Many patients discontinue and reinitiate GLP-1 drugs

February 18, 2025

Time to discontinuation of GLP-1 medications

Time to reinitiation of GLP-1 medication

Source: Rodriguez, PJ JAMA Network Open January 31, 2025

A large observational study using de-identified electronic health record data for over 125,000 patients who newly began GLP-1 medications for either diabetes or obesity shows that a majority of those who started these medications discontinued them in the first two years.

Those with higher incomes and those under 55 were less likely to stop the medications, and those with obesity were more likely to stop the medications than those with diabetes. This could be because those with obesity had a more difficult time obtaining insurance benefits for these expensive medications. Those who complained of gastrointestinal adverse effects were also more likely to discontinue these medications. Those who lost more weight were less likely to discontinue the medications.

Many of those who discontinued GLP-1 medications went back on these drugs within the two-year observation window. Forty-seven percent of those with diabetes who discontinued this drug class went back on them, as did 36% of those treated with GLP-1s for obesity. Those who regained weight after discontinuation of GLP-1 medications were more likely to restart the medications.

The researchers noted that this study might have overestimated voluntary GLP-1 discontinuation as some might have stopped filling prescriptions due to shortages, and others might have moved to compounded drugs. They also noted that clinical notes often reflected the role played by cost in discontinuation.

Implications for employers:

• This research confirms findings of other research that has used only medical claims.

• GLP-1 drugs could exacerbate existing disparities if those with higher incomes are more likely to maintain prescriptions, especially as obesity is more common among those with lower wages.

• Weight fluctuations from dietary interventions (“yo-yo” dieting) historically led to worsening obesity; we do not know if this will be true with on-again, off-again GLP-1 medications.

• For employers that want to allow members to “trial” GLP-1s, (starting, stopping, and starting again), they can confirm prior authorization requirements allow for continuation of therapy to avoid incentivizing members to stay on these meds even if they want to discontinue treatment on a trial basis.

Tomorrow: Insurer medical loss ratios are high