Getting patients started on GLP-1 therapies is easier than it was a year ago now that supply issues have improved. But another significant challenge persists: keeping patients on therapy. Many patients who fill their first prescription don’t make it to their third or fourth refill.
More than 38 million Americans live with diabetes—most with type 2. Another 84 million are at risk. During American Diabetes Month®, it’s time to ask: Why do so many patients abandon GLP-1 treatment early? And how can end-to-end engagement strategies improve patient adherence?
What’s Blocking Patient Adherence Now?
The GLP-1 shortages that dominated headlines from 2022 to 2024 have largely disappeared. By early 2025, both tirzepatide and semaglutide were removed from the FDA’s drug shortage list, as manufacturing caught up to demand.
That shift returns the focus to the remaining barriers. Two stand out: improving patient adherence and tackling the cost and coverage challenges that threaten long-term treatment success.
The Make-or-Break Window for Improving Patient Adherence
A 2024 JAMA Network Open study tracking 195,915 GLP-1 users managing type 2 diabetes or weight loss reveals that more than one-quarter (26%) of patients stopped therapy within the first three months. At the one-year mark, the treatment abandonment rate rose by another 10%.
Early wins build confidence, so the first 90 days are critical for long-term success. For instance, a study published in the Journal of Managed Care & Specialty Pharmacy found that patients who reduced A1c by more than 1% or lost over 3% of body weight in the first 3-6 months showed 45% adherence at 18 months. By comparison, among those without early success, only 37% were adherent.
Patients who see their blood sugar improve and feel better continue treatment. Those who don’t experience quick results often conclude that the therapy isn’t worth the side effects. The problem is that patients often abandon therapy too soon. Because doses are increased gradually to reduce side effects, patients may not feel benefits right away.
Patients need to understand what to expect and how to manage side effects. They need reassurance that experiencing nausea in week two doesn’t mean it will continue through week 12. Engaging patients right after prescribing with personalized texts that offer educational resources can give them the peace of mind they need to keep going.
Coverage and Cost Barriers Expand
Even as supply issues receded, coverage challenges intensified—particularly for Medicare beneficiaries who represent a sizable portion of the type 2 diabetes population.
Administrative Hurdles Add Delays
Recent JAMA research published in October 2025 reveals that prior authorization (PA) requirements for GLP-1s became nearly universal (97%) across Medicare Part D plans. For providers and their patients, this means inevitable delays between prescribing and first fill.
Cost Pressures Push Patients Away
Out-of-pocket costs for GLP-1 medications nearly doubled in 2025 as Medicare Part D plans shifted from fixed copayments to percentage-based coinsurance:
- Between 49% and 77% of beneficiaries now face coinsurance requirements, compared to 27% to 36% in 2024.
- For some patients, a one-month supply can cost $1,000 or more.
Even a slight increase in cost can make patients more likely to stop treatment. The medications work, but many patients struggle to afford them.
Coverage issues don’t just make treatment harder to afford—they delay therapy and hurt patient confidence. Delays between when a physician writes a prescription and when a patient receives approval and fills that prescription can create doubt. Patients may question whether they really need medication and decide to “wait and see” if lifestyle changes alone will work. By the time approval comes through, the moment has passed.
So, how can real-time engagement tools improve patient adherence?
Support Prescribing Decisions in the EHR Workflow
Prescription abandonment often starts with information gaps at the point of prescribing. Physicians write prescriptions without knowing whether the patient’s insurance covers the medication, what the patient will pay, or whether administrative requirements will delay access. When patients encounter these barriers at the pharmacy, many never fill the prescription.
By embedding coverage and brand-specific insights in the prescribing workflow, physicians can immediately see:
- Patients’ out-of-pocket expenses, along with copay cards or patient support programs that patients may qualify for
- Relevant ICD-10 codes to simplify the PA process—or even immediately satisfy the requirement
- Pharmacy routing alerts when a medication requires specialty pharmacy dispensing or has a limited distribution network
With this information readily available in the EHR, physicians can discuss barriers with patients and make the best prescribing decision possible—every time.
Activate Patient Engagement Moments After Prescribing
Improving patient adherence isn’t just about getting past PAs or lowering out-of-pocket costs. Patients also need ongoing support—starting the moment a prescription is written.
Removing barriers upstream helps address access problems, but patients also need resources that cater to the complexity of the medication and their individual circumstances.
Provider-to-patient interactive text messages put useful information at patients’ fingertips, including:
- Educational messaging that prepares patients for expected side effects, monitoring requirements, or dosing adjustments
- Digital copay cards or links to enroll in patient support programs to overcome cost barriers
- Tap-to-call for clinical guidance from nurses or care coordinators
- Well-timed reminders to keep refills on schedule
From First Fill to Long-Term Success
American Diabetes Month is a reminder that type 2 diabetes requires sustained management. GLP-1 medications are powerful tools for managing type 2 diabetes—but only if patients stay on them. Improving patient adherence starts with removing barriers and stays strong through ongoing personalized messaging.
Our end-to-end engagement platform, TimelySM by DrFirst®, helps patients get past those critical first 90 days—when dropout risk is highest—by delivering support exactly when they need it.
Ready to improve patient adherence and long-term health outcomes? Download the Moving Patients Forward Guide now!
