---
type: claim
domain: health
description: "Two-year real-world data shows only 15% of non-diabetic obesity patients remain on GLP-1s, meaning most patients discontinue before downstream health benefits can materialize to offset drug costs"
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
depends_on: ["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"]
---

# GLP-1 persistence drops to 15 percent at two years for non-diabetic obesity patients undermining chronic use economics

Real-world claims data from 125,474 commercially insured patients initiating GLP-1 receptor agonists for obesity (without type 2 diabetes) reveals a persistence curve that fundamentally challenges the economic model: 46.3% remain on treatment at 180 days, 32.3% at one year, and approximately 15% at two years.

This creates a paradox for payer economics. The "chronic use inflation" concern assumes patients stay on GLP-1s indefinitely at $2,940+ annually. But the actual problem may be insufficient persistence: under capitation, a Medicare Advantage plan pays for 12 months of GLP-1 therapy for a patient who discontinues and regains weight—net cost with no downstream savings from avoided complications.

The economics only work if adherence is sustained AND the payer captures downstream benefits. With 85% of non-diabetic patients discontinuing by two years, the downstream cardiovascular and metabolic savings that justify the cost never materialize for most patients.

## Evidence

**Persistence rates for non-diabetic obesity patients:**
- 180 days: 46.3%
- 1 year: 32.3%
- 2 years: ~15%

**Comparison with diabetic patients:**
- Non-diabetic patients: 67.7% discontinue within 1 year
- Diabetic patients: 46.5% discontinue within 1 year (better persistence due to stronger clinical indication)
- Danish registry data: 21.2% of T2D patients discontinue within 12 months; ~70% discontinue within 2 years

**Drug-specific variation:**
- Semaglutide: 47.1% persistence at 1 year (highest)
- Liraglutide: 19.2% persistence at 1 year (lowest)
- Formulation matters: oral formulations may improve adherence by removing injection barrier

**Key discontinuation factors:**
- Insufficient weight loss (clinical disappointment)
- Income level (lower income → higher discontinuation, suggesting affordability/access barriers)
- Adverse events (primarily GI side effects)
- Insurance coverage changes

**Critical nuance from source:** "Outcomes approach trial-level results when focusing on highly adherent patients. The adherence problem is not that the drugs don't work—it's that most patients don't stay on them."

## Challenges

This data comes from commercially insured populations (younger, fewer comorbidities than Medicare). Medicare populations may show different persistence patterns due to higher disease burden and stronger clinical indications. However, Medicare patients also face higher cost-sharing barriers, which could worsen adherence.

No data yet on whether payment model affects persistence—does being in an MA plan with care coordination improve adherence vs. fee-for-service? This is directly relevant to value-based care design.


### Additional Evidence (extend)
*Source: [[2025-12-23-cms-balance-model-glp1-obesity-coverage]] | Added: 2026-03-16*

The BALANCE Model directly addresses low persistence by mandating lifestyle supports alongside GLP-1 coverage. CMS is testing whether behavioral interventions can sustain metabolic benefits after medication discontinuation, potentially solving the adherence problem that makes GLP-1s inflationary under current coverage models.

---

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]]
- [[medical care explains only 10-20 percent of health outcomes because behavioral social and genetic factors dominate as four independent methodologies confirm]]

Topics:
- domains/health/_map