Reuters has a news flash for us. People are quick to quit taking GLP-1 medicines. In an “exclusive” story, the Reuters report comes from a analysis from Prime Therapeutics and Magellan Rx (Prime/MRx) – a pharmacy benefit manager (PBM). The headline finding is that 85% of people who start on GLP-1 medicines have quit taking them two years later.

Does this surprise anyone who knows anything about human behavior with medicines? On top of this baseline, we have the absolute chaos inflicted by an inadequate supply from pharma, high costs, and hurdles from PBMs. Yes, companies like Prime/MRx are indeed part of the problem.

Normal Persistence Patterns

Even when doctors and patients know full well they are dealing with a chronic disease that requires chronic therapy, people often stop taking their medicine. For hypertension, within four years about half have stopped. In type 2 diabetes, persistence can be as low as 17%.

But it is quite common to deny that obesity is a chronic disease. For evidence of this, the language of the Prime/MRx report makes it quite clear. They write about these drugs almost exclusively in terms of “weight loss.” That framework is acute. Weight loss is generally a three to six month endeavor.

Prime/MRx sells its clients a lifestyle program, KeepWell, which implicitly taps into patient beliefs that chronic weight management is down to them. A common, but false presumption is that healthy eating and an active life will keep obesity at bay. You shouldn’t need to keep taking these medicines is the implicit messaging. It is misleading and pervasive.

A Chaotic Environment

On top of the prevalent short-term focus of the weight loss framework, add all of the chaos surrounding these medicines. Even if a person wants to keep taking them, Lilly and Novo Nordisk are not providing an uninterrupted supply. Many people must stop taking them simply because they cannot get them. Others cannot afford the ongoing out-of-pocket costs. Or their PBM looks for excuses to stop covering them. Most maddening is the notion that if a person loses a lot of weight, the PBM will deny coverage because of the new, lower weight a patient has reached.

So, really, it is hilarious to hear that a PBM would suggest anyone should be surprised lo learn many people quit taking GLP-1 medicines for obesity after a couple of years. They are part of the systematic bias that discourages people from continuing with care.

Click here for the report from Reuters, here for a research poster on the one-year data, and here for the report from Prime/MRx. For further perspective on confusion between weight loss and obesity care, click here. Finally, you can find additional perspective on persistence with obesity medicines here.

Stop Sign in a Car Park, photograph by Benoît Prieur / Wikimedia Commons