High cost or insurance-related issues are the most common reasons for discontinuation with semaglutide or tirzepatide

High cost or insurance-related issues are the most common reasons for treatment discontinuation with semaglutide or tirzepatide for obesity, according to researchers from Cleveland Clinic, Cleveland, OH. The researchers said the findings highlight the need for policies to address cost and could inform discussions between healthcare providers and patients concerning cost and side effects.

This study sought to characterise the reasons for treatment discontinuation with injectable semaglutide or tirzepatide for obesity in regular clinical practice. From the pool of individuals who met the criteria, they randomly selected 300 patients whose initial obesity medication prescription was placed by a Cleveland Clinic provider and the last medication fill before treatment discontinuation was either semaglutide or tirzepatide, and they conducted manual chart reviews to determine the primary reason for discontinuation.

A total of 8184 individuals with obesity or overweight (and one or more weight-related comorbidities) and without T2D initiated obesity pharmacotherapy with a prescription fill for injectable semaglutide or tirzepatide from January 1, 2022, to December 31, 2023. Of those, 54.9% (4492) discontinued their medication within the first year.

Out of the 300 randomly selected patients who were identified to have discontinued their treatment, 288 patients were included in the study. These patients completed an initial prescription for injectable semaglutide (n=145) or tirzepatide (n=143) and discontinued the therapy within the first year. Mean (SD) age was 52.1 (13.3) years, baseline weight was 116.1 (28.5) kg and baseline BMI was 39.7 (7.9). A total of 179 patients (62.2%) were female and 109 (37.8%) were male. Most patients were privately insured (221 [76.7%]); 41 (14.2%) had Medicare, 17 (5.9%) Medicaid and 9 (3.1%) were self-paying or had other insurance.

A total of 137 patients (47.6%) discontinued their medication due to cost or insurance-related issues (including insurance denial, expiration of manufacturer discount coupon, or out-of-pocket cost being unaffordable), 42 (14.6%) due to side effects, 34 (11.8%) due to medication shortages, seven (2.4%) due to switching to a compounded medication and five (1.7%) due to unsatisfactory weight loss; 31 (10.8%) discontinued for other reasons, and 32 (11.1%) patients specified no reason.

Among those who discontinued the treatment due to side effects (n=42), the most commonly reported side effects included nausea (13), abdominal pain (8), vomiting (seven), diarrhoea (six) and (worsening) depression (four). Other reasons included other health events unrelated to the treatment course (nine), hesitancy about the treatment (five), pharmacotherapy being part of bariatric preoperative preparation (four), treatment being paused/stopped after achieving desired body weight (four), communication issues related to required documentation (four), medication hold due to surgical procedure (two), other personal reasons (two) and patients no longer meeting the BMI criteria for obesity pharmacotherapy (one).

Discontinuation due to cost or insurance-related issues was more common in patients who discontinued late compared to those who did early (54.0% vs. 40.6%, p=0.02). However, discontinuation due to intolerance to side effects was more prevalent in those who discontinued early vs. late (21.0% vs. 8.7%, p=0.003). Whereas discontinuation due to cost or insurance-related issues was also more common in patients with Medicare or Medicaid coverage compared to those with private payer (61.0%, 76.5%, and 43.0%, respectively, p=0.01). The distribution of treatment discontinuation reasons did not significantly differ by treatment initiation year (2022 vs. 2023) or index medication (semaglutide vs. tirzepatide).

“Our findings have important clinical and policy implications. Third-party payers cite high discontinuation rates as a key rationale for restricting insurance coverage for obesity medications. However, our findings indicate that high costs, often imposed by the insurance companies themselves, and medication shortages significantly contribute to treatment discontinuation...” the authors stated. “This highlights the need for a more nuanced insurance benefit design that relies on evidence-based management tools, rather than simply limiting or denying pharmacotherapy coverage for obesity. In addition, manufacturers should evaluate the long-term impact of time-limited savings programmes and discount coupons. Finally, recognising the primary reasons for discontinuation may facilitate more informed discussions between healthcare providers and their patients, helping to address challenges in long-term persistence with these highly effective medications.”

This study was supported by the Cleveland Clinic Research Program Committees.

The findings were featured in the paper, ‘Reasons for Discontinuation of Obesity Pharmacotherapy With Semaglutide or Tirzepatide in Clinical Practice’, published in Obesity. To access this paper, please click here