---
type: source
title: "JMCP 2026: Real-World GLP-1 Medicaid Persistence 60.8% at 6 Months — Tirzepatide 71.7% vs Semaglutide 56.5%; Cost #1 Discontinuation Driver"
author: "Journal of Managed Care & Specialty Pharmacy"
url: https://www.jmcp.org/doi/full/10.18553/jmcp.2026.32.3.271
date: 2026-03-01
domain: health
secondary_domains: []
format: research-paper
status: unprocessed
priority: medium
tags: [GLP-1, Medicaid, persistence, adherence, semaglutide, tirzepatide, real-world-evidence, cost-barriers]
intake_tier: research-task
---

## Content

Real-world 6-month persistence and adherence data from a Medicaid population (JMCP, 2026, Vol. 32, No. 3).

**Persistence rates:**
- Overall GLP-1 (semaglutide): **60.8% at 6 months**
- GLP-1/GIP (tirzepatide): **60.1% at 6 months** (same overall)
- Tirzepatide specifically: **71.7% persistence** and **69.9% adherence**
- Semaglutide specifically: **56.5% persistence** and **55.9% adherence**

**Key driver of discontinuation:**
- **Cost is #1 reason for discontinuation**
- Financial barriers account for nearly half of all discontinuations in some cohorts
- Adverse effects and perceived lack of efficacy are secondary reasons

**Tirzepatide vs. semaglutide:**
- Tirzepatide has 15 percentage point higher persistence (71.7% vs 56.5%)
- Possible mechanism: tirzepatide's dual GLP-1/GIP mechanism may produce better tolerability and efficacy, reducing discontinuation
- OR: tirzepatide is newer (2023 approval) and attracts more motivated patients — selection bias possible

**Context:**
- Medicaid population (lower income, higher chronic disease burden)
- 6-month timeframe — not 12-month durability data
- Companion behavioral programs not measured in this study

## Agent Notes
**Why this matters:** This is the real-world Medicaid data showing that COST — not efficacy and not side effects — is the primary barrier to GLP-1 persistence. This directly challenges any framing that adherence failure is a patient behavior problem. The barrier is structural (drug price), not behavioral. This is also the lowest-income population data point — the most relevant for understanding population-health impact, since GLP-1 benefits the chronic disease populations that are also lower-income.

**What surprised me:** The 15 percentage point gap between tirzepatide (71.7%) and semaglutide (56.5%) in Medicaid. This is larger than I expected from a comparator study. If tirzepatide's better persistence translates to better outcomes in this population, the drug formulary/cost structure for Medicaid becomes a significant health equity issue.

**What I expected but didn't find:** 12-month data. The 6-month data is useful but the durability question (does anyone stay on >1 year in Medicaid?) remains unanswered here.

**KB connections:**
- [[GLP-1 receptor agonists are the largest therapeutic category launch in pharmaceutical history but their chronic use model makes the net cost impact inflationary through 2035]] — cost as #1 discontinuation reason is evidence the chronic use model isn't sticking in low-income populations
- SDOH interventions show strong ROI but adoption stalls because Z-code documentation remains below 3 percent — cost barrier to GLP-1 access is an SDOH problem (financial security = social determinant)
- medical care explains only 10-20 percent of health outcomes because behavioral social and genetic factors dominate — GLP-1 is one of the rare clinical interventions that addresses metabolic disease, but its impact is limited by access barriers that are fundamentally SDOH

**Extraction hints:**
- Consider enriching existing GLP-1 claim with this Medicaid persistence data and cost barrier finding
- The cost-as-barrier finding is politically significant: if cost is the primary driver, then drug price negotiation/rebate structure determines population health impact more than clinical factors
- The tirzepatide vs. semaglutide persistence gap (71.7% vs. 56.5%) could be a standalone claim if confirmed at 12 months

**Context:** First major Medicaid-population real-world GLP-1 persistence study. This population (low-income, high chronic burden) is the most affected by the GLP-1 cost problem. The data confirms what was suspected: those who most need the drug are least able to sustain access.

## Curator Notes (structured handoff for extractor)
PRIMARY CONNECTION: GLP-1 receptor agonists are the largest therapeutic category launch... — specifically the adherence/chronic use model problem
WHY ARCHIVED: Medicaid real-world persistence data is the most relevant population for understanding whether GLP-1 can address the population-level chronic disease burden; cost-as-barrier finding challenges any claim that adherence is primarily behavioral
EXTRACTION HINT: The structural insight is that cost — not behavior — determines persistence in the lowest-income, highest-chronic-disease population. This has policy implications (drug pricing, Medicaid formulary design) more than clinical implications.
