GEOFF BENNETT: We return now to our series exploring GLP-1 medications, tonight, a look at the challenges around access.

Despite some recent improvements, millions of Americans still face significant barriers to affording these powerful drugs.

So, many patients have found alternative, cheaper ways to get their hands on unregulated versions.

Stephanie Sy has the story, part of our GLP-1s: Reshaping America series.

STEPHANIE SY: Robin Washington does her best these days to keep up with her 2-year-old grandson.

ROBIN WASHINGTON, Maryland Resident: He keeps me on my toes, but by the time it's time to go to bed, I'm done.

ROBIN WASHINGTON: And when he takes a nap, sometimes, I take a nap.

W for what?

STEPHANIE SY: For the 67-year-old, that exhaustion is a reminder of a nearly lifelong struggle with her weight.

ROBIN WASHINGTON: I had my second kid, and then that's when I could not get the weight off.

I weigh like, what, 255?

If I could just get past the 200.

(LAUGHTER) STEPHANIE SY: In the past few years, Washington started hearing a lot about weight loss medications like Ozempic and Wegovy.

ROBIN WASHINGTON: I know it's a big fad, kind of, but it's not a fad.

It's really a revolution.

Yes, we have corn back there.

STEPHANIE SY: She wondered whether the drugs could jump-start her weight loss and help ward off future health problems like diabetes.

So she asked her doctor about them.

ROBIN WASHINGTON: She said, yes, that's an option.

She gave me some names, brand names, and I looked them up on the app for my insurance.

And it came up not covered, not covered, not covered.

And then she -- so then I asked her, how much would it be a month?

And she was like $1,000, $1,500.

I was like, whoa.

STEPHANIE SY: So that was a nonstarter.

ROBIN WASHINGTON: Yes, right.

That was like, oh, well.

CHARLES BARKLEY, Former NBA Player: I have lost 45 pounds.

STEPHANIE SY: Now, amid a sea of celebrity endorsements and before-and-after photos online, Washington thinks GLP-1s have become another example of America's haves and have-nots.

Despite a high prevalence of obesity, Black Americans were almost 50 percent less likely to be on obesity medications like GLP-1s than white Americans.

But issues with access and affordability are widespread.

Out of an estimated 30 million American adults currently on a GLP-1, more than half said paying for the medication is difficult.

RYAN DEWALT, Former GLP-1 User: I was at the time unemployed and on -- literally on having to make a decision between taking care of my family or getting the medication.

MELANIE BARRETO, GLP-1 User: I am going through bankruptcy.

I haven't filed yet, but I do have a lawyer.

For the quality of life change that I have had by being on this drug, to me, it's really worth going through any financial challenges.

LIONEL LENOIR, Former GLP-1 User: It makes total sense that you get to the point where you're willing to do anything just to be a little more comfortable in your own skin.

STEPHANIE SY: Most insurance plans still cover GLP-1s for conditions like type 2 diabetes.

But as more and more people get on the drugs, companies are dropping coverage for weight loss, citing soaring costs.

By one estimate, the number of employers covering GLP-1s for obesity fell 17 percent over just the last year.

DR.

BETTY WANG, BW Primary Care: The carve-outs are going to remove the ones who are on the edge.

But the problem at hand is that there are lots of people with prediabetes and other clues who should have access to this medication.

STEPHANIE SY: Dr.

Betty Wang is one of the co-founders of BW Primary Care, a practice outside Baltimore where Robin Washington is a patient.

Right now, about half of the calls coming into the clinic are from people curious about GLP-1s.

Discussions about access and cost can be all-consuming and frustrating.

NARRATOR: Get started for a lower price.

DR.

BETTY WANG: Often, a person will come in with a sound bite or a coupon in hand thinking it's going to be a very quick conversation and that it's going to be something like $25 a month.

We have seen people be irate, almost to the point of being very upset with us, as if we have more control in the process than we do.

STEPHANIE SY: At the same time, many Americans are finding easy access to GLP-1s, especially to compounded versions of the drug they can get through telemedicine.

These less expensive options, which can have the same active ingredient as the brand names, but are often mixed with other substances, are not approved by the Food and Drug Administration.

SALLY BRALLIER, GLP-1 User: It was very easy.

Just went online, answered maybe 10 questions about your health.

As far as I know, nobody checked to see if I was telling the truth or not.

RYAN MILLIKEN, GLP-1 User: It was very surprising.

I was expecting a consultation with a lot of medical history being discussed.

That was all absent.

It felt almost as though they were trying to get me through the process as quickly as possible.

STEPHANIE SY: Now, this is really different.

But another avenue has emerged for getting cheaper GLP-1s, the so-called gray market.

ELIZABETH ZIBILICH, GLP-1 User: This is the Tirzepatide.

This is a 10 milligram vial.

STEPHANIE SY: Elizabeth Zibilich is among the thousands of people who currently mix their own GLP-1s at home.

ELIZABETH ZIBILICH: I go slow because it tends to dissolve a little bit easier that way.

STEPHANIE SY: Zibilich buys peptide powder from China, labeled for research purposes only, not human consumption, and mixes it with sterile water before injecting herself once a week.

ELIZABETH ZIBILICH: You really don't feel it because it's such a small needle.

STEPHANIE SY: That's it.

ELIZABETH ZIBILICH: And that's it.

STEPHANIE SY: In 2015, Zibilich was hit by a truck while crossing the street.

She suffered a serious back injury, which led to weight gain.

At one point, she reached nearly 430 pounds.

She underwent bariatric surgery, which helped her lose weight and keep it off for years, but the weight came back during the pandemic.

So, at this point, you talk to your doctor?

ELIZABETH ZIBILICH: I did.

We decided to try Ozempic.

I lost 20 or so pounds, finally feeling like I'm getting on track.

And then, because I am on Medicaid, it was ripped away from me.

Medicaid at that time in Louisiana was only covering GLP-1 for type 2 diabetes.

STEPHANIE SY: So, at that point, you're starting to game out like, what, how am I going to get this?

Like, are you feeling like this is -- this drug is so important in your life that you have got to find a way to keep... ELIZABETH ZIBILICH: At that point, I was starting to give up.

STEPHANIE SY: After about nine months off Ozempic, Zibilich, a self-employed artist, discovered the gray market.

She's now paying about $100 a month, far less than the up to $500 she'd pay for a brand name GLP-1.

ELIZABETH ZIBILICH: I go through a friend who orders it for several people.

They are not doing it to make money.

They're not doing it for their own benefit.

They are doing it to help others.

And the batches that they get, they will have it tested so that you can see, is it truly this thing?

ELIZABETH ZIBILICH: And we have not had any trouble any time.

STEPHANIE SY: The FDA has warned that products on the gray market are illegally sold and of unknown quality and may be harmful to consumers' health.

But Zibilich has been on this version for over two years and has kept the weight off.

Do you wish that you did not have to go through the gray market?

ELIZABETH ZIBILICH: I do.

But this was for my health.

If I had continued again on that path after I gained another 100 pounds back during COVID, I was going to die.

STEPHANIE SY: Yes.

ELIZABETH ZIBILICH: More people with access to this means healthier bodies.

WOMAN: How are you?

ROBIN WASHINGTON: I'm good.

How are you?

WOMAN: Good.

STEPHANIE SY: Back in Maryland, Robin Washington found out she's eligible for a national pilot program that allows certain Medicare recipients to access GLP-1s for $50 a month.

We followed Washington to her appointment at BW Primary Care, when she finally received her first injection of Zepbound.

How does it feel to all of a sudden be there at the point?

ROBIN WASHINGTON: It was crazy.

I'm glad that I was able to have that chance, because, like I said, I thought I wasn't going to be able to do it.

That's very good.

STEPHANIE SY: In just three weeks, she lost about five pounds, saw her blood pressure drop, and had less inflammation in her knees.

But Washington is aware that the Medicare pilot program is set to end next year.

And since most people lose the benefits of these drugs when they stop taking them, she knows she may be right back where she started.

For the "PBS News Hour," I'm Stephanie Sy.

GEOFF BENNETT: Tomorrow night, our series continues with a look at the promise GLP-1s have shown in treating addiction.