 treatment frequently face the highest financial barriers. The accessibility gap isn’t just economic; it’s structural, reinforcing the divide between who can access these medications and who cannot.

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 expected TrumpRx 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”.

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 (based on TrumpRx pricing of approximately $350 per month) 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.

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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