Key takeaways
- GLP-1 prescriptions for patients with serious mental illness rose from 2.3% in 2018 to 13.7% in 2024, outstripping the general population.
- Patients with serious mental illness face significantly higher rates of obesity (42.9%) and type 2 diabetes (22.4%) than those without.
- The clinical surge reflects growing provider confidence after the FDA cleared GLP-1s of psychiatric warning labels in early 2026.
- Widespread insurance exclusions are pushing these high-risk psychiatric patients toward cash-pay telehealth and compounded alternatives.
What happened
A new analysis of U.S. insurance claims data reveals that GLP-1 receptor agonist prescriptions surged by approximately 500% among patients with serious mental illness (SMI) between 2018 and 2024. The study, published in JAMA Psychiatry, found that prescribing rates for patients with SMI who had an underlying metabolic condition rose from 2.3% to 13.7%, outstripping the prescribing growth seen in the general population.
Why it matters
This clinical shift highlights growing medical acceptance of medications like semaglutide (Ozempic, Wegovy) and tirzepatide (Mounjaro, Zepbound) for high-risk psychiatric patients. Individuals living with serious mental illness—such as major depressive disorder, bipolar disorder, and schizophrenia—frequently experience premature mortality driven by cardiovascular disease, which is often exacerbated by weight gain from antipsychotic medications.
While clinicians increasingly view GLP-1s as safe and highly beneficial for these patients, widespread insurance barriers and high out-of-pocket costs remain a massive hurdle. For patients whose commercial or employer-sponsored plans restrict coverage, this clinical shift is driving a growing number of individuals to seek out cash-pay telehealth options and compounded alternatives to secure treatment.
What the data says
The researchers, led by Emma McGinty, PhD, MS, of Weill Cornell Medicine, analyzed deidentified claims data from the Inovalon Insights database, which tracks more than 104 million commercial, Medicare Advantage, and Medicaid Managed Care beneficiaries across the United States.
Among patients with an underlying medical indication for a GLP-1 (such as type 2 diabetes, obesity, sleep apnea, or being overweight with a comorbidity), the data revealed distinct trends:
- SMI Group: GLP-1 prescription rates rose from 2.3% in 2018 to 13.7% in 2024.
- Non-SMI Group: Prescription rates rose from 1.8% in 2018 to 11.1% in 2024.
- The Schizophrenia Exception: Among patients specifically diagnosed with schizophrenia and diabetes, prescription rates rose from 3.4% to 19.4%, lagging behind the 23.1% rate seen in diabetic patients without an SMI.
The study also highlighted a disproportionately high burden of metabolic issues among the 14.1 million adults identified with serious mental illness. Compared to those without SMI, patients with SMI had much higher rates of:
- Obesity: 42.9% vs. 21.8%
- Type 2 Diabetes: 22.4% vs. 11.5%
- Sleep Apnea: 17% vs. 6.3%
How it compares
The massive rise in prescribing reflects a major shift in how the medical community views GLP-1 safety. In early 2024, the FDA initiated a preliminary review into potential suicidal ideation risks associated with these medications. However, after extensive safety evaluations, the FDA ultimately requested that drug manufacturers remove warning language regarding suicidal behavior and ideation from GLP-1 labels entirely in January 2026.
Despite clinical safety clearance, cost remains the primary barrier. Brand-name Wegovy and Zepbound carry U.S. list prices ranging from $1,000 to $1,350 per month. Even when patients have commercial insurance, many find their claims denied due to employer exclusions. This financial gap has made the cheapest telehealth GLP-1 services highly popular. On online provider platforms, cash-paying patients can access compounded semaglutide starting around $100 to $200 per month, or compounded tirzepatide starting around $200 to $320 per month, bypassing insurance altogether.
How this fits the bigger picture
This study adds to a growing body of evidence supporting the broad systemic benefits of GLP-1 therapies. We have previously detailed how clinical trials demonstrate that GLP-1s cut mental illness mortality by 24%, primarily through critical cardiovascular protections. Despite these life-saving benefits, the broader trend in the US healthcare landscape is one of restriction rather than expansion.
As metabolic drug costs rise, many payers are pulling back. Our coverage of how employers overhaul benefits as GLP-1 costs surge shows that rising costs are forcing companies to drop weight-loss coverage entirely. For patients with serious mental illness, who already face systemic barriers to receiving high-quality, guideline-concordant healthcare, these coverage cutbacks present a steep hurdle. When formal insurance fails, the direct-to-consumer compounded-vs-brand-name-semaglutide pathway becomes a vital alternative for maintaining access to therapy.
What happens next
Researchers noted that further study is urgently needed to track long-term GLP-1 treatment continuity among patients with serious mental illness. Because this insurance claims study did not capture out-of-pocket cash purchases, the true rate of GLP-1 utilization among this population may be even higher than reported.
Additionally, medical advocates continue to push for more equitable prescribing policies. While clinical guidelines increasingly support the use of GLP-1s alongside traditional psychiatric medications to manage medication-induced weight gain, solving the financial access puzzle remains the critical next step for US patients.
Disclaimer: CompareRx does not provide medical advice. Always consult with a licensed healthcare provider or psychiatric specialist before starting or changing any medication regimen.