LONDON, UNITED KINGDOM – OCTOBER 21: A photo illustration of a woman with an Ozempic (semaglutide) injection pen. (Photo by Peter Dazeley/Getty Images)
Peter Dazeley
High patient out-of-pocket costs and side effects are causing a large percentage of people who start on weight loss medications to stop. But a rather sobering account last week shows how most people who stop taking the drugs regain their weight and lose other benefits they saw while on the medicines.
STAT News cited a recently published British Medical Journal review of 37 studies, tallying an aggregate of more than 9,300 participants, in which approximately 50% of the people who started on the drugs stop taking them within one year. The return to baseline weight occurred in an average of 1.7 years.
Weight regain wasn’t the only thing that happened after stopping GLP-1s. Researchers observed reversals in the positive effects from GLP-1s, including reduced cardiovascular risk, and lower blood sugar, cholesterol and blood pressure levels. Notably, the reversals are worse than what happens when people stop behavioral weight loss programs that aren’t based on pharmaceutical interventions.
In another study involving more than 96,000 patients initiating GLP-1s, 46% of patients with and 65% without Type 2 diabetes discontinued the drugs within one year.
About 1 in 8 adults in the U.S. say they’re currently taking one of 11 GLP-1s for weight loss or other indications like diabetes, according to the health policy group KFF. Glucagon-like peptide-1 is a naturally occurring gut hormone that regulates appetite, blood sugar, insulin and weight. The FDA label states that these medications are to be used with a reduced-calorie diet along with increased physical activity.
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Insurance coverage of GLP-1 medications for obesity has invariably been relatively poor across all markets, including commercial and Medicaid. (Medicare is prohibited by law from covering weight loss medications.) Insurers cite high costs as one reason for not covering obesity drugs. To illustrate, because of rising costs, five more Medicaid state agencies, including California’s MediCal, ended coverage of weight loss drugs per the first of this month. Other state Medicaid programs are considering similar moves.
Patients discontinuing GLP-1s is likely also driving insurers to avoid covering products in the first place or to drop coverage over time. Lack of patient adherence or persistence on the medications implies that for many patients, short-term gains in weight loss and other benefits could evaporate. Adherence refers to the extent to which a patient follows prescribed therapeutic recommendations or instructions on the label, while persistence is the duration of time a patient continues to take a medication without discontinuing it.
The pharmacy benefit manager Prime Therapeutics published an analysis last summer that highlights this ongoing challenge with respect to the real-world effectiveness over time of the GLP-1 drugs used to treat obesity: Most overweight or obese patients without diabetes stop treatment within the first few years.
Side effects are one contributing factor with respect to discontinuation. As many as 20% of patients may experience gastrointestinal problems, which include nausea, vomiting, bloating and diarrhea. Furthermore, clinical trials have reported that 35% to 45% of GLP-1 weight loss is not fat, but “lean mass” including muscle and bone.
And high patient out-of-pocket costs owing to lack of insurance coverage continues to be a substantial obstacle, limiting initial uptake and leading to discontinuation for some who do start. In a Cleveland Clinic study of patients who stopped a semaglutide (Ozempic, Wegovy) or tirzepatide (Zepbound) product, nearly half cited out-of-pocket cost as the primary reason.
As manufacturers’ direct-to-consumer alternatives have expanded, the cash-pay prices for obesity products have decreased considerably. Two makers of GLP-1s, Eli Lilly and Novo Nordisk, established direct-to-consumer programs to allow patients to buy the medicines without using insurance at prices as low as $149 for starter doses and between $250 and $375 for monthly maintenance doses.
There is now a rather bewildering array of DTC prices for patients seeking access to GLP-1s for weight loss. President Trump announced last fall that his administration reached agreements with drug manufacturers Novo Nordisk and Eli Lilly on lowering the price of certain obesity drugs on the TrumpRx online platform that launches this month. The blockbusters Zepbound and Wegovy will be sold directly to patients starting in January 2026 through the online portal, at prices starting on average at $345 a month. These prices are projected to come down to $250 by 2028. The website directs patients to drugmakers’ DTC portals. These options help cash-paying patients, say, in the deductible phase of their insurance, or those who are not insured (either no health insurance at all, or not insured for obesity medicines).
Nonetheless, even at heavily discounted prices, products such as Wegovy and Zepbound still remain unaffordable for many. And the steeper discounts aren’t (yet) leading to better insurance coverage. If anything, the opposite appears to be occurring.
Perhaps the launch last week of an oral pill version of Wegovy offering both convenience and a lower price could lead to some patients staying on their medications longer. But this is far from certain. It also remains to be seen if this somewhat cheaper medicine will lead to more insurers covering the product.