Every prepay ladder on this site’s price desk asks the same thing: commit to a term and the monthly figure falls. That trade is only worth what it looks worth if the term is completed, and the published data on how often a GLP-1 course is completed is the missing half of the calculation. HealthRX publishes both ends of that ladder, which makes the gap easy to see.
How often a course stops
A retrospective analysis of 1,374 adults dispensed an initial GLP-1 between January 2018 and June 2023 found that 436 of them, 31.7%, discontinued inside 180 days[1]. Among those who stopped, an adverse drug reaction was the documented reason in 26.8% of cases, a cost concern in 14.4%, and non-adherence in 11.2%[1]. An overweight or obesity indication, rather than diabetes with obesity, was associated with discontinuation (adjusted odds ratio 2.46; 95% CI 1.17 to 5.17)[1].
A larger claims cohort of 15,811 commercially insured US adults starting semaglutide for weight management put five-month discontinuation at 46%, and at 48% among those who started after the supply shortage resolved[2]. Most of that cohort also deviated from the recommended dose-escalation schedule inside the first five months.
Tolerability is part of it. A nationwide multicenter study of 2,549 patients treated with semaglutide (n = 1,434) or tirzepatide (n = 1,115) recorded at least one adverse event in 50.9% and 51.0% of the two groups respectively (p = 0.524), with gastrointestinal events the most frequent[3]. Discontinuation due to adverse events was similar between the two drugs except for pancreatic events, which were more frequent with semaglutide (p = 0.006)[3].
What a term costs if it is not completed
The following is arithmetic on published seller terms rather than a finding from any study. A twelve-month plan advertised at $99 a month against a $165 month-to-month rate saves $66 a month, which is $792 across a completed year. The same plan billed as a single up-front charge asks for $1,188 before the first fill arrives.
A buyer who stops at month five, which the cohorts above suggest is a common point to stop, has consumed five months of a twelve-month purchase. Whether the remaining seven are refunded is the question, and it is the question most sellers on this desk do not answer on the page that sells the term. Where a site does not publish a refund policy, the honest reading is that the policy has not been established rather than that money comes back — the case at He & She MD, whose annual plan bills a year at once.
Restarting is its own cost
Discontinuation is often not permanent, and a restart usually means beginning the titration ladder again at a low dose. On a seller whose price holds flat across doses that changes nothing about the bill. On a seller whose price rises with the dose, a restart resets the buyer to the lowest rung and walks them back up it, so the average monthly cost over a year of stopping and restarting sits somewhere the pricing page does not describe. Midi Health is the unusual case that prints every rung, so the walk back up can at least be priced.
Whether stopping and restarting affects weight outcomes differently from continuous treatment is a question the cohorts above do not answer. They record who stopped and why, not what happened to the people who came back. That is a real gap in the evidence, and no figure on this site should be read as covering it.
The practical reading
A prepay rung is a bet that a course will be completed, priced by a seller who knows the completion rates better than the buyer does. The published rates are not a reason to avoid a term. They are a reason to treat the advertised term rate as conditional on something the data says happens between half and two-thirds of the time, and to find the refund policy before the term is bought rather than after. What a month costs before any term is applied is what the cost calculator is for.