High discontinuation rates linked to cost, access and side-effects are putting the focus on multidisciplinary support after patients begin GLP-1 therapy.
Starting a glucagon-like peptide-1 medication is only the beginning, according to Brian Smith, chief pharmacy officer at Shields Health Solutions, who argues that the real measure of success comes from the support that follows the first prescription. In an interview with Drug Topics and in a recent episode of the “Over the Counter” podcast, Smith said patients do best when physicians, pharmacists, dietitians and nurses work together, giving people enough time, guidance and trust to stay on treatment and reach their goals.
That team-based approach matters because GLP-1 medicines have a high drop-off rate in the real world. Drug Topics reported that between 45% and 65% of patients stop treatment within the first year, while roughly three-quarters have discontinued by year two. The reasons are familiar: side-effects that are not managed well, insurance problems and monthly costs that can run to about $900 to $1,200. Cleveland Clinic researchers have reached a similar conclusion, finding that nearly half of patients who stopped GLP-1 treatment for obesity did so because of financial barriers, including insurance denials and unaffordable bills, while side-effects accounted for another significant share.
Pharmacists, Smith said, are central to preventing that pattern. Pharmacy Times has described them as the “operational glue” in GLP-1 care, because they help set expectations before the first dose, explain how to handle digestive side-effects and keep patients on track when access or affordability becomes difficult. That role is growing as demand for the drugs rises and clinicians need more support with dose escalation, medication checks and counselling around nutrition and chronic disease management.
The importance of persistence is echoed in a recent review in Nature, which found that real-world continuation of GLP-1 receptor agonists and tirzepatide remains poor for many patients with type 2 diabetes and obesity. The review warned that stopping treatment can lead to weight regain and worsening cardiometabolic risk factors, reinforcing Smith’s argument that success depends on more than writing the prescription. A separate retrospective study reported on medRxiv found that a multidisciplinary cardiology-pharmacy programme achieved high continuation rates among patients who stayed in follow-up, along with improvements in weight, blood pressure and haemoglobin A1C, suggesting that closer integration of pharmacy into care pathways can strengthen outcomes.
Disclaimer: This content is for informational purposes only and is not intended to be a substitute for professional medical judgment, advice, diagnosis, or treatment.
