“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,” Alison Sexton Ward, PhD, a scholar and research scientist at the University of Southern California’s Schaeffer Institute and Center, El Dorado Hills, California, told Medscape.
Out-of-pocket costs are one of the strongest drivers of discontinuing GLP-1 medications, while having a diabetes diagnosis predicts staying on the drugs, according to survey data presented at Obesity Week 2026. Previous studies show that between 24% and 65% of patients who start GLP-1 receptor agonist medications stop taking them within the first year. Most of those earlier figures relied on pharmacy claims data that miss cash-paying patients.
Ward and her colleagues used data from the nationally representative Understanding America Study, established by USC in 2014. The survey tracks active panel members, capturing insured individuals, cash-pay patients, and those using manufacturer discounts. Surveys go out monthly, with participants answering detailed questions about GLP-1 experiences starting in November 2025.
Access Differences in Diabetes and Weight Loss Patients
Of 9,139 respondents in the fall and winter 2025 survey, 1,256 reported ever using a GLP-1. Nearly half of those users took the medications mainly for weight loss rather than diabetes. Another 945 respondents stated they were interested in GLP-1s but not currently using them.
Insurance coverage varied sharply between the two groups in the data. Among respondents with diabetes, 97% had health insurance coverage for GLP-1s, with 61% paying a copay and 36% having zero copay. For participants using the drugs strictly for weight loss, 43% had no insurance coverage at all, 34% had coverage with a copay, and 23% had no copay.
“What we see right away is that our concerns about claims data are confirmed, and there is a difference in the access story between people using these drugs for weight loss vs diabetes,” Ward noted.
Prescribing patterns also split along diagnostic lines. Primary care or specialty clinicians wrote 96% of prescriptions for patients with diabetes. By contrast, 33% of patients using GLP-1s solely for weight loss obtained their prescriptions from nontraditional clinicians.
Retail pharmacies filled 97% of prescriptions for the diabetes group. Only 59% of the weight-loss only group used retail pharmacies, while 14% used compounding pharmacies, 12% relied on online or foreign sources, and the rest turned elsewhere.
Weight Loss Efficacy Versus Dropout Realities
Participants tracking weight loss lost about 19% of their body weight over two years. Those managing diabetes lost about 14% of their body weight over the same period.
“Discontinuation…was not due to a lack of efficacy,” Ward said.
Overall GLP-1 discontinuation rates landed at 12.8% at 6 months, 22.1% at 12 months, and 33.4% at 24 months. These figures sit lower than many claims data analyses because the survey captures the cash-pay population.
Fully adjusted models showed that the strongest predictor of stopping GLP-1 treatment was having an out-of-pocket cost of $51 or greater per month compared to having no copay, yielding a hazard ratio of 2.7. Vomiting followed with a hazard ratio of 2.1, and out-of-pocket costs between $1 and $50 per month produced a hazard ratio of 1.8. Using the drug for weight loss as the main indication carried a hazard ratio of 1.5.
Having a baseline diabetes diagnosis proved protective 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.
“I thought the study provided really good insight,” Douglas Maready, MD, chief medical officer at Forte-Well Being in Phoenix, a preventive and lifestyle medicine practice, told Medscape Medical News. “We see that with our patients too — that many drop out because of cost.”
“Moreover, we actually see it at the front end too,” Maready noted. “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.”
Common Questions About GLP-1 Discontinuation
Why do cash-pay patients stop taking GLP-1 medications more often than insured diabetes patients?
Cash-pay patients face significantly higher out-of-pocket expenses because weight loss indications lack the broad insurance coverage that diabetes treatments receive. The survey found that out-of-pocket costs exceeding $51 per month triple the likelihood of discontinuing treatment.
How does the Understanding America Study differ from pharmacy claims data?
Traditional pharmacy claims databases only capture insured individuals who fill prescriptions through standard retail channels. The Understanding America Study captures uninsured individuals, cash-pay patients, and those using manufacturer discounts or compounding and online pharmacies.
What were the exact discontinuation rates tracked in the survey?
Discontinuation rates reached 12.8% at 6 months, 22.1% at 12 months, and 33.4% at 24 months among survey respondents.
Where do weight-loss patients obtain their prescriptions compared to diabetes patients?
While 96% of diabetes patients get prescriptions from primary care or specialty clinicians and fill them at retail pharmacies, 33% of weight-loss users turn to nontraditional clinicians, with 14% using compounding pharmacies and 12% utilizing online or foreign sources.
Ward reported no relevant financial relationships. Maready is a speaker for Novo Nordisk, Eli Lilly and Company, and IntraSana.