Low GLP-1 Discontinuation in Specialty Pharmacy: Sophy Levine, PharmD

Many patients who start glucagon-like peptide-1 (GLP-1) receptor agonist therapy stop within the first year, limiting the long-term benefit of treatment. A poster presented at the National Association of Specialty Pharmacy (NASP) inSPire2026 conference by Sophy Levine, PharmD, an ambulatory care clinical pharmacist at Shields Health Solutions, examined real-world discontinuation of injectable incretin therapies in an integrated health system specialty pharmacy (HSSP). It also explored how that care model may help patients stay on treatment.

The primary outcome was the percentage of patients who discontinued a newly started injectable GLP-1 within 1 year. Discontinuation was defined as 70 or more days without medication on hand. The 1-year discontinuation rate was 3.9%, substantially lower than rates reported in broader real-world studies.¹ Levine pointed to 2 features of the integrated HSSP model that may explain the difference.

The first is streamlined access. Pharmacists and care liaisons work directly with health system providers and payers on prior authorizations and coverage issues, which can prevent the treatment gaps that often lead to discontinuation. The second is structured clinical follow-up from onboarding onward. Regular touchpoints give the team a chance to address adverse effects, tolerability, and patient questions early, before they become reasons to stop.

“Our clinical teams are closely connected to health systems and specialty pharmacies, allowing our pharmacists and care liaisons to help patients navigate access barriers and help them stay on therapy,” said Levine. “Additionally, there’s proactive, ongoing clinical follow-up.”

The analysis also compared once-weekly tirzepatide with once-daily liraglutide. Differences in dosing frequency, when each drug entered the market, and cohort size may all influence persistence. However, the liraglutide group included only 20 patients, and Levine cautioned against overinterpreting results for that subgroup.

Taken together, the findings suggest GLP-1 persistence is shaped by several factors at once: medication characteristics, when patients started therapy, and the access and follow-up support an integrated specialty pharmacy provides.

Reference

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, 2025; National Harbor, MD.