Out-of-Pocket Costs Rival Vomiting in GLP-1 Discontinuation
“Whereas diabetes is routinely covered by insurance, and therefore we can get a good indication of how people are using GLP-1s in that space from claims data, we need to look to other data sources to get the full picture for the weight loss treatment,” Alison Sexton Ward said, Medscape reported on November 15.
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Key Clinical Takeaways:
- Out-of-pocket expenses above $50 monthly nearly triple the hazard ratio for stopping GLP-1 therapy compared with having zero copay.
- Patients prescribed GLP-1 receptor agonists solely for weight loss face higher discontinuation rates and frequently access medications through cash-pay markets, online sources, or compounding pharmacies.
- Baseline diabetes diagnosis acts as a protective factor against discontinuing the medications, whereas vomiting and financial strain accelerate drop-off rates.
Survey Data Reveals Cash-Pay Realities
Out-of-pocket costs rival vomiting as a primary reason patients stop taking GLP-1 receptor agonists, according to survey data presented at Obesity Week 2026. Previous claims-based analyses showed that between 24% and 65% of patients discontinue these therapies within the first year. However, those insurance-based datasets frequently miss individuals who pay cash for weight-loss indications.
Ward, a scholar and research scientist at the University of Southern California’s Schaeffer Institute and Center, El Dorado Hills, California, explained that the cash-pay market remains largely invisible in traditional pharmacy claims.
To capture a more complete picture, Ward and her colleagues utilized data from the nationally representative Understanding America Study. Established by USC in 2014, the panel includes 15,000 active members and tracks insured individuals, cash-paying patients, and those receiving manufacturer discounts through rolling monthly surveys.
Access Divides Between Diabetes and Weight Loss
The fall and winter 2025 survey queried 9,139 respondents, identifying 1,256 individuals who reported current or past GLP-1 use. Nearly half of those users took the medications primarily for weight loss rather than diabetes. Substantial disparities emerged regarding how these two patient populations accessed their treatments and secured financial coverage.
Among participants managing diabetes, 97% held health insurance coverage for GLP-1 medications, with 61% paying a copay and 36% receiving the drugs without a copay. Conversely, among individuals using the medications strictly for weight loss, 43% reported zero insurance coverage, 34% faced an active copay, and 23% had no-copay coverage. Prescribing pathways also diverged significantly between the two cohorts.
“What we see right away is that our concerns about claims data are confirmed, and there is a difference in the access story between people using these drugs for weight loss vs diabetes,” Ward said.
While 96% of the diabetes group obtained prescriptions through primary care or specialty clinicians, only 33% of the weight-loss-only group relied on traditional providers. Retail pharmacies filled 97% of diabetes prescriptions, compared with 59% for the weight-loss group, with the remainder turning to compounding pharmacies, online vendors, or foreign sources.
Efficacy versus Financial Hurdles
Discontinuation rates recorded in the survey reached 12.8% at 6 months, 22.1% at 12 months, and 33.4% at 24 months. These figures trend lower than many conventional claims analyses because the panel successfully captures cash-paying populations. Weight tracking data showed that participants utilizing GLP-1s solely for weight loss shed approximately 19% of their baseline body weight, outperforming the 14% average weight loss observed in the diabetes cohort.
“Discontinuation…was not due to a lack of efficacy,” Ward said. Fully adjusted statistical models revealed that an out-of-pocket expense ranging from $1 to $50 per month increased the hazard ratio for discontinuation to 1.8 compared with a zero copay.
Costs scaling to $51 or greater per month elevated the hazard ratio to 2.7. Vomiting presented a hazard ratio of 2.1, while using the drug primarily for weight loss carried a hazard ratio of 1.5. Having a baseline diabetes diagnosis reduced the likelihood of stopping treatment, registering a protective 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 said.
Clinical Perspectives on Patient Drop-Off
“I thought the study provided really good insight. We see that with our patients too — that many drop out because of cost,” Douglas Maready, MD, chief medical officer at Forte-Well Being in Phoenix, told Medscape Medical News.
“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.”
Disclaimer: The information provided in this article is for educational and scientific communication purposes only and does not constitute medical advice. Always consult with a qualified healthcare provider regarding any medical condition, diagnosis, or treatment plan.