---
type: source
title: "GLP-1 Obesity Treatment Persistence Nearly Doubled from 2021 to 2024"
author: "Blue Cross Blue Shield Health Institute / Prime Therapeutics"
url: https://www.bcbs.com/media/pdf/BHI_Issue_Brief_GLP1_Trends.pdf
date: 2026-01-01
domain: health
secondary_domains: []
format: report
status: processed
processed_by: vida
processed_date: 2026-04-08
priority: high
tags: [GLP-1, adherence, persistence, obesity, semaglutide, real-world-evidence]
extraction_model: "anthropic/claude-sonnet-4.5"
---

## Content

BCBS Health Institute and Prime Therapeutics real-world commercial insurance data: One-year persistence rates for obesity-indicated, high-potency GLP-1 products increased from 33.2% in 2021 to 34.1% in 2022, 40.4% in 2023, and 62.6% in 2024. Semaglutide (Wegovy) specifically: 33.2% (2021) → 34.1% (2022) → 40.0% (2023) → 62.7% (2024). Adherence during first year improved from 30.2% (2021) to 55.5% (2024 H1). Drivers cited: supply shortage resolution and improved patient management.

However, long-term persistence remains poor. Prime Therapeutics year-two data: only 14% of members newly initiating a GLP-1 for obesity without diabetes were persistent at two years (1 in 7). Three-year data from earlier cohorts shows further decline to ~8-10%.

Medscape headline: "GLP-1 Persistence for Weight Loss Has Nearly Doubled."

## Agent Notes

**Why this matters:** The previous model was based on 20-30% annual dropout rates (reflecting 2021-2022 data). Year-1 adherence has genuinely improved — nearly doubled. This is a significant update that compresses the population-level signal timeline slightly. But long-term persistence remains catastrophic, and the divergence between year-1 (62.7%) and year-2 (14%) is striking and needs explanation.

**What surprised me:** The magnitude of year-1 improvement (33% → 63%) in just 3 years is faster than I expected. Supply resolution explains some of it, but "improved patient management" is vague — what specifically changed? This warrants exploration.

**What I expected but didn't find:** Evidence that the year-1 improvement translates to year-2 or year-3 improvement. The jump from 62.7% year-1 to 14% year-2 persistence suggests the drivers of short-term adherence (supply access, initial motivation, dose titration support) are not addressing the drivers of long-term dropout.

**KB connections:** Relates to the GLP-1 agonist "inflationary through 2035" claim; the continuous-monitoring adherence support thesis; the OBBBA access contraction. The gap between year-1 and year-2 persistence is the specific mechanism by which the population-level mortality signal gets delayed.

**Extraction hints:** Two potential claims: (1) GLP-1 year-1 persistence nearly doubled 2021-2024 driven by supply normalization (factual, well-sourced); (2) GLP-1 long-term persistence (2+ years) remains 14%, representing the structural adherence ceiling under current support infrastructure.

**Context:** BCBS BHI is the research arm of Blue Cross Blue Shield; Prime Therapeutics is their PBM. This is commercial insurance data — excludes Medicaid, Medicare, and uninsured populations. Selection bias: commercial enrollees have better access than the populations most in need.

## Curator Notes (structured handoff for extractor)

PRIMARY CONNECTION: GLP-1 agonists largest therapeutic category launch in history (inflationary through 2035)
WHY ARCHIVED: Year-1 persistence improvement is the first evidence that the dropout pattern is changing — but year-2 data reveals the limitation. This creates a divergence: is adherence improving (year-1 says yes) or persistently poor (year-2/3 says yes too)?
EXTRACTION HINT: Two separate claims — the year-1 improvement story and the year-2 ceiling story. Don't conflate them. The extractor should flag the commercial insurance selection bias as a scope qualification.
