Few areas of medicine have captured public interest over the past two years quite like glucagon-like peptide-1 (GLP-1) receptor agonists. Originally developed to improve glycemic control in type 2 diabetes, drugs like semaglutide (Ozempic/Wegovy) and tirzepatide (Mounjaro/Zepbound) have proven remarkably effective at helping patients lose weight. Physicians, employers and investors are watching closely as the market grows, supply ebbs and flows and new research emerges.
This post digs deep into the latest real-world data, safety signals and market dynamics shaping GLP-1 therapies. It summarizes clinical trial results with new evidence on adherence, demographics and emerging indications and explains what it all means for patients and providers. A section reserved for HealthVerity Marketplace data illustrates the richness of real-world evidence available to inform strategic decisions. Finally, we close with guidance on how to stay ahead of the curve and a call to action to harness these insights.
HealthVerity Marketplace provides real-time visibility into one of the most important shifts in modern therapeutics. By linking privacy-protected pharmacy records, HealthVerity Marketplace includes prescription data on more than 19.1 million patients taking GLP-1 drugs such as Ozempic, semaglutide, and Rybelsus. These insights reveal how GLP-1 therapies are being used in the real world, including how much weight patients are actually losing, a topic that’s driving intense interest across healthcare and policy circles.
Analysis from two EHR (electronic health record) sources in HealthVerity Marketplace shows the rapid adoption of GLP-1 therapy among people with type 2 diabetes. Between early 2022 and mid-2024, more than 6 million patients were identified with a type 2 diabetes diagnosis. Of those, roughly 1 in 5 had an active GLP-1 prescription. This provides a clear view into how these therapies are being integrated into diabetes care at scale and highlights the value of Marketplace data for tracking treatment adoption and patient outcomes in real time (Figure 1).
Figure 1: Data from 2 EHR sources in HealthVerity Marketplace showing GLP-1 prescription use in type 2 diabetes patients.
The Marketplace also captures prescribing activity from over 790,000 providers at the NPI level, offering one of the broadest and most detailed resources for understanding adoption patterns nationwide. With this unmatched coverage, pharmaceutical manufacturers and healthcare researchers can move beyond traditional claims analysis to access verified insights that illuminate real-world treatment dynamics across diverse patient populations.
In a separate analysis between 2020 and 2023, one HealthVerity closed claims dataset had more than 1.5 million patients who had at least one prescription for tirzepatide or semaglutide. Notably, about one in four of these patients did not carry a type 2 diabetes diagnosis, suggesting that a substantial portion of GLP-1 use is being driven by weight loss and other emerging indications outside of diabetes care (Figure 2).
Figure 2: Distribution of GLP-1 closed claims from one source in HealthVerity Marketplace indicating patients with tirzepatide or semaglutide prescriptions from 2020–2023.
For years, semaglutide held the spotlight. That changed when the SURMOUNT-5 trial compared tirzepatide (the active ingredient in Zepbound) and semaglutide directly. The trial showed that tirzepatide achieved roughly 20% weight loss (about 50 pounds) versus 14% weight loss (33 pounds) with semaglutide.¹ This significant difference prompted analysts to declare tirzepatide the winner.¹ As a result, clinicians are updating treatment algorithms and patients on semaglutide are asking about switching. Still, insurance coverage and cost considerations mean both drugs remain relevant, and patient-centred conversations about therapy choice are critical.¹
Non-alcoholic fatty liver disease (NAFLD) and the more severe metabolic dysfunction-associated steatohepatitis (MASH) have few effective pharmacologic treatments. Recent research suggests GLP-1 therapy may help. Wegovy has shown promise in improving MASH.¹ If confirmed in larger trials, GLP1 drugs could become a cornerstone of liver disease management.
The SELECT trial demonstrated that GLP-1 therapy rapidly reduces heart attacks and strokes.¹ These cardiovascular benefits have long been hinted at in diabetes trials, but the magnitude observed in SELECT surprised even seasoned cardiologists. As a result, payers and guideline bodies are considering broader coverage for patients at high cardiovascular risk.
GLP-1s may address conditions well beyond metabolic diseases:
The takeaway? GLP-1s are no longer just “weight-loss drugs”; they may soon be used to treat liver disease, cardiovascular conditions, sleep apnea and even reduce cancer risk.2
One of the most promising innovations in obesity management is the integration of digital coaching with flexible medication dosing. A Danish cohort study evaluated an online weight-loss program that combined behavioral support with individualized semaglutide dosing. Participants lost 16.7% of baseline weight over 64 weeks, matching clinical trial outcomes despite using half the typical drug dose. Only 28.8% of participants exceeded 1 mg/week. The “treat-to-target” strategy allowed patients to start low and increase the dose only when weight loss stalled. Side effects were mostly mild.3
These results suggest that robust digital support can optimize dosing, reduce costs and improve adherence.3 As more employers incorporate digital GLP-1 programs, expect to see insurers incentivize treat-to-target approaches.
Usage across the population
A nationally representative survey conducted by RAND found that 11.8% of Americans have used GLP-1 drugs for weight loss, and about 14% express interest, while 74% say they do not plan to take them. Women use GLP-1s at higher rates than men, particularly those aged 50–64.4 Among individuals aged 30–49, women are more than twice as likely as men to have used the drugs.4 This demographic skew underscores the importance of gender-specific messaging and benefit design.
Side effects
About 50% of users reported nausea and one-third reported diarrhea in RAND’s survey.4 Gastrointestinal side effects are the most common reason for discontinuation.5
Persistence and discontinuation
Persistence with GLP-1 therapy has been a major concern. Real-world analyses show that half of patients discontinue within a year.5,6 However, persistence appears to be improving. A recent analysis of pharmacy claims found that 63% of patients starting Wegovy or Zepbound in early 2024 were still taking the drug one year later.7 This is up from 40% among patients who started in 2023. The improvement may reflect easing drug shortages, expanded insurance coverage and better management of side effects. Despite this progress, only 14% of patients remain on Wegovy after three years (Figure 3).7
For patients who stop treatment early, weight regain is common. In a recent observational study, individuals who discontinued semaglutide or tirzepatide within the first three months lost only 3.6% of their body weight, while those who quit between three and twelve months lost 6.8%. The same study showed that patients taking higher doses and remaining adherent achieved weight loss comparable to clinical trials.5
Figure 3: Pharmacy claims data show that 63% of patients initiating Wegovy or Zepbound in early 2024 remained on therapy at one year, up from 40% in the 2023 cohort. Despite these improvements, persistence declines sharply over longer durations, with only 14% of patients remaining on Wegovy after three years. Created using data from Prime Therapeutic's study.7
Clinical trials enrol carefully selected participants, provide intensive coaching and deliver high medication doses. The real world is messier. A 2025 study published in Obesity found that GLP1 users lost 7.7% of body weight on semaglutide and 12.4% on tirzepatide after one year, roughly half the weight loss seen in randomized trials.5 Two factors drive this gap:
Even modest weight loss is clinically meaningful: reductions of 5% of baseline weight can improve blood pressure, glucose levels and cardiovascular risk.5 Providers should set realistic expectations, encourage lifestyle changes and address barriers such as cost and insurance hurdles.
While gastrointestinal discomfort is the most common issue, new safety signals continue to emerge. Recent analyses have raised questions about psychiatric side effects, particularly mood changes and anxiety.¹ Patients with asthma may be at increased risk of respiratory complications,¹ and nutrient deficiencies can occur with long-term therapy.¹ Monitoring mental health and nutritional status should be part of any GLP-1 program.
The GLP-1 market has matured quickly but remains volatile. Zepbound’s price has fallen to $349–$499 per month.¹ Competition has intensified as insurers respond to rising utilization, sometimes switching patients to “second-choice” drugs.¹ Meanwhile, supply shortages have eased; both semaglutide and tirzepatide are off the FDA shortage list.6
Employers and government agencies are weighing whether to broaden coverage. While early data show improved persistence, only a minority of patients remain on therapy beyond two years.6 Payers must balance high upfront costs against potential long-term savings from reduced complications.
The future of weight management may soon involve more than current GLP-1s:
Providers should prepare for a rapidly evolving landscape and educate patients about upcoming options.¹
Real-world evidence is essential for guiding coverage decisions, tailoring treatment protocols and maximizing patient outcomes. By linking pharmacy claims, electronic medical records, social determinants and lab results, we can uncover patterns in adherence, dosing and comorbidities that clinical trials can’t reveal. HealthVerity Marketplace offers a privacy-protected, interoperable platform that makes these insights accessible at scale.
If you’re a payer, employer or provider navigating the GLP-1 revolution, don’t rely solely on published trials. Use comprehensive, longitudinal data to understand how these medications perform in the populations you serve. Whether you’re evaluating cost-effectiveness, optimizing adherence or designing a lifestyle program to accompany pharmacotherapy, the right data makes the difference.
Visit HealthVerity Marketplace to access robust, real-world data on GLP-1 therapies and other high-impact drugs. Our platform can help you answer pressing questions about utilization, adherence, outcomes and more, empowering you to deliver better care and make smarter decisions. Reach out today to learn how HealthVerity Marketplace can support your team.