Out-of-pocket costs drive patients to stop glucagon-like peptide-1 receptor agonists just as frequently as adverse gastrointestinal side effects like vomiting, according to survey data presented at Obesity Week 2026.
While previous analyses have relied on pharmacy claims data capturing insured populations, new findings from the Understanding America Study provide a broader look at discontinuation patterns across both insured and cash-paying cohorts. The research highlights a stark divide in access and discontinuation predictors between patients treating type 2 diabetes and those utilizing the therapies strictly for chronic weight management.
High Costs Drive Medication Discontinuation More than Side Effects
- Cost over side effects: Financial expenses of $51 or more per month create a higher dropout hazard than physical adverse events such as vomiting.
- Insurance disparities: Patients using these medications for weight loss face significantly higher out-of-pocket hurdles and reliance on nontraditional prescribers than individuals treated for diabetes.
- Efficacy is not the issue: Discontinuation frequently occurs despite substantial therapeutic weight reduction, pointing to economic rather than pharmacological barriers.
Access and Prescription Sources Diverge by Indication
Among 9,139 respondents in the fall and winter 2025 survey, 1,256 individuals reported past or current use of a GLP-1 receptor agonist, with 48.6% taking the medication primarily for weight loss rather than glycemic control. Study investigator Alison Sexton Ward, PhD, a research scientist at the University of Southern California’s Schaeffer Institute and Center, detailed the findings, Medscape reported.
“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,” Ward said.
Disparities in insurance coverage dictated where and how patients obtained their prescriptions. Among respondents with diabetes, 97% held health insurance coverage for GLP-1s, with 61% paying a copay and 36% paying nothing. Conversely, 43% of patients utilizing the drugs solely for weight loss lacked insurance coverage entirely, while 34% had a copay and 23% had zero copay.
Prescribing channels also diverged between cohorts. While 96% of diabetes-related prescriptions originated from primary care physicians or specialists, 33% of weight-loss-only users acquired prescriptions through nontraditional clinicians. Furthermore, 97% of the diabetes group filled prescriptions at traditional retail pharmacies, compared with 59% of the weight-loss cohort, with the remainder relying on compounding pharmacies or online and foreign sources.
Weight Loss Success Fails to Prevent Discontinuation
Despite high dropout rates, clinical efficacy among continuing users stayed high. Over a two-year tracking window, participants using GLP-1s for weight loss achieved an average body weight reduction of approximately 19%, compared with roughly 14% among those managing diabetes. “Discontinuation…was not due to a lack of efficacy,” Ward said.
Overall discontinuation rates in the survey cohort reached 12.8% at 6 months, 22.1% at 12 months, and 33.4% at 24 months. Fully adjusted multivariate analysis identified an out-of-pocket expense of $51 or more monthly as the single strongest predictor of cessation, yielding a hazard ratio of 2.7 compared with zero copay.
Vomiting followed with a hazard ratio of 2.1, while costs between $1 and $50 monthly yielded a hazard ratio of 1.8, and weight loss as the primary indication carried a hazard ratio of 1.5. Baseline diagnosis of diabetes served as a protective factor against stopping treatment, registering 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, according to Medscape.
| Discontinuation Predictor | Comparison Group | Hazard Ratio (HR) |
|---|---|---|
| Out-of-pocket cost $51+ / month | vs. No copay | 2.7 |
| Vomiting side effect | vs. No vomiting | 2.1 |
| Out-of-pocket cost $1-$50 / month | vs. No copay | 1.8 |
| Weight loss as primary indication | vs. Diabetes indication | 1.5 |
| Baseline diabetes diagnosis | vs. No diabetes | 0.5 |
Clinical Perspectives on Patient Retention
External clinical specialists observed that financial friction influences treatment trajectories before patients even initiate therapy. Douglas Maready, MD, chief medical officer at Forte-Well Being in Phoenix, evaluated the findings for Medscape Medical News.
“I thought the study provided really good insight. We see that with our patients too — that many drop out because of cost,” Maready told Medscape. He added, “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.”
