The data: Most patients who got prescribed a GLP-1 for the first time in 2023 or 2024 ended up discontinuing treatment before long, and many never filled their prescription at all, according to a November 2025 IQVIA analysis of GLP-1 prescription claims.

Among patients newly prescribed GLP-1s for obesity, 90% either never start their therapy or drop off within a year. This includes people who never filled their initial prescription and those who filled a GLP-1 prescription but stopped refilling at some point throughout the year.

• Just 30% of patients filled their first GLP-1 obesity prescription.
• 19% of obesity GLP-1 users filled only a single prescription, referred to in the pharma space as “one and done.”
• Among obesity GLP-1 patients who do fill their first prescription, 32% are still taking their medication 13 months later.

What’s driving the trend: Cost-related insurance barriers and patients feeling that they’ve lost enough weight are primary factors limiting long-term GLP-1 adherence.

• Nearly half (48%) of patients’ health plans failed to approve a GLP-1 the first time their doctor prescribed it for weight loss.
• GLP-1 abandonment rises sharply as out-of-pocket costs increase—once costs exceed $500, drop-off rates surge, IQVIA’s data showed. Many plans don’t cover GLP-1s for weight loss, and those that do often have strict coverage restrictions.
• Behavioral factors, including hitting weight goals and perceived stigma, also lower adherence rates, per IQVIA.
• An Evernorth survey earlier this year found that concerns over side effects, no longer needing the medication, and cost issues were the top reasons patients discontinued their GLP-1 regimens.

Implications for GLP-1 drugmakers and pharmacies: The two dominant weight loss drug makers, Novo Nordisk and Eli Lilly, have mostly figured out how to meet escalating consumer demand for GLP-1s. But they haven’t solved the challenge of medication nonadherence and keeping patients on these medications for more than a year or two. (It’s worth noting that pharma companies across most drug categories struggle with patients taking their prescribed medications.)

Using their direct-to-consumer online pharmacies can improve adherence, giving the drugmakers clearer insights into why patients don’t fill or refill prescriptions to offer targeted support.

Beyond that, drugmakers should work with their telehealth partners and commonly used pharmacies to give patients resources on managing side effects, navigating insurance issues, and understanding why maintenance dosing remains important after achieving some weight loss.