(P42-33-26) Bridging Evidence and Practice: A Scoping Review Protocol on Access to GLP-1 Receptor Agonists for Obesity in the United States

Objectives: This scoping review systematically examines barriers to access to glucagon-like peptide-1 receptor agonists (GLP-1 RAs) for obesity among adults in the United States. The objectives are to characterize insurance coverage policies across commercial, Medicare, Medicaid, and employer-sponsored plans; identify patient-, provider-, and system-level barriers to initiation and sustained use; and map translational gaps between clinical evidence, policy decision-making, and equitable real-world implementation.

Methods: This study will be conducted in accordance with the PRISMA-ScR framework. A comprehensive literature search was performed using PubMed, Scopus, and CINAHL. Eligible sources include peer-reviewed empirical studies and policy analyses focused on adults with obesity in the U.S. Studies primarily addressing pediatric populations, or non-U.S. contexts, are excluded. Three reviewers will independently screen titles, abstracts, and full texts. In cases where consensus cannot be reached, a senior author will adjudicate. Data extraction will capture payer coverage criteria, cost-sharing requirements, utilization management strategies, patient experiences of access and affordability, provider prescribing constraints, and system-level implementation challenges. Findings will be synthesized narratively and interpreted through a complexity science lens, conceptualizing access as an emergent outcome of interactions among patients, clinicians, payers, policymakers, and wider societal forces.

Results: This scoping review is expected to potentially identify heterogeneity in coverage policies across payer types, elucidate multi-level barriers affecting initiation and persistence of GLP-1 RA therapy, and uncover persistent translational gaps between robust clinical trial evidence and access. The synthesis may clarify how insurance design, administrative burden, affordability, stigma, and public narratives interact to produce inequitable patterns of access.

Conclusions: This protocol outlines a systematic approach to synthesizing U.S.-based evidence on access to a novel pharmacologic obesity treatment. The resulting review is expected to inform policy, implementation strategies, and future research aimed at integrating GLP-1 RAs into equitable, evidence-based obesity care.

Funding Sources: No external funding