Significant disparities and low prescribing rates of semaglutide and tirzepatide for obesity from 2021 through 2024 highlight that there may be potential links to the social factors of race, ethnicity, social vulnerability, urbanicity, and underutilization that demand careful monitoring of not only evolving prescribing practices for these medications but also potential contributions from policy and reimbursement strategies.
These findings from a new analysis of electronic health record data, gleaned from the Epic Cosmos Dataset, were published online today in JAMA.1
Background
Under the brand name Wegovy (Novo Nordisk), semaglutide was approved for chronic weight management in 2021,2 and as Zepbound (Eli Lilly), tirzepatide was approved for the same indication in 2023.3 Semaglutide is a glucagon-like peptide-1 receptor agonist (GLP-1 RA), and tirzepatide is a dual GLP-1 RA and glucose-dependent insulinotropic polypeptide.
However, with evidence that there are health outcome disparities that can potentially be linked back to the impact of nonclinical factors on the prescribing practices toward these multibeneficial medications—and knowing their positive effects extend beyond weight management4,5—the present study investigators set out to evaluate potential strategy gaps, with the hope of using those results “to promote equitable access to these therapies.”
The Epic Cosmos Dataset they used helped to facilitate this investigation, being linked as it is to geospatial socioeconomic data.6
The Investigation’s Findings
From the 277 million patient records included in Epic Cosmos, patients were included for the present study (N = 39 million overall; n = 887,110 prescribed semaglutide or tirzepatide) who did not have type 2 diabetes but who did have a body mass index (BMI) of 27 kg/m2 or greater or 30 kg/m2 or greater and at least 1 obesity-related comorbidity between July 2020 and October 2024. The prescription orders they considered also had to be specifically for obesity and not diabetes.
Additional Coverage of Tirzepatide
The mean (SD) overall patient age was 51.8 (17.6) years. Compared with patients not prescribed medications, those prescribed semaglutide or tirzepatide were slightly younger, at 47.3 (13.1) years (P < .001), and these patients also had a higher BMI, at 39.0 (7.5) kg/m2 vs 34.3 (6.2) kg/m2 overall (P < .001). Race/ethnicity were well balanced between the overall and semaglutide/tirzepatide cohorts: Hispanic, 10.3% and 8.2%, respectively; non-Hispanic Asian, 2.1% and 1.6%; non-Hispanic Black, 16.4% each; and non-Hispanic White, 68.2% and 71.3%.
Most participants lived in a socially vulnerable area, as gauged by the Social Vulnerability Index (SVI), with 58.4% of each group living in an area with an SVI ranking of 3 or 4 (more vulnerable). Most of these patients, too, lived in a metropolitan area, as measured by rural-urban commuting area code (83.3% overall; 86.9% of patients prescribed semaglutide or tirzepatide).
Factors Influencing Prescriptions
There were several trends apparent among those less likely to be prescribed semaglutide or tirzepatide:
- Male (1.2%) vs female (3.0%) patients (OR, 0.397; 95% CI, 0.395-0.399)
- Hispanic (1.8%; OR, 0.758; 95% CI, 0.752-0.764), non-Hispanic Asian (1.7%; OR, 0.729; 95% CI, 0.717-0.742), and non-Hispanic Black (2.3%; OR, 0.951; 95% CI, 0.946-0.956) vs White (2.4%)
- High SVI (1.9%) vs low SVI (2.6%) quartile (OR, 0.740; 95% CI, 0.736-0.745)
- Rural (1.5%) vs metropolitan (2.4%) area (OR, 0.633; 95% CI, 0.623-0.642)
However, overall patterns that may have indicated worsening disparities were not consistent across subgroups for times when these drugs were in shortage. For reference, the semaglutide shortage was declared resolved by the FDA on February 21, 2025, and the tirzepatide shortage on December 19, 2024.7
Conclusions
Despite the study authors seeing an uptick in prescriptions for semaglutide and tirzepatide for their study period, uptake remained at a level indicating underutilization (3% of eligible patients).
This finding, coupled with the disparate outcomes they saw among their subgroups of patients, “likely reflect both system-level access barriers and patient-level demand, including narrow eligibility, limited insurance coverage, and financial considerations that may lead some individuals to forgo treatment after prescription,” the authors wrote.
Because of this, they recommend consistent monitoring of prescribing practices centered around the 2 medications, findings of which can help bolster strategies to increase equitable access to them.
References
1. Kim C, Ross JS, Jastreboff AM, et al. Uptake of and disparities in semaglutide and tirzepatide prescribing for obesity in the US. JAMA. Published online April 29, 2025. doi:10.1001/jama.2025.4735
2. FDA approves new drug treatment for chronic weight management, first since 2014. News release. FDA. June 4, 2021. Accessed April 25, 2025. https://www.fda.gov/news-events/press-announcements/fda-approves-new-drug-treatment-chronic-weight-management-first-2014
3. Joszt L. FDA approves diabetes drug tirzepatide for chronic weight management. AJMC®. November 8, 2023. Accessed April 25, 2025. https://www.ajmc.com/view/fda-approves-diabetes-drug-tirzepatide-for-chronic-weight-management
4. Wilding JPH, Batterham RL, Calanna S, et al; STEP 1 Study Group. Once-weekly semaglutide in adults with overweight or obesity. N Engl J Med. 2021;384(11):989-1002. doi:10.1056/NEJMoa2032183
5. Jastreboff AM, Aronne LJ, Ahmad NN, et al; SURMOUNT-1 Investigators. Tirzepatide once weekly for the treatment of obesity. N Engl J Med. 2022;387(3):205-216. doi:10.1056/NEJMoa2206038
6. Tarabichi Y, Frees A, Honeywell S, et al; Cosmos Collaborative. The Cosmos Collaborative: a vendor-facilitated electronic health record data aggregation platform. ACI Open. 2021;5(1):e36-e46. doi:10.1055/s-0041-1731004
7. FDA clarifies policies for compounders as national GLP-1 supply begins to stabilize. FDA. March 10, 2025. Accessed April 25, 2025. https://www.fda.gov/drugs/drug-safety-and-availability/fda-clarifies-policies-compounders-national-glp-1-supply-begins-stabilize
