Eva Cornman

Weight loss medications such as Ozempic, Wegovy, and Mounjaro have attracted widespread attention, making headlines across pop culture and scientific sectors alike. But it appears that hearing about these medications is a lot easier than actually getting them.

Using electronic health records from across 280 health care systems in the United States, Yale researchers discovered that only 3% of eligible adults have received a prescription for these weight loss medications. Their 

Journal of the American Medical Association

“These medications have gotten lots of attention from the media because of how effective they are, not just for weight loss, but also for improving overall cardiovascular health,” says 

 assistant professor of medicine (cardiology) at Yale School of Medicine (YSM) and senior author of the study. “But we wanted to ask 

 is actually getting these prescriptions? Are there any gaps or disparities?

“Turns out, very few people who could benefit from these drugs are actually getting them,” Lu adds. “We have a powerful new treatment here, but it is not reaching everyone who needs it.”

Using a nationwide dataset maintained by the medical record company Epic, Lu and her team gathered information on almost 40 million adults collected between 2020 and 2024 and analyzed how prescribing trends for semaglutides (which include brands such as Ozempic and Wegovy) and terzepatides (which include Mounjaro) varied with race, ethnicity, social vulnerability, and whether patients lived in an urban or rural area.

Even among the 3% of eligible adults who were receiving semaglutide and tirzepatide prescriptions, there were a number of differences. Men were less likely to receive prescriptions than women, and people living in rural areas or in communities with more socioeconomic challenges were also less likely to receive prescriptions. Black, Hispanic, and Asian patients were all less likely to receive prescriptions than white patients, differences which persisted across the entire three-year period.

This is especially concerning given that Black and Hispanic patients have higher prevalences of obesity in the United States compared with white patients.

“Some of these minority populations bear the biggest burden of obesity,” says Lu, who is also an assistant professor of biomedical informatics and data science at YSM and of chronic disease epidemiology at Yale School of Public Health. “However, many of these patients may be less likely to be seen by specialists who can prescribe for these medications, or even when they are being seen by these specialists, they may be less likely to receive prescriptions due to factors such as cost and insurance coverage.”

Lu suspects gaps could be even greater than what the study estimates. The data only reflect prescriptions documented in medical records and do not account for whether the patients actually filled those prescriptions.

Without insurance, semaglutide and tirzepatide medications can cost about $1,000 a month or more. Even for those with insurance, these medications are not widely covered, and insurance programs such as Medicare and Medicaid are prohibited from covering them when prescribed only for weight loss.

“Even if patients receive a prescription, they may not fill it in the pharmacy because of inadequate insurance coverage and high out-of-pocket cost,” Lu says. “There are many factors related to social determinants of health contributing to these differences.”

Informing the future of weight loss prescriptions

These low prescription rates and prescription differences are concerning because of the benefits these 

drugs could provide for millions of Americans

Studies have shown that semaglutides and tirzepatides are not only effective for weight loss, but can also lower cardiovascular risk factors such as blood pressure, cholesterol, and glucose, and 

can reduce the risk of heart attack, stroke, and cardiovascular death

. The protective effects of these drugs are so striking that, given current evidence, Lu believes the benefits outweigh potential negative side effects that the drugs might confer, such as nausea, vomiting, and stomach pain.

Lu is already working on investigating these prescribing trends further, comparing the real-world benefits of these weight loss medications to clinical trials, and looking at prescription rates in different subgroups such as patients with heart failure and severe obesity.

“The overall takeaway is that we have effective medications for obesity, but the uptake is very slow, and we have a long way to go to ensure that the effective treatments are available to everyone who needs them,” Lu says. “There are some subgroups left behind, and there’s effort needed to address that.”

Other Yale co-authors include Chungsoo Kim, PharmD, PhD; Joseph S. Ross, MD; Ania M. Jastreboff, MD, PhD; Daniella Meeker, PhD; and Harlan M. Krumholz, MD.

Articles

Weight loss medications like Ozempic, Wegovy, and Mounjaro are underutilized, with only 3% of eligible adults receiving prescriptions, despite their effectiveness in weight loss and cardiovascular health improvement. Disparities exist in prescription rates, with men, rural residents, and minority groups less likely to receive these medications. High costs and inadequate insurance coverage further limit access. These medications offer significant health benefits, but uptake is slow, necessitating efforts to address disparities and improve access. Further research is ongoing to understand and mitigate these prescribing gaps.

Despite the effectiveness of weight loss medications like Ozempic and Wegovy, only 3% of eligible adults receive prescriptions, highlighting significant disparities.

Why Aren’t People Who Need Weight Loss Drugs Getting Them?

Adults aged 80 and older experience the highest prevalence of cardiovascular disease, yet the optimal blood pressure targets for this group have been unclear in clinical guidelines. Now, a new study from Yale School of Medicine (YSM) suggests that intensive blood pressure management may offer important benefits for very elderly patients.

As the American population rapidly ages, the proportion of adults aged 80 and above is expected to significantly increase over the next few decades. But despite their growing numbers, this population has been understudied and often excluded from clinical trials investigating blood pressure management. The 

American Heart Association’s current blood pressure guidelines

 adults call for blood pressure of 130/80 mmHg or below, but it’s unclear if this range is appropriate for the very elderly.

“The key challenge is the lack of strong evidence for this age group,” says Yuan Lu, ScD, assistant professor of medicine (cardiology) at YSM, and the senior author of the study published in the 

Journal of the American College of Cardiology

. “Much of the scientific evidence in the hypertension guidelines is based on clinical trials, but these studies have often excluded adults aged 80 and older. When they are included, their numbers are usually too small to draw clear conclusions for this age group.”

To address this evidence gap, Lu and her team used data from the Centers for Disease Control and Prevention’s National Health and Nutrition Examination Survey and National Death Index to investigate the association between blood pressure and death from cardiovascular disease in adults aged 80 and above who had been actively treated with hypertension medication. Despite previous conjecture that higher blood pressure might be acceptable in this age group due to concerns such as increased fall risk and other side effects when blood pressure is too low, Lu and her team found evidence suggesting that lower blood pressure and more intensive management may be associated with better outcomes for these patients.

Evidence-based guidelines for blood pressure management

With little evidence to guide hypertension treatment for this age group, physicians have often relied on experience, expert opinions, and observational studies. This has frequently led to the idea that higher blood pressure might be acceptable for very elderly patients.

“There’s concern that lowering blood pressure too much in very elderly patients could cause side effects like dizziness, falls, or other injuries,” Lu explains. "That’s why there’s still uncertainty among doctors about how aggressively to manage blood pressure in this age group. We simply don’t have enough data to say what the ideal target should be. Should we aim for 120 or 130? Or is 140 to 150 still acceptable for elderly patients?”

Lu and her team sorted data from over 1,500 patients aged 80 and above who had been treated for hypertension into three groups: those with systolic blood pressure lower than 130, those between 130 and 160, and those above 160. They found that those with systolic blood pressure below 130 had the lowest risk of dying from heart disease and stroke, even after accounting for factors such as frailty that could potentially moderate the benefits of aggressive blood pressure management. They also found that systolic blood pressure even in the range of 145 held significant cardiovascular disease mortality risk for these patients.

Balancing blood pressure management in the elderly

While these results challenge earlier suggestions that higher blood pressure might be acceptable in this age group, Lu emphasizes the importance of individualized care. “Blood pressure management in this age group should involve thoughtful conversations between patients and their physicians,” she explains. “It’s essential to consider each patient’s overall health, potential side effects, and personal preferences.”

Although the study found that lower blood pressure was associated with reduced cardiovascular mortality, Lu cautions that given the multiple comorbidities in very elderly patients, antihypertensive medications may increase the risk of additional complications—factors that need to be carefully weighed when making treatment decisions.

“Physicians need to engage in shared decision making and consider the full medical history of the patient. Starting medication slowly and closely monitoring their patient’s progress and symptoms as they reach blood pressure targets may help find the right balance,” says Lu, who is also an assistant professor of biomedical informatics and data science at YSM and of chronic disease epidemiology at Yale School of Public Health. “If there are no side effects, the benefits may outweigh the risks. If there are side effects, physicians may need to reassess and weigh the trade-offs.”

Ultimately, Lu believes that both this shared decision-making and follow-up research in the form of randomized control trials will be important moving forward.

“These findings provide evidence and support for more aggressive treatment among elderly patients, but at the same time, we also want to raise the point that the treatment decision would need to be personalized for frail patients and those with multiple comorbidities,” Lu says.

Other Yale co-authors include Huanhuan Yang, PhD; Chenxi Huang, PhD; Mitsuaki Sawano, MD, PhD; Jeph Herrin, PhD; Erica S. Spatz, MD; and Harlan M. Krumholz, MD.

The research reported in this news article was supported by the National Heart, Blood, and Lung Institute (award R01HL169954) and Yale University. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

A recent study from Yale School of Medicine suggests that intensive blood pressure management may benefit adults aged 80 and older, a group often excluded from clinical trials. The study analyzed data from over 1,500 patients and found that those with systolic blood pressure below 130 had the lowest risk of cardiovascular mortality. Despite concerns about side effects, the findings challenge previous beliefs that higher blood pressure might be acceptable for the very elderly. The study emphasizes the need for individualized care and shared decision-making in managing hypertension in this population.

New research suggests intensive blood pressure management may significantly benefit adults aged 80 and older, challenging previous treatment assumptions.

Lower Blood Pressure May Offer Benefits Even for the Very Elderly

Nearly half of all adults in the United States are living with hypertension, or blood pressure above 130/80 mmHg. Despite its prevalence, managing high blood pressure 

remains a major challenge in healthcare settings

Hypertension management can be challenging for a number of reasons, explains Benjamin Gallagher, MD, a hypertension specialist and assistant professor of medicine at Yale School of Medicine (YSM). Aside from difficulties patients may have sticking to their recommended medication regimens, clinicians 

 regarding complicated hypertension cases.

For these reasons, Gallagher and his colleagues have been working over the past two years to address this issue by developing a 

 for internal medicine residents at YSM. The curriculum covers advanced topics in hypertension management, including hypertensive urgency, a condition marked by blood pressure over 180/110 mmHg but without damage to vital organs.

Recently, Gallagher, along with Donna Windish, MD, MPH, professor of medicine (general medicine) at YSM, and Natasha Cigarroa, MD, hospital resident at Yale New Haven Hospital, tested how the curriculum impacted residents’ treatment of hypertensive urgency in the outpatient setting. The 

Modifying hypertensive urgency management

The study involved 104 residents who see patients at the New Haven Primary Care Consortium. While all residents received background training on hypertension, only some of them received the hypertensive urgency curriculum, which involved a half-day workshop with lectures and educational materials. Gallagher and his colleagues then compared residents’ notes from appointments with patients diagnosed with hypertensive urgency and measured the frequency of appropriate clinical actions taken by residents from each group. The research team found that the curriculum had a positive impact on residents’ performance: those who received the new curriculum were more likely to increase their patients’ blood pressure medications and/or counsel their patients on medication adherence.

“We were able to show a small but meaningful change in clinicians’ behavior as a result of an educational intervention,” Gallagher says. “At least for a brief period of time after residents received this curriculum on hypertensive urgency, there was an uptick in appropriate management of that condition.”

Given the high incidence of hypertension and how difficult it is to manage, the curriculum could be a helpful tool not only for residents, but also for highly experienced clinicians, including those who might already feel confident in their hypertension management skills, Gallagher says. In fact, a version of the curriculum is available online through the 

Society of General Internal Medicine’s learning portal, GIMlearn

There were some challenges associated with introducing the specialized curriculum, Gallagher notes. “How do you convince people that they need to learn more about something that they think they already know how to do well—and do that without antagonizing or belittling them and making them feel like they are inexperienced?” Gallagher adds. “A lot of the aspects of the curriculum were about protocolized care, using easy-to-follow protocols and couching it in a way of trying to make things easier for clinicians.”

Hypertension affects nearly half of U.S. adults, posing significant management challenges. To address this, a specialized curriculum for internal medicine residents at Yale School of Medicine was developed, focusing on advanced hypertension management, including hypertensive urgency. A study involving 104 residents demonstrated that those who received the curriculum showed improved management of hypertensive urgency, such as increased medication adjustments and patient counseling. The curriculum, available online, aims to enhance clinicians' skills without undermining their confidence, emphasizing protocolized care to simplify clinical decision-making.

New research tested how specialized hypertennsion medical curriculum impacted residents’ treatment of hypertensive urgency in the outpatient setting.