Views: 0
The Phone Call That Started a Geographic Mystery
My friend Emma called me from Rhode Island last month, practically shouting into the phone. “I cannot find a single pharmacy within twenty miles that has Wegovy in stock! My doctor says half her patients are on these medications now. What is happening?”
Meanwhile, my friend David in rural Arkansas told me his local pharmacy had plenty of GLP-1 medications gathering dust on the shelves. “Nobody around here is asking for them,” his pharmacist mentioned casually.
That stark contrast sent me down a rabbit hole of research, and what I discovered was fascinating. GLP-1 medications like Ozempic, Wegovy, Mounjaro, and Zepbound are not spreading evenly across North America and the UK. Instead, we are seeing dramatic regional differences that tell a story about healthcare access, insurance coverage, cultural attitudes toward weight loss, and even the urban-rural divide.
If you have been curious about whether your state, province, or region is ahead of the curve or lagging behind on GLP-1 adoption, this deep dive into the geographic patterns will answer your questions.
Understanding the GLP-1 Explosion: A Quick Refresher
Before we map out where these medications are taking off, let me briefly explain what we are talking about. GLP-1 (glucagon-like peptide-1) receptor agonists are medications that were originally developed for type 2 diabetes but have become cultural phenomena due to their dramatic weight loss effects.
The major players include:
Semaglutide (Ozempic for diabetes, Wegovy for weight loss), Tirzepatide (Mounjaro for diabetes, Zepbound for weight loss), Liraglutide (Victoza for diabetes, Saxenda for weight loss).
These medications work by mimicking a natural gut hormone, slowing digestion, increasing insulin production, and reducing appetite. The result can be weight loss of 15 to 20 percent of body weight in many patients, which explains why demand has exploded.
A 2024 survey estimated that between 900,000 and 1.4 million Canadians were taking these injectable medications or similar drugs, while in the United States, semaglutide received FDA approval in January 2025 for an additional indication to reduce the risk of kidney disease worsening in adults with type 2 diabetes and chronic kidney disease, further expanding its potential user base.
United States: The Northeast Leads While the South Follows a Different Path
The Growth Champions: Rhode Island, Massachusetts, and New Jersey
When researchers analyzed insurance claims data from 2023 to 2025, they found that GLP-1 prescription growth was far from uniform. Twenty-three states showed double-digit growth, but three Northeastern states absolutely dominated the rankings:
Rhode Island led the nation with a staggering 67.8 percent increase in GLP-1 prescriptions year over year. For perspective, if 1,000 Rhode Islanders were using these medications in 2023, nearly 1,680 were using them by 2024.
Massachusetts came in second with 48 percent growth. The Boston area, with its concentration of academic medical centers and health-conscious population, became a hotbed of GLP-1 adoption.
New Jersey rounded out the top three with 35.8 percent growth. This is likely benefiting from proximity to major pharmaceutical companies and a population with relatively good insurance coverage.
What explains this Northeastern surge? Several factors appear to be at play. These states have higher rates of private insurance coverage, which often includes GLP-1 medications for weight loss. They also have dense concentrations of specialist physicians who stay current with the latest treatments. Additionally, the cultural acceptance of medical weight management interventions seems higher in urban Northeastern communities compared to other regions.
Emma’s pharmacy shortage in Rhode Island suddenly makes perfect sense. When prescriptions jump nearly 70 percent in a single year, supply chains struggle to keep pace.
The Decline States: When Growth Goes Backward
Not every state joined the GLP-1 boom. Six states actually saw prescriptions decline from 2023 to 2025:
Arkansas, Louisiana, West Virginia, Idaho, South Dakota, Vermont
What could cause prescriptions to drop during a national surge? The most likely explanation involves insurance coverage changes. Many employers and state Medicaid programs made the difficult decision to restrict or eliminate coverage for GLP-1 medications used for weight loss due to cost concerns. Independence Blue Cross, for instance, stopped covering GLP-1s for weight loss in certain plans starting January 2025, and Kaiser Permanente dropped GLP-1 coverage for people with a body mass index below 40 when the medications are used solely for weight loss.
In states with lower average incomes and higher rates of Medicaid coverage, these policy changes hit particularly hard. When a medication costs over $1,000 per month without insurance, most people simply cannot afford it out of pocket.
The Geographic Split: Diabetes in the South, Weight Loss in the Northeast
Here is where things get really interesting. When researchers mapped prescription fills by indication (diabetes versus weight loss), a clear regional pattern emerged:
Southern states including Oklahoma, Alabama, Louisiana, and Texas show higher fill rates for diabetes-labeled GLP-1 medications. This makes epidemiological sense. The South has the highest rates of type 2 diabetes in the nation, driven by a combination of dietary patterns, obesity rates, exercise habits, and socioeconomic factors.
Northeastern states including Massachusetts, New Jersey, Rhode Island, and Delaware lead in fill rates for weight-loss-labeled GLP-1 medications. This suggests that people in these states are more likely to pursue and obtain coverage for medications specifically prescribed for weight management rather than diabetes.
The distinction matters because insurance coverage rules differ dramatically depending on whether you have a diabetes diagnosis. Medicare, for instance, covers GLP-1 medications for diabetes. However, it is prohibited by law to cover medications prescribed solely for weight loss. Many commercial insurance plans follow similar logic, making that diagnostic label crucial for access.
Alaska: The Unexpected Leader
In one of the more surprising findings, Alaska topped the charts for combined fill rates across all weight-loss medications, not just GLP-1s. This seems counterintuitive for a rural state with limited healthcare infrastructure and harsh geography.
Several factors might explain Alaska’s high ranking. The state has a relatively affluent population despite its rural character. With many residents working in well-paying industries like oil, fishing, and government that provide excellent health insurance. Limited access to gyms, fresh produce, and outdoor exercise during brutal winters may make medical weight management more appealing. And Alaskans may be early adopters of telemedicine solutions that make accessing specialist prescribers easier despite geographic isolation.
The National Picture: How Many Americans Are Actually Using GLP-1s?
Multiple nationally representative surveys conducted in 2024 and early 2025 provide a clear answer. About 12 percent of U.S. adults have ever used a GLP-1 medication, and approximately 6 percent are current users.
Among adults with diagnosed type 2 diabetes, the numbers jump significantly. About one in four people with diabetes used a GLP-1 injectable in 2024. Usage peaks among adults aged 50 to 64. This aligns with the age range when both diabetes and obesity rates reach their highest levels.
These numbers represent remarkable market penetration for medications that only became widely known to the public in the past few years. If 6 percent of American adults are current users, that translates to approximately 15 million people taking these medications at present.
Canada: Provincial Patterns Show Explosive Growth Everywhere
The Numbers That Tell the Story
While the United States shows uneven regional adoption, Canada presents a different picture: explosive growth across every single province. Fresh data from IQVIA Canada tracking anti-obesity medication users from 2019 to 2023 reveals the scale of change. IQVIA’s national pharmacy utilization data shows a dramatic rise in people using anti-obesity medicines across every province from 2019 to 2023. The provincial counts below reflect all anti-obesity medications. GLP-1s now dominate this category, which makes these figures a strong proxy for GLP-1 adoption. IQVIA
- Ontario 30,651 to 207,144 users.
- Quebec 13,113 to 88,622 users.
- Alberta 13,001 to 87,605 users.
- British Columbia 9,375 to 74,352 users.
- Atlantic Provinces (NL, NS, NB, PEI combined) 4,140 to 36,968 users.
- Manitoba and Saskatchewan combined 1,949 to 27,048 users.
Nationally, Canadians using medications to treat obesity rose from 72,228 in 2019 to 521,739 in 2023. In the same period, GLP-1 receptor agonists posted the greatest growth among diabetes drug classes, This aligns with the surge you see in the obesity counts. IQVIA. Source scope note: IQVIA’s public report covers 2019 to 2023. A 2024 or 2025 province-by-province user count has not been posted publicly yet.
These provincial counts reflect all anti-obesity medications, but GLP-1 receptor agonists now dominate this category. The same IQVIA data confirms that GLP-1 medications showed the greatest growth among all diabetes drug classes during this period. This makes these figures a reliable proxy for GLP-1 adoption specifically.
Why Ontario Leads in Absolute Numbers
Ontario’s position as the leader in total users makes sense given that it is Canada’s most populous province. Ontario is home to about 40 percent of all Canadians. Toronto, with its diverse population and concentration of medical specialists, has become a hub for GLP-1 prescribing.
But the proportional growth rates are remarkably similar across provinces. This suggests that whatever factors are driving GLP-1 adoption are operating nationally rather than regionally. Universal healthcare coverage through provincial health plans likely plays a role in creating more equitable access compared to the United States, though as we will see, coverage varies significantly by indication.
The Insurance Coverage Evolution in Canada
Survey results from 2025 show that 31 percent of Canadian employers now cover GLP-1 drugs for both diabetes and weight loss. This represents a significant increase from just 17 percent in early 2024. This near-doubling of employer coverage in a single year helps explain the explosive user growth we are seeing.
However, 56 percent of employers still provide coverage for diabetes only (down from 66 percent in 2024). 31 percent now provide coverage for both diabetes and weight loss (up from 17 percent in 2024). This means that most Canadians can access GLP-1 medications if they have diabetes, but coverage for weight management remains the exception rather than the rule.
Provincial public drug plans vary in their coverage policies. Some provinces cover GLP-1 medications for diabetes under their formularies, while coverage for weight loss typically requires private insurance. This creates a two-tier system where access depends heavily on employment status and the generosity of employer health benefits.
What Is Coming Next for Canada: The Biosimilar Revolution
Canadians could get more affordable versions of Ozempic in early 2026. Health Canada is considering applications from multiple companies to make and sell biosimilar versions. Since biosimilars do not require new clinical trials, they could be available within weeks of Health Canada approval.
This development could be transformative. Biosimilars typically cost 30 to 50 percent less than brand-name medications, potentially opening access to millions of Canadians who currently cannot afford these treatments. If provinces add biosimilar GLP-1s to their public drug formularies at these lower prices, we could see adoption rates double or triple from current levels.
United Kingdom: The Postcode Lottery Nobody Wants to Win
How NHS Access Actually Works (or Does Not Work)
If you live in the United States or Canada, you might assume that the UK’s National Health Service, with its universal coverage model, would provide equitable access to GLP-1 medications across the country. Unfortunately, the reality is far more complicated and frustrating for patients.
The UK uses a system of Integrated Care Boards (ICBs). These ICBs make local commissioning decisions about which treatments to fund and how many patients to serve. For GLP-1 medications prescribed for weight loss, access depends on referral to specialized Tier 3 weight management clinics. Those must be commissioned and funded by your local ICB.
The result has been what journalists and patient advocates call a “postcode lottery.” Depending on where you live, you might have excellent access to these medications through the NHS. You may also face years-long waiting lists or find that your local ICB has not commissioned the service at all.
Freedom of Information requests mapping access across all 42 ICBs in England revealed shocking disparities. Some areas were treating only a handful of patients despite having populations of hundreds of thousands, while others had built robust pathways serving significant numbers.
The 2025 Policy Shift: Reason for Optimism
The good news is that change is happening. In March 2025, NHS England published interim commissioning guidance that expands funded access to include tirzepatide (Mounjaro) for obesity, building on earlier decisions to fund semaglutide (Wegovy). This national guidance should gradually improve regional equity, though implementation at the ICB level will take time.
The challenge remains one of capacity. Even when ICBs receive guidance to commission these services, they need to fund clinic infrastructure, hire specialist staff, and establish referral pathways. In a healthcare system that is chronically underfunded and overwhelmed with demand across multiple areas, building new weight management capacity competes with urgent needs in cancer care, surgery, mental health, and emergency services.
Where Private Markets Fill the Gap
The NHS capacity constraints have created a booming private market for GLP-1 medications in the UK. Private clinics and online telemedicine services now offer consultations and prescriptions. However, these patients must pay out of pocket for both the medical visit and the medication itself.
This private market serves people with means while those dependent on NHS care wait. It is precisely the kind of inequality that the NHS was designed to prevent, yet the explosive demand for these medications has overwhelmed the public system’s ability to respond.
Regional Variation Across the UK Nations
It is worth noting that Scotland, Wales, and Northern Ireland operate their own health systems separate from NHS England. Coverage decisions and implementation timelines differ, adding another layer of complexity to UK access patterns. Generally speaking, Scotland has been somewhat more progressive in commissioning weight management services, while Wales and Northern Ireland have faced even greater capacity constraints than England.
What These Geographic Patterns Reveal About Healthcare Access
Income and Insurance: The Ultimate Determinants
The most obvious pattern across all three regions is that access follows money. States, provinces, and areas with higher average incomes and better insurance coverage see faster adoption. This holds true even in Canada’s universal healthcare system, where private employer coverage determines access to medications for weight management.
The decline states in the US, the variation in Canadian employer coverage, and the UK postcode lottery all illustrate the same fundamental truth: when medications cost $1,000 to $1,500 per month, systemic barriers prevent most people from accessing them without robust insurance or public funding.
Urban-Rural Divides
GLP-1 adoption tends to be higher in urban and suburban areas compared to rural regions. This reflects several factors: greater concentration of specialist physicians who prescribe these medications, better pharmacy infrastructure to stock and distribute them, higher rates of private insurance coverage, and potentially greater cultural acceptance of medical weight management interventions.
Alaska’s high ranking as an exception proves the rule. It succeeds despite rural geography because of unusually good insurance coverage and telemedicine adoption.
The Diabetes-Obesity Coverage Gap
The geographic split between diabetes prescribing and weight loss prescribing reveals a fundamental inequity in how we approach metabolic disease. People with diabetes can access these medications relatively easily through insurance coverage. People who have obesity without diabetes, even when their excess weight puts them at high risk of developing diabetes, heart disease, and other conditions, face far greater barriers.
This makes little sense from a public health perspective. Treating obesity before it progresses to diabetes would prevent enormous suffering and healthcare costs. Yet our insurance systems, particularly in the United States, remain anchored to treating disease after it develops rather than preventing it in the first place.
Regulatory and Policy Lag
The UK situation illustrates how regulatory approval does not automatically translate to patient access when healthcare systems lack the capacity or funding to deliver approved treatments. NICE (the National Institute for Health and Care Excellence) has recommended these medications, but implementation at the ICB level lags far behind.
Similarly, in both the United States and Canada, the pace of clinical evidence demonstrating benefits has outstripped the pace of policy change around coverage and reimbursement.
What Patients Should Know About Access in Their Area
If You Live in a High-Adoption State or Province
Living in Rhode Island, Massachusetts, New Jersey, Ontario, Alberta, or British Columbia means you are in a region where GLP-1 medications have become relatively mainstream. Your healthcare providers are likely familiar with prescribing them, and pharmacies in your area should have reasonable access to supply, though shortages still occur during periods of high demand.
However, high adoption does not necessarily mean easy access for you individually. Your specific insurance coverage remains the key determinant. Review your policy carefully, understand any prior authorization requirements, and be prepared for the possibility of coverage denial if you are seeking these medications for weight loss rather than diabetes.
If You Live in a Low-Adoption or Decline State
Being in Arkansas, Louisiana, West Virginia, Idaho, South Dakota, Vermont, or similar regions means you face additional challenges. Not only might insurance coverage be restricted, but you may also find that local healthcare providers are less experienced with these medications and local pharmacies are less likely to stock them.
Consider telemedicine options that connect you with prescribers in other states. Several online services specialize in GLP-1 prescribing, though you will still need to solve the insurance coverage and pharmacy access challenges. Some patients are using mail-order pharmacies in other states to fill prescriptions when local pharmacies cannot obtain supply.
If You Live in the UK
Prepare for a potentially long journey. Ask your GP about the Tier 3 weight management pathway in your specific ICB area. Some regions have well-functioning services with reasonable wait times, while others have barely begun implementation.
If NHS access proves impossible or involves unacceptable wait times, research private options. Understand that you will be paying hundreds of pounds per month for the medication itself, plus consultation fees. Some UK residents are exploring options to obtain medications from other European countries where prices may be lower.
Be wary of unregulated online sources. The FDA (and UK’s MHRA) have warned that unapproved versions of GLP-1 drugs do not undergo safety, effectiveness, and quality review before marketing. Counterfeit or improperly compounded versions can be dangerous.
Looking Forward: Trends That Will Shape 2025 and Beyond
Biosimilars Will Transform Canadian Access
The arrival of biosimilar semaglutide in early 2026 could be the most significant development for Canadian access. Lower prices may prompt provincial governments to add these medications to public formularies, dramatically expanding access beyond those with private insurance.
US Insurance Coverage Will Remain the Battleground
In 2025, Medicare Part D caps yearly out-of-pocket costs for covered drugs at $2,000, which provides some protection for diabetes patients on GLP-1s. However, the fundamental Medicare prohibition on coverage for weight loss persists, and efforts to change this law face significant political obstacles.
Private insurance coverage will continue its current trajectory, with some plans expanding access while others restrict it due to cost concerns. Watch for continued growth in programs that require patients to meet certain criteria (BMI thresholds, failed diet attempts, participation in lifestyle programs) before approval.
The UK Will Slowly Expand NHS Capacity
Implementation of the March 2025 guidance expanding coverage to tirzepatide will gradually improve access, but expect the process to take years rather than months. ICBs with limited resources will prioritize patients with the highest BMIs and most severe obesity-related complications.
Private market growth will continue, creating a parallel system that raises uncomfortable equity questions in a country proud of its universal healthcare model.
New Indications Will Expand the Eligible Population
Semaglutide’s January 2025 FDA approval for kidney disease protection in diabetic patients is just the beginning. Wegovy awaits FDA decisions in 2025 for MASH (metabolic dysfunction-associated steatohepatitis) in Q3 and an oral formulation for weight loss in Q4.
Each new approved indication expands insurance coverage to additional patient populations, potentially accelerating adoption in regions that currently lag behind.
Supply Chain Maturation
Pharmaceutical manufacturers are investing billions in expanded production capacity. The shortage-driven stockouts that plagued 2022 and 2023 have largely resolved, though demand surges in high-adoption regions can still cause temporary local shortages.
As production scales up and biosimilars enter markets, the supply constraints that currently limit access should continue to ease.
Why Geographic Patterns Matter for Everyone
Even if you are not personally using or considering GLP-1 medications, these geographic patterns reveal important truths about healthcare access in North America and the UK. They show us how insurance design, regional prosperity, urban infrastructure, and healthcare system capacity create winners and losers in accessing breakthrough treatments.
The same patterns observed with GLP-1 medications also apply to cancer immunotherapies, gene therapies, advanced surgical techniques, and cutting-edge diagnostic tools. Where you live profoundly affects what healthcare you can access, even in countries with universal coverage aspirations.
Understanding these patterns is the first step toward addressing them. Patients can advocate more effectively when they understand the systemic barriers they face. Healthcare providers can work to build infrastructure and access programs in underserved areas. Policymakers can design interventions that target the specific gaps revealed by geographic data.
The Bottom Line: Access Is Improving But Remains Unequal
Emma in Rhode Island eventually found a pharmacy that could fill her Wegovy prescription, though she had to call seven different locations. David in Arkansas reported that his doctor was not comfortable prescribing GLP-1s for weight loss, suggesting he “just try harder with diet and exercise.” These personal stories illustrate the stark reality behind the statistics.
GLP-1 medications represent one of the most significant advances in treating obesity and metabolic disease in decades. The 2024-2025 geographic data shows adoption accelerating across most regions, with particularly dramatic growth in certain states and provinces. But access remains deeply unequal, shaped by insurance coverage, healthcare infrastructure, regional prosperity, and policy decisions.
If you live in a high-adoption region with good insurance coverage, you are fortunate to have relatively straightforward access to these potentially life-changing medications. If you live elsewhere, you face additional hurdles, but options exist through telemedicine, patient assistance programs, and persistence in navigating the system.
The next few years will bring important changes: biosimilars entering markets, new indications expanding covered populations, and ongoing policy debates about funding and access. Stay informed about developments in your specific state, province, or region. Healthcare is increasingly local in its implementation, even when medications are globally available.
And if you find yourself making seven phone calls to fill a prescription or driving across state lines to find a pharmacy with stock, know that you are not alone. Millions of people across North America and the UK are navigating the same challenges, and their collective experience is slowly but surely pushing systems to improve access and equity.
About This Data: This article draws on insurance claims analyses, prescription fill-rate mapping, national surveys, IQVIA Canada provincial tracking, NHS England commissioning reports, and Freedom of Information requests covering 2024-2025. Geographic patterns continue to evolve, and readers should verify current conditions in their specific locations.
Leave a Reply