A recent retrospective analysis presented at AMCP 2025 highlights persistent access challenges for patients seeking glucagon-like peptide-1 receptor agonists (GLP-1 RAs) for weight loss, despite signs of gradually improving payer coverage from 2021 to mid-2024.

The study examined 8.3 million claims across 3.4 million patient lives using data from the Symphony Health Integrated Dataverse. Patients included had at least 1 claim for a GLP-1 RA indicated for weight loss—specifically, liraglutide (Saxenda), semaglutide (Wegovy), or tirzepatide (Zepbound)—and were new to treatment during the index period between January 1, 2021, and June 30, 2024.

The overall rejection rate across the study period was 62.4%, with 31.1% of rejections attributed to prior authorization (PA) requirements and 42.1% due to formulary exclusion. Year-over-year rejection rates declined from 74.0% to 60.5%, suggesting expanding payer acceptance. However, rejection due to PAs rose from 23.8% to 35.1% before decreasing to 28.2% in 2024.

Pull-through rates—defined as successful fulfillment following initial PA rejection—improved from 34.1% to 45.0%, before falling to 37.8% in 2024. Abandonment rates fluctuated year to year, ranging from 17.3% to 28.5%, with no clear trend. The authors noted, “Abandonment rates were inconclusive, which fluctuated year to year, indicating further analysis into contributing factors for patients not fulfilling their prescriptions.”

The median time to overcome a PA was 7 days, with a range of 0 to 21 days. Among patients who successfully completed the PA process and filled their prescription, the median out-of-pocket (OOP) cost was $24.99, compared to $30 for those who overcame PAs but ultimately did not fill the medication.
The authors concluded, “The analysis showed an annual decrease in overall rejection rates for GLP-1 RAs, suggesting a gradual increase in payer coverage for these medications.” However, continued PA burdens and inconsistent fulfillment rates underscore the need for further evaluation of policy and administrative barriers. These findings emphasize the evolving payer landscape for GLP-1 RAs and highlight the need for targeted strategies to support patient access, particularly as clinical demand continues to rise.

Reference 
Son M, Edwards A, Burns B. Yearly trends in payer coverage rates for GLP-1 receptor antagonists in weight loss. Presented at: AMCP 2025; March 31-April 3; Houston, TX.