The Most Important GLP-1 Decision Happens After Treatment Begins

Most GLP-1 benefit designs focus heavily on who qualifies to start treatment. Just as important is helping appropriate participants remain on therapy while regularly evaluating whether treatment continues to deliver meaningful clinical benefit over time.

The Short Version

Determining who starts a GLP-1 is only the beginning. The bigger challenge is making sure every participant who remains on therapy continues to receive meaningful clinical benefit. The American Diabetes Association's Standards of Care recommend reassessing patients who do not achieve approximately 5% weight loss after the initial treatment period to determine whether ongoing therapy remains appropriate.⁵ A large cohort study published in JAMA Network Open found that many patients discontinue GLP-1 therapy within the first year,² while the ADA also notes that patients who discontinue semaglutide or tirzepatide typically regain one-half to two-thirds of the weight they lost within a year.⁵ Ongoing clinical evaluation, rather than a one-time coverage decision, gives employers the greatest opportunity to support better patient outcomes while making more informed benefit investments.

The Question Almost Everyone Skips

Here's the pattern in most GLP-1 benefits: check eligibility once, fund the first fill, then auto-refill for as long as the prescription runs. Nobody circles back at six months, or twelve, or twenty-four, to ask whether this particular participant should still be on the drug. That silence is expensive, because a GLP-1 isn't a one-time purchase, it's a recurring one, and AssuredPartners' own claims analysis puts the added drug cost at roughly $6,540 a year per participant on the medication. ¹ The recurrence is the budget problem, not the sticker price on any one fill.

The persistence data makes the case for asking harder. A 2025 study in JAMA Network Open followed more than 125,000 adults on GLP-1s and found that 53.6% had stopped within a year, and 72.2% had stopped within two years. ² Among people without type 2 diabetes specifically, the one-year discontinuation rate climbed to 64.8%.² So a large share of the people a plan funded at the start are already gone by the time a continuation gate would even fire. The people who remain on therapy are the ones whose long-term outcomes matter most, making ongoing clinical evaluation essential for both patients and employers.

That leaves two real questions, not one. Is this participant responding? And if they are, is the response holding up over time? Neither can be answered from a fill record alone.

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Supporting Long-Term Success on Therapy

A clear clinical framework is more effective than making continuation decisions case by case. Current cardiology and obesity guidelines, including the American College of Cardiology/American Heart Association and the European Society of Cardiology, recognize that achieving at least 5% weight loss from baseline is associated with meaningful cardiometabolic benefit. ³ Ongoing therapy should be evaluated using that milestone alongside biomarkers, treatment tolerability, and overall clinical progress.⁵

Participants who continue demonstrating clinical benefit should receive the ongoing support and monitoring needed to sustain long-term success. When progress stalls, biomarkers stop improving, or side effects interfere with adherence, the next step should be a clinical review by a licensed provider, not an automatic refill or an automatic discontinuation.

For employers, the goal is not deciding who stays on therapy. It is supporting the right participants with the right level of clinical care over time while ensuring benefit decisions are informed by objective clinical evidence.

The Regain Problem Nobody Wants to Talk About

A single good weigh-in at six months does not tell the whole story. The STEP 1 trial extension found that participants who discontinued semaglutide regained about two-thirds of the weight they had lost within one year. ⁴ That finding highlights an important reality: long-term success depends on what happens after the initial weight loss, not just the number on the scale at a single point in time.

For employers, that reinforces the value of ongoing clinical support and regular evaluation throughout treatment. The goal is not simply to achieve an early result. It is to help appropriate participants sustain meaningful health improvements over time while ensuring therapy continues to deliver clinical benefit.

Why a Measured Rule Holds Up When Someone Asks About It

Self-insured plans get judged on consistency. A continuation decision anchored to a measured 5% threshold and a documented biomarker panel, applied the same way to every participant on a defined schedule, is easy to defend. If a participant asks why their coverage continued while a coworkers’ went to review, the answer is a number on a lab result, not a judgment call made on the spot. ³

That's also why the rule must be written down before it ever fires. Decide the threshold, the measurement cadence, and the clinical review path in advance, and apply all three the same way for everyone. A standard you can point to on paper holds up a lot better than a decision made participant by participant, after the fact.

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Making Long-Term GLP-1 Management More Practical

The challenge is not recognizing the value of ongoing clinical evaluation. It is making it practical at scale. Reassessing an entire population every few months can create logistical barriers, from lab visits and missed appointments to participants dropping off therapy because the process becomes difficult to navigate.

At-home diagnostics can help remove much of that friction. Participants collect a blood sample at home, complete guided measurements such as body weight, and connect with an independently licensed provider through an app. Clinical data, including A1c, lipid levels, and other health measures, can help inform ongoing treatment decisions without requiring routine trips to a laboratory.

That is the approach behind eMed's Population Health GLP-1 Program for Employers. At-home diagnostics, care delivered by independently licensed providers, and direct contracted pricing work together in a single experience designed to support long-term engagement. Participants who continue benefiting from therapy receive ongoing monitoring and support, while those who need additional clinical attention receive a clinical evaluation to determine the most appropriate next step. Employers gain greater visibility into program outcomes, and participants receive care that evolves with their clinical needs over time.

Source

1. AssuredPartners. "GLP-1 Cost Effectiveness for Employer Sponsored Health Plans" (case study). February 20, 2025. https://www.assuredpartners.com/-/media/Files/Corporate/Blogs/Case-Study-GLP-1-Cost-Effectiveness-and-Coverage-for-Employer-Sponsored-Health-Plans.pdf
2. Rodriguez PJ, et al. "Discontinuation and Reinitiation of Dual-Labeled GLP-1 Receptor Agonists Among US Adults With Overweight or Obesity." JAMA Network Open. 2025;8(1). https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2829779
3. Yurista SR, Eder RA, et al. "A Closer Look at ACC/AHA and ESC Guidelines for Managing Obesity and Overweight in Adults." JACC: Advances. 2023. https://www.jacc.org/doi/10.1016/j.jacadv.2023.100570
4. Wilding JPH, Batterham RL, Davies M, et al. "Weight Regain and Cardiometabolic Effects After Withdrawal of Semaglutide: The STEP 1 Trial Extension." Diabetes, Obesity and Metabolism. 2022;24(8):1553-1564. https://dom-pubs.onlinelibrary.wiley.com/doi/10.1111/dom.14725
5. American Diabetes Association Professional Practice Committee. "8. Obesity and Weight Management for the Prevention and Treatment of Diabetes: Standards of Care in Diabetes—2026." Diabetes Care. 2026;49(Supplement 1). https://diabetesjournals.org/care/article/49/Supplement_1/S166/163915/8-Obesity-and-Weight-Management-for-the-Prevention 
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