— "I'm jumping through hoops just to survive," exclaims one patient

For over a year and a half, Tandra Cooper Harris and her husband, Marcus, both living with diabetes, have encountered countless difficulties in obtaining the medications necessary to manage their blood sugar levels.

Without vital treatments like semaglutide (Ozempic) and other GLP-1 agonists, Cooper Harris experiences blackouts, lacks the energy to care for her grandchildren, and struggles to continue her job as a hairstylist specializing in braiding. Meanwhile, Marcus Harris, a cook at Waffle House, requires dulaglutide (Trulicity) to prevent painful swelling and bruising in his legs and feet.

The couple’s doctor has attempted to prescribe alternative GLP-1 agonists, which are designed to mimic a hormone that reduces appetite and regulates blood sugar by enhancing insulin secretion. However, these alternatives are often unavailable. In other instances, their Affordable Care Act insurance puts them through arduous approval procedures or imposes hefty out-of-pocket costs they cannot afford.

"It feels like I’m constantly jumping through hoops just to stay alive," said Cooper Harris, 46, who resides in Covington, Georgia, east of Atlanta.

Supply shortages and insurance complications surrounding this potent group of drugs have left countless diabetics and individuals with obesity unable to access the life-saving medications they need to remain healthy.

The driving factor behind these obstacles is the steep pricing from drug manufacturers. In a recent KFF survey, about 54% of adults using GLP-1 drugs reported that even with insurance, the cost was difficult to manage. It’s the individuals with the fewest financial resources being hit the hardest—people who already struggle with accessing healthcare and purchasing nutritious food are particularly vulnerable.

Currently, Novo Nordisk charges roughly $1,000 for a monthly supply of semaglutide (used for diabetes), while Eli Lilly prices tirzepatide (Mounjaro) similarly. The price range for a month’s supply of other GLP-1 agonists varies from $936 to $1,349 before insurance, as reported by the Peterson-KFF Health System Tracker. In 2022 alone, Medicare’s expenses for popular diabetes and weight-loss medications — injectable semaglutide, its oral version (Rybelsus), and tirzepatide — totaled $5.7 billion, a dramatic rise from just $57 million in 2018, based on KFF’s research.

Notably, Sen. Bernie Sanders (I-Vt.) cautioned that these "outrageously high" prices have the potential to bankrupt Medicare, Medicaid, and the entire U.S. healthcare system. He relayed these concerns to Novo Nordisk in an April letter as part of his work chairing the Senate Committee on Health, Education, Labor, and Pensions.

As a result of such steep costs, not all who need these medications can access them. "These patients are already disadvantaged, and now that’s one more hurdle for them," said Dr. Wedad Rahman, an endocrinologist with Piedmont Healthcare in Conyers, Georgia. Rahman treats many low-income patients, including Cooper Harris, who either have high-deductible insurance plans or are on government programs such as Medicaid or Medicare.

Although most pharmaceutical companies offer assistance programs for those needing medications at low or no cost, these programs are often unreliable for drugs like semaglutide and dulaglutide due to supply shortages. Additionally, insurance requirements for prior authorization or demands to try cheaper options first create further delays in patient care.

By the time many of Rahman’s patients reach her, their diabetes has been uncontrolled for years, resulting in significant complications such as foot ulcers or blindness. "At that point, it’s the end of the road," Rahman remarked. "Then I have to resort to different, less effective, and more affordable medications for them."

GLP-1 agonists, a class that includes semaglutide, dulaglutide, and tirzepatide, were initially introduced as diabetes treatments. Over the past three years, FDA approvals have expanded to rebranded versions of these drugs — such as Zepbound for tirzepatide and Wegovy for semaglutide — for weight loss. This expansion has led to a dramatic surge in demand, and as more benefits of this treatment class become evident, demand continues to escalate. For example, in March, the FDA approved the weight-loss formulation of semaglutide for managing heart conditions, a decision that is anticipated to further drive demand and spending. Financial analysts forecast that by 2030, up to 30 million Americans could be relying on a GLP-1 agonist, according to estimates from J.P. Morgan.

However, as more patients seek prescriptions, drug manufacturers are struggling to keep up with demand.

In response, Eli Lilly has urged individuals not to use its drug, tirzepatide, for cosmetic weight loss to preserve supplies for those with medical conditions. Nonetheless, the drug's popularity shows no signs of waning, even with side effects like nausea and constipation, bolstered by its effectiveness and endorsements from celebrities. For instance, in March, Oprah Winfrey aired a one-hour special discussing the medications' weight-loss benefits.

"It feels like everyone’s taking these meds," said Dr. Jody Dushay, an assistant professor at Harvard Medical School and endocrinologist at Beth Israel Deaconess Medical Center. "But it’s fewer people than it seems because we just keep running out of stock!"

Even when the drugs are in supply, insurance constraints leave both patients and healthcare providers grappling with ever-changing coverage policies. State Medicaid programs vary in how they cover these drugs for weight loss. Medicare doesn’t cover GLP-1 agonists prescribed for obesity, and commercial insurers are tightening restrictions due to the hefty price tag associated with these medications.

Because of this, healthcare professionals are forced to create treatment plans based on availability and affordability. For example, Cooper Harris’s insurance covers dulaglutide but not semaglutide, the latter of which she prefers due to fewer side effects. But when the pharmacy is out of dulaglutide, Harris has to rely more on insulin, despite preferring semaglutide, as Rahman explained.

Dr. Brandi Addison, an endocrinologist based in Corpus Christi, Texas, recounted that one day in March, she had to modify prescriptions for all 18 of her patients due to issues with drug access and cost. One of her patients, covered by a teacher retirement health plan with a high deductible, simply could not afford a GLP-1 agonist. As a result, Addison resorted to prescribing insulin to the patient, even though it lacks the same advantages as GLP-1 agonists.

"Patients on fixed incomes are the most vulnerable in this situation," Addison emphasized.

KFF Health News is an established newsroom dedicated to providing in-depth coverage on health matters. It is one of the main editorial programs at KFF, a nonpartisan source of health policy analysis, polling, and journalism. Learn more about KFF’s mission and work here.