Two-tiered access to GLP-1 agonists
GLP-1 is a hormone that helps regulate blood sugar levels. Weight-loss treatments based on the hormone have the potential to play a pivotal role in the future management of obesity. Demand for these treatments has soared in recent years, fuelled in part by social media and celebrity influencers.
In the UK, however, National Health Service-funded access is limited. In December 2024, there were 500,000 people taking semaglutide and tirzepatide in the UK – of these, 95% were buying the medications privately at a cost of around £150 a month.
The pace of national roll-out has been slow, and intentionally so, with UK health bodies seeking to ration access over concerns that intense demand could overwhelm the health system in terms of both capacity and cost. In 2024, NHS England requested a phased approach to the roll-out of tirzepatide over a maximum 12-year period, to allow time for service providers to put staffing, training and resource capacity in place. In response, the National Institute for Health and Care Excellence has restricted access to just 220,000 (out of an eligible population of 3.4 million in England) over the first three years of tirzepatide roll-out. According to the Obesity Health Alliance (OHA), the NHS has projected that fewer than 50,000 people per year will receive semaglutide by 2028, despite the eligible population for this treatment being 4.1 million people.
The UK is not alone in its approach to accommodating the surge in demand for GLP-1 weight-loss treatments. In Germany, weight-loss medicines are not reimbursed by the national insurance system – which covers approximately 90% of the population – nor by private insurance companies. This means they can only be accessed by people paying out of pocket. The situation in similar in France, which has opted not to cover the treatments through its national insurance programme.
Health inequalities are being exacerbated
For many people, paying privately for weight-loss treatments is simply not an option. With low-income families already disproportionately at risk of obesity, this raises serious concerns that the two-tiered system of access to GLP-1 agonists will widen the gap in health outcomes between the wealthiest and the poorest people, at least in the short term. This concern has been echoed by a number of professional groups and charities, including the UK Royal College of Physicians and the OHA.
