GLP-1 RA Adherence Shows Drop-Off After 1 Year

More than half of glucagon-like peptide-1 receptor agonist (GLP-1 RA) users stopped utilization after only 1 year in a recent population-based study of semaglutide discontinuation in Denmark.¹ The study is being presented at the 2025 European Association for the Study of Diabetes in Vienna, Austria (September 15-19).

The surge in GLP-1 RA usage for weight loss, although originally developed for diabetes, is a result of its efficiency in reducing appetite and increasing satiety signals from the gut to the brain.² However, the FDA-approved GLP-1 RA drugs for weight loss (semaglutide [Wegovy], liraglutide [Saxenda], and tirzepatide [Zepbound]) can cost up to $1300 or more for a month’s supply without insurance, potentially widening health disparities for those in marginalized communities.^2,3 As of 2024, health insurance companies are not required to and may not cover GLP-1 RA drugs for weight loss unless a patient has an obesity-related medical reason, such as high cholesterol or high blood pressure, the National Association of Insurance Commissioners reported.³

A recent study in Denmark showed first time GLP-1 users discontunied use after the just 1 year. | Image Credit: @Patrick Bay Damsted-Adobestock.png

Furthermore, Medicare and Medicaid do not currently cover GLP-1 RA drugs for weight loss; the Trump administration rejected former President Joe Biden’s 2026 proposed rule for Medicare Part D prescriptions, which would have recognized anti-obesity medication coverage under Medicare.⁴ Therefore, people without an obesity-related medical condition would have to pay out-of-pocket monthly costs for the drug, which researchers also associated with the high discontinuation rates.¹

“In Denmark, people pay out of their own pockets, and colleagues showed that there's a massive bias that those who earn more are far more likely to use these drugs compared to poor ones,” senior author Reimar W. Thomsen, PhD, from the Department of Clinical Epidemiology at Aarhus University Hospital in Aarhus, Denmark, said in an interview with The American Journal of Managed Care^®. “I also think people with more money and resources are probably better at being on the drug, not discontinuing, tolerating side effects, and continuously being able to pay for the drugs.”

Of the 77,310 first-time users of semaglutide included in the study, over half (n = 40,262; median age, 50 years; 72% women) stopped taking it after 1 year. More specifically, 18%, 31%, and 42% stopped treatment within 3, 6, and 9 months, respectively. Researchers compiled data from Denmark’s nationwide health registries using health data from adults 18 years or older without diabetes and who initiated treatment between December 1, 2022, and October 1, 2023—when the drug launched in Denmark.²

Reasons for Discontinuation

The study analysis found that among younger users aged 18 to 29 years, 48% were more likely to discontinue usage within the first year compared with those aged 45 to 59 years. Similarly, users in low-income areas were 14% more likely to discontinue use within the first year compared with users in higher-income areas.²

Researchers assume that age and income factors associated with discontinuation are likely due to the high costs of the medication. As of June 2025, the study reported out-of-pocket costs for the lowest dose of semaglutide were €2000, or approximately US$2350 to $2360.

In addition to costs, patients who experienced adverse effects of anti-obesity medication, specifically those who previously took gastrointestinal medication, were 9% more likely to discontinue use within the first year. Those who had taken gastrointestinal medication were more susceptible to common adverse gastrointestinal effects like nausea, vomiting, and diarrhea. People who also had a history of psychiatric medication were 12% more likely and those living with cardiovascular disease or other chronic conditions were 10% more likely to discontinue use within the first year.

“I think there's clearly an association between those who can tolerate some side effects, who are resilient and compliant, and then lose a lot of weight and have success,” Thomsen said.

People on low doses are more likely to be able to handle the adverse effects, Thomsen said; however, their weight loss is not as significant, which in turn encourages them to request a higher dosage, but then they may be unable to cope with the adverse effects, leading them to discontinue usage.

“I think it's a mix of things,” Thomsen said. “Having the side effects but also being disappointed due to a combination of maybe not feeling well and not losing the weight. It’s clearly not as easy a treatment.”

The study had several limitations, including the lack of detailed clinical data such as exact body mass index, individual income, insurance coverage, and out-of-pocket costs, which could influence the findings. Milder adverse effects and other reasons for treatment discontinuation were also likely underestimated because registry data cannot fully capture them. Additionally, the researchers did not have information on actual weight loss outcomes after starting semaglutide, limiting assessment of treatment effectiveness.

Thomsen emphasized the need for familial and physician support as well as clarity, especially when it comes to adverse effects, in order to increase long-term adherence. However, he also expressed that the popularity of the drug has overwhelmed family physicians in Denmark due to the needed resources to keep up with patient requests and continuous counseling to encourage long-term adherence. Overall, there is still a need for more research to further understand such a high drop-off rate of anti-obesity medication usage.

“We can see people who have some vulnerability to side effects, previously had some gastro levels or some mental illness, may be more vulnerable to side effects,” he said. “You need different kinds of research, qualitative research, following patients, and finding out what's going on. That type of research will be important in predicting poor [adherence].”

References

1. Mailhac A, Pedersen L, Petersen I, Pottegård A, Sørensen HT, Thomsen RW. Discontinuation of semaglutide therapy for weight loss: population-based study of the first 77,310 users in Denmark. Presented at: European Association for the Study of Diabetes (EASD) Annual Meeting; September 15-19, 2025; Vienna, Austria.

2. Easdnews. Half of people stop taking popular weight-loss drugs within a year, a national study finds. EurekAlert! Accessed September 15, 2025. https://www.eurekalert.org/news-releases/1097806

3. Does insurance cover prescription weight loss injectables? NAIC. August 31, 2024. Accessed September 15, 2025. https://content.naic.org/article/does-insurance-cover-prescription-weight-loss-injectables

4. Anti-obesity drugs will not be covered by Medicare and Medicaid in 2026. American College of Gastroenterology. April 17, 2025. Accessed September 16, 2025. https://gi.org/2025/04/17/anti-obesity-drugs-will-not-be-covered-by-medicare-and-medicaid-in-2026/