Health System Pharmacies Keep Patients on GLP-1 Therapy

Patients receiving injectable glucagon-like peptide-1 receptor agonist (GLP-1 RA) therapy through integrated health system specialty pharmacies (HSSPs) stayed on treatment at far higher rates and started it faster than is typical in real-world practice, according to 2 posters from Shields Health Solutions and partner health systems.^1,2

Real-world persistence with GLP-1 RAs and dual GLP-1/glucose-dependent insulinotropic polypeptide (GIP) RAs has been poor. In a retrospective cohort of more than 125,000 US adults with overweight or obesity, nearly half of patients with type 2 diabetes (T2D) and about two-thirds of those without it discontinued within 1 year.³ Cost, access barriers, and adverse effects are common drivers, and HSSPs, which embed pharmacists and care liaisons in the treatment process, are positioned to address each, the poster authors wrote.¹

Just 3.9% Stopped Therapy Within the First Year at NYU Langone

The first poster evaluated treatment-naive adults newly started on injectable liraglutide, semaglutide, dulaglutide, or tirzepatide for T2D, obesity, or overweight with at least 1 comorbidity at the NYU Langone Health Specialty Pharmacy between August 2022 and May 2025. Patients were enrolled in a structured pharmacist service with clinical onboarding on day 1, reassessments at months 1 and 6, and ongoing engagement after that, with care liaisons following up between visits. Discontinuation was defined as 70 or more days without medication on hand; switching agents without such a gap counted as continuous treatment.

Of 2943 patients (mean age, 49.6 years; 66% female; 83.4% commercially insured), 115 (3.9%) discontinued within the first year. Most patients (87%) had a diagnosis of obesity. Discontinuation rates were 25% for liraglutide, 6.1% for semaglutide, 5.9% for dulaglutide, and 1.8% for tirzepatide, although the liraglutide and dulaglutide groups included only 20 and 17 patients, respectively.

Among patients who stopped, the median time to discontinuation was 93 days, from 28 days for dulaglutide to 175 days for liraglutide. That is shorter than the 176-day median reported in a large cohort study, which the authors attributed partly to their smaller sample, shorter study window, and medication shortages during the study period.

“What we found was a much lower 1-year discontinuation rate than what’s been reported in broader real-world studies,” said study author Sophy Levine, PharmD, an ambulatory care clinical pharmacist at Shields Health Solutions, in an interview with The American Journal of Managed Care^® (AJMC^®). “This suggests that coordinated specialty pharmacist services may help support medication persistence through improved access, patient support, and ongoing follow-up.”

Median of 5 Days From Prescription to First Fill

The second poster examined 1707 adults receiving semaglutide or tirzepatide for obesity through an integrated HSSP between September 2024 and August 2025, including both new starts and patients transferring from outside pharmacies.² Tirzepatide (Zepbound; Eli Lilly) accounted for 65% of dispensed brands and semaglutide (Wegovy; Eli Lilly) for 29%.

The median time from prescription receipt to first dispense was 5 days. Of all first fills, 62 occurred the same day, and 1000 (58.6%) occurred within 5 days; 147 (8.6%) took more than 15 days.

Prior authorization was required for 95% of patients, and the pharmacy completed submissions and documentation on the prescriber's behalf. The median patient out-of-pocket cost was $24.98. The mean proportion of days covered was 95%, well above the 80% benchmark for chronic disease management, and pharmacists' clinical interventions were accepted 99% of the time.

“A closed-loop pharmacist intervention includes trying to proactively detect barriers that a patient can experience in the journey of receiving their medications, as well as documenting those barriers, right, and making recommendations, but not just that—we don’t stop there,” said Adaolisa Anaka, PharmD, BCACP, AAHIVP, clinical pharmacist, Shields Health Solutions, in an interview with AJMC. “We also follow through with the process to make sure that those recommendations actually move the patient forward to receiving their treatment.”

Together, the posters suggest that coordinated specialty pharmacy services, spanning prior authorization support, cost mitigation, and longitudinal pharmacist follow-up, may address the access and persistence gaps that have limited GLP-1 therapy in practice. Both analyses were retrospective, drew on single-organization data, and lacked a comparator group, and the authors called for further research into predictors of discontinuation, the effect of pharmacist-led interventions on long-term adherence, and remaining barriers to timely access.

References

1. Levine S, Shemesh YA, Wojciechowski K, et al. Discontinuation of GLP-1 and GLP-1/GIP receptor agonists among adults with type 2 diabetes, overweight or obesity. Poster presented at: NASP inSPire2026; September 22-25, 2026; National Harbor, MD.
2. Anaka A, Lindner C, Stutsky M, Periyasamy S. Health system specialty pharmacy supports access and adherence for GLP-1 receptor agonists for patients with obesity. Poster presented at: NASP inSPire2026; September 22-25, 2026; National Harbor, MD.
3. Rodriguez PJ, Zhang V, Gratzl S, et al. Discontinuation and reinitiation of dual-labeled GLP-1 receptor agonists among US adults with overweight or obesity. JAMA Netw Open. 2025;8(1):e2457349. doi:10.1001/jamanetworkopen.2024.57349