Cost and insurance, not side effects, lead patients to stop obesity drugs, Cleveland Clinic study finds

Cleveland Clinic researchers found that cost and insurance problems, not side effects, were the most common documented reason patients stopped taking injectable semaglutide or tirzepatide for weight loss during their first year of treatment ^[1][2].

The study, published October 2 in the journal Obesity, looked at the electronic health records of 288 adults who started one of the two drugs and stopped within a year ^[1][2]. Cost or insurance-related issues were the documented primary reason for 137 of them, or 47.6% ^[1][2].

The records came from a single health system with locations in Ohio and Florida and covered January 2022 through December 2024 ^[1][2]. All the patients had overweight or obesity and did not have type 2 diabetes ^[1][2]. The 288 patients were randomly selected from a larger group who discontinued. Of them, 145 received semaglutide and 143 received tirzepatide ^[1][2].

The other reasons

After cost, the next most common documented reasons were:

• 42 patients (14.6%) could not tolerate the side effects ^[1][2]
• 34 patients (11.8%) could not fill the prescription because of shortages ^[1][2]
• 7 patients (2.4%) switched to a compounded version of the medication ^[1][2]
• 5 patients (1.7%) stopped because their weight loss was unsatisfactory ^[1][2]

Another 31 patients (10.8%) stopped for other reasons, and for 32 patients (11.1%) the record did not specify why treatment ended ^[1][2].

The authors reported that cost or insurance barriers were the most common reason at every point during the first year, but that the timing differed. Patients who stopped because of cost tended to stop later in treatment, while those who stopped because of side effects tended to stop earlier ^[2]. The paper's conclusion calls for policies to address cost and says the findings could inform conversations between providers and patients about cost and side effects ^[1][2].

Several things are not established in the study. It draws on one health system, so the pattern may not match other parts of the country or other types of practices ^[1][2]. The study does not report how much patients were paying out of pocket, what insurance they had, or what happened to them after they stopped. It also does not explain what the "other reasons" were for the 31 patients in that group. The research was funded by the Cleveland Clinic Research Program Committees ^[2]. Two authors disclosed outside payments: Dr. W. Scott Butsch reported advisory board fees from Novo Nordisk, Eli Lilly, Boehringer Ingelheim and Abbott, plus research funding from Eli Lilly, and Dr. Michael Rothberg reported consulting fees from the Blue Cross Blue Shield Association ^[1].

Why it matters for patients

Much of the public discussion about these medications focuses on side effects and how long people stay on them. This study offers a different picture of why people stop in the first year: nearly half of the documented cases were about money or coverage, roughly three times the share attributed to side effects ^[1][2].

For patients, that has a few practical implications. First, the medication a person is prescribed and the medication they can actually keep taking may be two different things, and the gap often shows up after the first few months rather than at the start ^[2]. Second, side effects remain a real factor, but they accounted for about one in seven documented stops, and those stops happened earlier, when doses are typically being increased ^[1][2]. Third, shortages were still a factor for about one in eight patients even across a period running through the end of 2024 ^[1][2].

It is worth noting that these were documented reasons in medical records. When a reason is not written down, or when a patient stops for several overlapping reasons, the record may only capture one of them. The 11.1% of cases with no specified reason ^[1][2] mean the true picture could shift somewhat in either direction.

What happens next

The authors say their findings point to a need for policy interventions on cost and could help guide discussions between doctors and patients ^[1][2]. Specific policy changes, coverage decisions or follow-up studies tied to this paper have not been reported ^[1][2].