3 barriers to GLP-1 adherence — and how systems are overcoming them

Health systems are finding that the biggest challenge with GLP-1 medications isn’t starting patients on therapy — it’s keeping them on it.

During a panel at Becker’s Spring Chief Pharmacy Officer Summit, pharmacy and physician leaders said adherence has emerged as one of the most persistent gaps tied to GLP-1 use, with implications for both patient outcomes and long-term costs.

“If we do not have that discussion, then you put a patient on an expensive, life-changing medication and they’re not adherent,” Girish Kaimal, PharmD, vice president of pharmacy at Parkview Health in Fort Wayne, Ind., said.

That gap is not unique to any one system. Here are three barriers to adherence — and how organizations are responding:

1. Patients discontinue therapy early

Research increasingly shows that a majority of patients discontinue GLP-1 therapies within the first year, with rates exceeding 60% in some populations and even higher among patients without diabetes.

Leaders said the reasons are consistent across settings: cost, side effects and lack of sustained support.

At Kaiser Permanente in Oakland, Calif., Associate Executive Director Maisha Draves, MD, said many patients stop treatment within one to two years — even after initially seeking out the medication.

Among patients who remain on therapy, without consistent follow-up, some may stay on lower doses or fail to titrate appropriately, reducing the potential long-term benefit of the medication.

“We really find that you need that high touch over the first 60 to 90 days,” Dr. Draves said.

That early window has become a focal point for many systems. Leaders said managing side effects, supporting dose escalation and maintaining engagement during that period are critical to achieving meaningful outcomes.

In practice, that has entailed building more structured onboarding processes — including scheduled follow-up visits, pharmacist check-ins and standardized titration protocols — rather than leaving patients to navigate early treatment on their own.

2. Care models incompatible with sustained support

For many organizations, adherence challenges are exposing a broader issue: GLP-1s cannot be managed as a one-time prescription.

“This is not transactional,” Thomas Carey, PharmD, senior director of pharmacy at UW Health in Madison, Wis., said. Instead, he described the need for continuous coordination. “It’s financial, it’s clinical, it’s operational,” he added.

In light of that, expanding the role of pharmacy has proven a strategic lever. At Kaiser Permanente, clinical pharmacists help initiate therapy, manage titration and maintain regular follow-up with patients — helping close gaps that traditional care models often leave unaddressed, Dr. Draves said.

Other organizations are building more coordinated workflows across care teams, integrating pharmacy, primary care and specialists to ensure patients don’t fall through gaps between visits, panelists said. Some are also leveraging digital tools — such as patient portals, automated reminders and remote monitoring — to maintain consistent touchpoints between appointments and flag adherence issues earlier.

3. Cost and side effects deter patients

Affordability remains one of the most persistent threats to adherence, particularly as coverage varies widely across payers and indications.

“Adherence is not just, ‘does the patient want to take the medication?’” Dr. Kaimal said. “It’s, ‘Can the patient afford to take that medication?’”

In response, panelists said their organizations are expanding financial navigation support, helping patients access manufacturer assistance programs or adjust therapy based on coverage changes.

At the same time, gastrointestinal side effects such as nausea and vomiting continue to drive early discontinuation. Leaders said they are implementing more proactive side-effect management — including earlier intervention, dose adjustments and patient education — to keep patients on therapy.

However, even when patients do discontinue, the long-term impact remains uncertain. Some transition to alternative treatments, while others regain weight or lose metabolic benefits.

“These are 10-year questions,” Dr. Draves said, referring to whether GLP-1s ultimately reduce downstream conditions like cardiovascular disease or improve long-term outcomes.

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