Closed claims no longer reflect real-world GLP-1 treatment patterns
GLP-1 utilization continues to grow across obesity and metabolic disease, but the way patients access these therapies is changing in ways that complicate traditional research approaches. As employers and payers reassess coverage for high-cost GLP-1 medications such as Wegovy and Zepbound, more patients are being directed toward direct-to-consumer purchasing models rather than filling prescriptions through insurance.1
For patients, these programs may preserve access to GLP-1 medication when coverage is reduced or eliminated. For researchers, they introduce a growing data fragmentation problem that challenges assumptions about how utilization is observed and measured.
When prescriptions are paid for out of pocket, they often fall outside standard pharmacy benefit workflows. Patients who continue therapy through direct-to-consumer programs can disappear from closed payer claims data even though treatment has not stopped. For research teams relying primarily on closed claims, this creates an incomplete and increasingly misleading view of GLP-1 utilization trends.
How direct-to-consumer GLP-1 access creates blind spots in claims data
Closed claims data has historically been effective for analyzing medication initiation, adherence, persistence, and discontinuation, but only when prescriptions are adjudicated through insurance. Direct-to-consumer GLP-1 programs disrupt that model.
As patients shift to cash-pay options, pharmacy claims may no longer be generated. Coverage loss can appear as treatment discontinuation. Utilization curves may flatten or decline even as demand remains strong. Longitudinal patient journeys fragment at precisely the moment when affordability pressures and coverage decisions matter most.
This dynamic is particularly important when interpreting persistence metrics. In a recent HealthVerity analysis of 3.9M patients receiving GLP-1 therapy, just 0.11% of patients appeared to remain on treatment at the two-year mark.2 While this finding highlights the challenges of long-term persistence, it also raises a critical question: how many patients classified as discontinued in claims data will continue therapy outside the insurance channel through direct-to-consumer programs?
Without visibility beyond closed claims, it becomes increasingly difficult to distinguish true treatment abandonment from changes in how patients pay for care.
What data is required to understand true GLP-1 utilization trends
Accurately tracking GLP-1 use now requires following the patient journey beyond payer visibility. Electronic health record (EHR) data and physician notes provide critical insight into prescribing behavior regardless of how a medication is paid for.
EHR data can document diagnoses and continued prescribing even when claims are absent, while clinical notes often capture coverage loss, affordability discussions, and decisions to continue therapy through direct-to-consumer programs. When combined longitudinally, these sources allow researchers to distinguish true discontinuation from changes in payment behavior and preserve continuity across coverage transitions.
How taXonomy Pathways supports GLP-1 research beyond closed claims
taXonomy Pathways was designed to address these evidence gaps by extending visibility beyond closed claims while preserving longitudinal continuity.
By combining the nation’s largest closed payer claims database with EHR, lab results, and physician notes, taXonomy Pathways enables researchers to observe GLP-1 utilization even when prescriptions move outside insurance workflows. Research teams can identify patients who lose coverage, see whether prescribing continues, and track treatment continuity across coverage transitions rather than treating those moments as endpoints.
For GLP-1 studies, this approach supports more accurate measurement of persistence, switching behavior, and real-world utilization patterns in a rapidly changing access environment.
Additional implications for GLP-1 research and decision-making
The rise of direct-to-consumer GLP-1 programs has implications beyond utilization counts. With more patients moving outside traditional claims workflows, HealthVerity data can also support:
- More accurate market sizing and demand forecasting
- Better assessment of employer coverage policy impacts
- Improved understanding of patient affordability strategies
- Stronger real-world evidence to inform policy and access decisions
- Reduced bias in studies that would otherwise undercount key populations
For life sciences teams, payers, and policy stakeholders, incomplete data does not just limit insight. It introduces risk.
The evolution of direct-to-consumer GLP-1 programs
Direct-to-consumer GLP-1 programs are becoming a durable part of the treatment landscape rather than a temporary workaround. As utilization increasingly extends beyond insurance boundaries, closed claims data alone will capture a shrinking share of real-world activity.
Research teams that broaden their data strategy to include longitudinal, multi-source views of the patient journey will be better positioned to interpret utilization trends, persistence metrics, and access dynamics with greater confidence. HealthVerity supports that shift by helping researchers maintain continuity and analytical rigor even as the market evolves.
Explore how taXonomy Pathways can help you capture GLP-1 utilization trends with greater accuracy in a direct-to-consumer world.
References
- Chen E. Employers drop coverage for weight loss drugs as pharma’s direct-to-consumer programs grow. STAT. December 18, 2025. https://www.statnews.com/2025/12/18/weight-loss-drugs-wegovy-zepbound-health-plans/
- HealthVerity. GLP-1 persistence: What semaglutide data reveals about patient behavior.
https://blog.healthverity.com/glp-1-persistence-what-semaglutide-data-reveals-about-patient-behavior
