---
type: source
title: "Real-world Persistence and Adherence to GLP-1 RAs Among Obese Commercially Insured Adults Without Diabetes"
author: "Journal of Managed Care & Specialty Pharmacy"
url: https://www.jmcp.org/doi/10.18553/jmcp.2024.23332
date: 2024-08-01
domain: health
secondary_domains: []
format: paper
status: unprocessed
priority: high
tags: [glp-1, adherence, persistence, discontinuation, real-world-evidence, obesity]
---

## Content

Real-world claims study of 125,474 patients initiating GLP-1 RAs for obesity (without type 2 diabetes) using commercial insurance data.

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

**By specific drug:**
- Semaglutide: 47.1% at 1 year (highest)
- Liraglutide: 19.2% at 1 year (lowest)

**Comparison with diabetic patients:**
- Diabetic patients: 46.5% discontinue within 1 year (better than non-diabetic 64.8%)
- Danish registry: 21.2% discontinue within 12 months for T2D; ~70% discontinue within 2 years

**Key factors associated with discontinuation:**
- Insufficient weight loss
- Income level (lower income → higher discontinuation)
- Adverse events (GI side effects)
- Insurance coverage changes

**Crucial nuance:** 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.

## Agent Notes
**Why this matters:** Adherence is THE binding constraint for the GLP-1 economic thesis. If only 32.3% of non-diabetic patients are still on GLP-1s at 1 year and ~15% at 2 years, the downstream savings that justify the cost never materialize for most patients. Under capitation, an MA plan pays for 12 months of GLP-1 ($2,940 at $245/month) for a patient who discontinues and regains weight — net cost with no benefit.
**What surprised me:** The drug-specific variation is large — semaglutide at 47.1% vs. liraglutide at 19.2%. Oral formulations may change this further (removing injection barrier). The income correlation suggests access/affordability drives discontinuation as much as clinical factors.
**What I expected but didn't find:** No analysis of how payment model affects persistence. Does being in an MA plan with care coordination improve adherence vs. FFS? No data on whether lifestyle interventions alongside medication improve persistence (directly relevant to BALANCE model design).
**KB connections:** The existing GLP-1 claim cites 64.8% non-diabetic discontinuation at 1 year. This source provides the full persistence curve and the crucial 2-year data (15%).
**Extraction hints:** The extractor should consider: "GLP-1 persistence at 2 years is only 15% for non-diabetic obesity patients, meaning the chronic use model fails not because patients choose indefinite use but because most cannot sustain it." This reframes the "inflationary chronic use" concern — the actual problem may be insufficient chronic use.
**Context:** Commercial insurance population — different from Medicare (younger, fewer comorbidities). Medicare population may have different persistence patterns due to higher disease burden and stronger clinical indications.

## Curator Notes (structured handoff for extractor)
PRIMARY CONNECTION: [[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]]
WHY ARCHIVED: The persistence data reframes the economic argument — the "chronic use" problem may actually be an "insufficient persistence" problem. Most patients don't stay on long enough for downstream benefits to materialize.
EXTRACTION HINT: Focus on the paradox: chronic use makes GLP-1s expensive, but discontinuation eliminates the downstream savings that justify the cost. The economics only work if adherence is sustained AND the payer captures downstream savings.
