Disparities in Prescription of Long-Acting GLP-1s.

PubMed1 Apr 2026·Obesity (Silver Spring, Md.)● 7/10i

Disparities in Prescription of Long-Acting GLP-1s.

Wasden K, Sheu N, Medhati P, Tsai TC, Kim DW et al.

Black and Hispanic patients with obesity were 49% and 47% less likely to receive semaglutide or tirzepatide compared to White patients, disparities that largely disappeared after Massachusetts Medicaid expanded coverage. Retrospective analysis of 2,060 patients at a tertiary care center, January and April 2024. This provides the first evidence that state Medicaid coverage policy directly eliminates racial prescribing disparities for GLP-1 medications. Analysis limited to single health system in Massachusetts.

Strategic signal

State Medicaid programs expanding GLP-1 coverage will face immediate budget pressure but can eliminate racial prescribing disparities within months. Massachusetts demonstrates the template for other states weighing coverage decisions. CMS will monitor these state experiments as it evaluates federal Medicaid coverage for obesity indications. Novo and Lilly should expect accelerated state-by-state negotiations as Massachusetts data becomes the equity argument for broader access.

GLP-1Pricing/accessNovo Nordisk Eli Lilly

Original Abstract

OBJECTIVE: Broadening usage of new antiobesity medications (AOMs, e.g., GLP-1 and GLP-1/GIP agonists) has prompted access concerns. We analyzed patient and appointment factors associated with AOM prescriptions, including changing AOM coverage in state Medicaid programs (MassHealth). METHODS: This was a retrospective pre-post study of medical weight management appointments at a large tertiary care center in January and April 2024, bracketing a MassHealth coverage change for AOMs. Patient and visit characteristics and AOMs prescribed were analyzed. RESULTS: A total of 2060 patients were analyzed. Multivariable analysis demonstrated that patients were more likely to receive Sema/Tirz compared to no or a different AOM with private insurance (aOR 2.744, p < 0.001), diabetes (aOR 2.507, p < 0.001), and established patient relationships (aOR 1.706, p < 0.001). In January 2024, Black and Hispanic patients were 49% and 47% less likely to be prescribed Sema/Tirz (p = 0.003, p = 0.025); in April 2024, after MassHealth changes, only patients of "Not Disclosed" race were less likely to receive these medications (p < 0.001). CONCLUSIONS: Black and Hispanic patients were less likely and patients with private insurance, diabetes, and established patient relationships were more likely to be prescribed Sema/Tirz. Racial and ethnic disparities in medication prescription were less apparent after a state Medicaid policy change to cover new GLP-1s.

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