Out-of-pocket costs drive discontinuation rates for GLP-1 receptor agonists, while a diabetes diagnosis predicts longer treatment adherence, according to survey data presented at Obesity Week 2026, Medscape reported.
Between 24% and 65% of patients stop taking GLP-1 medications within the first year of starting them. Traditional pharmacy claims data frequently miss these trends because they rely primarily on insured individuals, leaving out cash-pay patients who purchase weight loss treatments without insurance coverage.
“Whereas it’s traditional and perhaps most appropriate to use pharmacy claims data to examine patients’ uptake and discontinuation of most therapies, when we look to GLP-1s, especially for treating obesity, many people don’t have insurance coverage, and so they won’t be in those claims,” said Alison Sexton Ward, PhD, a research scientist at the University of Southern California’s Schaeffer Institute and Center, El Dorado Hills, California.
Ward and her colleagues evaluated data from the nationally representative Understanding America Study (UAS) to capture insured individuals, cash-pay patients, and those using manufacturer discounts. The analysis reviewed responses from 9,139 participants gathered during the fall and winter of 2025.
Access and Prescribing Differences by Condition
The survey data revealed distinct disparities between patients taking GLP-1s for diabetes and those taking them exclusively for weight loss. Of the respondents who reported using the medications, 48.6% took them mainly for weight loss, while the remainder used them for diabetes management.
Insurance coverage varied sharply between the two groups. Among patients with diabetes, 97% had insurance coverage for GLP-1 drugs, with 61% paying a copay and 36% receiving coverage without a copay. For patients using the medications solely for weight loss, 43% lacked insurance coverage entirely, 34% had coverage with a copay, and 23% had coverage with no copay.
Prescribing patterns also differed across indications. Primary care or specialty clinicians wrote 96% of prescriptions for patients with diabetes, and 97% of those patients filled their medications at retail pharmacies. By contrast, 33% of patients using GLP-1s for weight loss obtained their prescriptions from nontraditional clinicians, while 14% used compounding pharmacies and 12% relied on online or foreign sources.
Weight Loss Outcomes Versus Dropout Rates
Over a two-year period, patients using GLP-1s for weight loss lost roughly 19% of their body weight, compared with a 14% weight reduction among patients with diabetes. Overall discontinuation rates across the study population stood at 12.8% at 6 months, 22.1% at 12 months, and 33.4% at 24 months.
Adjusted statistical models identified an out-of-pocket cost of $51 or more per month as the strongest predictor of stopping the therapy, yielding a hazard ratio of 2.7 compared with having no copay.
Experiencing vomiting produced a hazard ratio of 2.1, while a monthly copay between $1 and $50 carried a hazard ratio of 1.8. Using the drug primarily for weight loss carried a hazard ratio of 1.5. Conversely, a baseline diagnosis of diabetes functioned as a protective factor against discontinuation, with a hazard ratio of 0.5.
“If we want to expand access, we need to push for policies that are going to increase insurance coverage and reduce out of pocket costs,” Ward concluded.
Clinician Observations on Patient Retention
“I thought the study provided really good insight. We see that with our patients too — that many drop out because of cost,” said Douglas Maready, MD, chief medical officer at Forte-Well Being in Phoenix, a preventive and lifestyle medicine practice.
“We actually see it at the front end too. Patients who know they’re going to have a copay or know they don’t have coverage don’t start it in the first place. So, it is a huge issue,” Maready told Medscape Medical News.
How Many Panel Members Participate and How Many Use GLP-1s?
How many active panel members participate in the Understanding America Study?
The Understanding America Study, established by the University of Southern California in 2014, maintains 15,000 active panel members who complete surveys on a rolling basis.
What percentage of survey respondents reported current or past GLP-1 use?
Out of 9,139 respondents in the fall and winter 2025 survey wave, 1,256 participants, or 13.7%, reported that they had ever used a GLP-1 medication.
How many survey respondents were interested in GLP-1s without using them?
An additional 945 respondents, representing 10.3% of the survey sample, said that they were interested in GLP-1 medications but were not currently using them.
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