EMBRACING CHANGE
Kentucky : The Ozempic Capital of the Nation
In an odd quirk of events , Kentucky is now recognized as having the greatest use of Glucagon-like peptide-1 ( GLP- 1 ) agonists per capita in the country . 1 , 2 Kentucky is not the heaviest state . The Commonwealth data indicates that Kentucky ranks eighth in the obesity table , with 36 % of male Kentuckians and 32.5 % of females considered to be obese . 3 GLP-1 agonists were originally developed as part of step therapy for diabetes . But Kentucky is in seventh place for adults with diabetes . Even though Kentucky is in the top 20 % of states for diabetes and for obesity , the ranking of use of GLP-1 agonists seems out of proportion . IRIS by Real Chemistry , an industry market intelligence platform , places Kentucky with 1.9 % of all patients – regardless of weight – as using a GLP-1 agonist ! 4
So how did Kentucky get the reputation of the “ Ozempic Capital ?” First , that appellation was a media inspiration . In actuality , for specific indications there is coverage in Kentucky for drugs other than Ozempic ( see box below ).
KY Medicaid Coverage 4 Diabetes Indication Obesity-Indication
Ozempic ( semaglutide )
Mounjaro ( tirzepatide )
Rybesus ( semaglutide )
Wegovy ( semaglutide )
Ye s
Ye s
Ye s
Ye s
12 LOUISVILLE MEDICINE
No
No
No
KY Medicaid
Saxenda ( liraglutide ) No No
Zepound ( tirzepatide )
No
No Victoza ( liraglutide ) Ye s No
by TOM JAMES , MD
There are a number of factors leading to the high rate of GLP-1 prescriptions . These include :
a .)
b .)
Diabetes Rates — The GLP-1 agonists along with the sodium-glucose cotransporter-2 inhibitors ( SGLT-2 ) have assumed a greater degree of importance in the management of Type 2 diabetes . In the 2025 Standards of Care by the American Diabetes Association , the use of GLP-1 drugs as well as the SGLT-2 drugs has taken over an earlier position in the diabetes management criteria . These drugs are now considered first line agents for those with Type 2 diabetes and at high risk of cardiovascular disease . The American Diabetes Foundation ( ADA ) continues to stress that diet , exercise and weight management are the cornerstones for diabetes management except for those with very high cardiovascular risk factors . So , where diabetes is highly prevalent , we would expect a corresponding increase in prescribing these agents . Diabetes rates do not explain Kentucky ’ s # 1 ranking for GLP-1 prescriptions .
Obesity Rates — While the GLP-1 family of drugs were being developed for diabetes , studies in the 1980s showed weight loss resulted from earlier satiety . Liraglutide received the first FDA approval for treatment of obesity in 2014 . The approval of semiglutide ( Ozempic ) in 2017 for diabetes was followed four years later for the approval of semaglutide ( as Wegovy ) for weight loss . Since so many people with obesity also have glucose instability , all of the semaglutide formulations have seen rapid growth . While most public and private insurers cover the GLP-1 agonists for diabetes , most do not cover the obesity indication . Since Kentucky has a high percentage of the population who are obese , it is not unexpected to see more prescriptions for GLP-1 agonist prescriptions . But again , the obesity standing does not explain the high ranking for Kentucky . Access to prescribers — In communities with more prescribers , especially in primary care , there is greater access for care and less reduction in prescribing . On the other hand ,