Nearly Half of Wegovy Users Stop Within 5 Months — Cost Is the Biggest Factor

Among 15,811 commercially insured adults who started semaglutide for weight management, 46% discontinued within the first 5 months. Discontinuation was strongly linked to out-of-pocket costs: rates ranged from 41% in the lowest copayment quintile ($1-$54/month) to 51% in the highest quintile ($161-$1,460/month). Most users deviated from the recommended monthly dose-escalation schedule. Similar discontinuation rates (48%) were observed in patients starting after supply shortages resolved (post-October 2023), indicating the problem is not supply-driven.

Retrospective cohort study using insurance claims data for 15,811 commercially insured US adults who initiated semaglutide for weight management (single-dose prefilled pens) between June 2021 and December 2023. Dose-titration patterns were tracked over 5 months. Multivariable Cox regression identified factors associated with discontinuation. Sensitivity analyses examined patterns after supply shortage resolution.

GLP-1 peptide drugs like semaglutide require ongoing use to maintain weight loss — stopping typically leads to weight regain. With nearly half of real-world users quitting within 5 months, the actual public health impact of these drugs may be far less than clinical trial results suggest. The strong association with cost highlights that access, not just efficacy, is the critical challenge for peptide-based obesity therapies.

The GLP-1 peptide drug revolution has produced impressive clinical trial results, but this study reveals a stark gap between trial outcomes and real-world persistence. Cost barriers are the dominant factor driving discontinuation, raising urgent questions about health equity and the sustainability of long-term peptide-based weight management. As these drugs become central to obesity treatment guidelines, insurance coverage and pricing policies will determine whether their benefits reach the patients who need them most.

The study used insurance claims data, which cannot capture reasons for discontinuation beyond cost (e.g., side effects, inadequate response, personal choice). It included only commercially insured adults, so patterns may differ for Medicare, Medicaid, or uninsured populations. The 5-month follow-up is relatively short for a chronic therapy. Dose-titration deviations could reflect supply shortages during part of the study period, though sensitivity analysis after shortage resolution showed similar patterns.