---
type: claim
domain: health
description: "Within the GLP-1 class, semaglutide shows 2.5x better one-year persistence than liraglutide (47.1% vs 19.2%), suggesting formulation and dosing frequency significantly impact real-world adherence independent of efficacy"
confidence: likely
source: "Journal of Managed Care & Specialty Pharmacy, Real-world Persistence and Adherence to GLP-1 RAs Among Obese Commercially Insured Adults Without Diabetes, 2024-08-01"
created: 2026-03-11
related: ["semaglutide-reduces-kidney-disease-progression-24-percent-and-delays-dialysis-creating-largest-per-patient-cost-savings", "GLP-1 long-term persistence remains structurally limited at 14 percent by year two despite year-one improvements", "GLP-1 year-one persistence for obesity nearly doubled from 2021 to 2024 driven by supply normalization and improved patient management", "semaglutide-achieves-47-percent-one-year-persistence-versus-19-percent-for-liraglutide-showing-drug-specific-adherence-variation-of-2-5x", "glp1-year-one-persistence-doubled-2021-2024-supply-normalization", "glp-1-persistence-drops-to-15-percent-at-two-years-for-non-diabetic-obesity-patients-undermining-chronic-use-economics", "glp1-long-term-persistence-ceiling-14-percent-year-two", "semaglutide-outperforms-tirzepatide-cardiovascular-outcomes-despite-inferior-weight-loss-suggesting-glp1r-specific-cardiac-mechanism"]
reweave_edges: ["semaglutide-reduces-kidney-disease-progression-24-percent-and-delays-dialysis-creating-largest-per-patient-cost-savings|related|2026-04-04", "GLP-1 long-term persistence remains structurally limited at 14 percent by year two despite year-one improvements|related|2026-04-09", "GLP-1 year-one persistence for obesity nearly doubled from 2021 to 2024 driven by supply normalization and improved patient management|related|2026-04-09"]
sourced_from: ["inbox/archive/health/2024-08-01-jmcp-glp1-persistence-adherence-commercial-populations.md"]
---

# Semaglutide achieves 47 percent one-year persistence versus 19 percent for liraglutide showing drug-specific adherence variation of 2.5x

Within the GLP-1 receptor agonist class, drug-specific persistence rates vary dramatically: semaglutide maintains 47.1% of non-diabetic obesity patients at one year, while liraglutide retains only 19.2%—a 2.5x difference.

This variation matters because it suggests adherence is not purely about the drug class mechanism or patient characteristics, but about formulation factors: semaglutide's once-weekly injection versus liraglutide's daily injection likely drives much of the difference. Oral formulations (like oral semaglutide) may further improve adherence by removing the injection barrier entirely.

For payer economics and value-based care design, this means drug selection within the GLP-1 class significantly impacts the probability that downstream savings will materialize. A plan that preferentially covers liraglutide for cost reasons may be optimizing for upfront price while guaranteeing that 80% of patients discontinue before benefits accrue.

## Evidence

**One-year persistence rates by drug (non-diabetic obesity patients):**
- Semaglutide: 47.1%
- Liraglutide: 19.2%
- Overall class average: 32.3%

**Likely mechanism:**
- Semaglutide: once-weekly subcutaneous injection
- Liraglutide: daily subcutaneous injection
- Injection frequency is a known adherence barrier across therapeutic classes

**Implications for formulary design:**
If a payer's goal is to maximize the probability of sustained adherence (and thus downstream ROI), preferencing higher-persistence drugs may justify higher upfront costs. The relevant comparison is not semaglutide cost vs. liraglutide cost, but (semaglutide cost × 47% persistence) vs. (liraglutide cost × 19% persistence).

---

Relevant Notes:
- [[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]]
- [[value-based care transitions stall at the payment boundary because 60 percent of payments touch value metrics but only 14 percent bear full risk]]

Topics:
- domains/health/_map

## Extending Evidence

**Source:** JMCP 2026 Medicaid study

Tirzepatide shows 71.7% 6-month persistence vs semaglutide 56.5% in Medicaid population — a 15 percentage point gap. This is larger than the previously documented semaglutide-liraglutide gap and occurs in the most cost-constrained population, suggesting the persistence advantage may be driven by superior tolerability/efficacy rather than selection bias alone. However, 6-month data only — 12-month durability unknown.
