Half of the people who hit it waited more than a week or never got an answer. The figure is 49.7%, among the 60.9% of respondents who faced a prior-authorization requirement at all [1]. Among people currently taking a weight-management medication, 32.4% reported a gap of two weeks or more.
Nearly everything written about people stopping these drugs treats it as a decision — the side effects were bad, the money ran out, the results disappointed. This survey asked people what actually happened, and much of it was not a decision at all. Cost still leads the list of stated reasons, and it is not the whole mechanism.
Read the sampling frame first
Invitations went to adults identified from one academic medical center’s records. Each had at least one GLP-1 prescription in the preceding six years and a subsequent gap of more than 90 days. [1] So this is, by construction, a survey of people who had already discontinued. It was never a sample of everybody taking the drug.
Then 261 of 4,890 invited people responded — 5.3%. Whatever else is true, people with a grievance answer surveys about their grievance more often than people without one. Every percentage below describes those 261 respondents, and none of them is a rate for any wider population.
What respondents described
60.9% reported prior-authorization requirements. Among those, 49.7% either waited more than seven days or were never approved at all. Among people currently taking a weight-management medication, 32.4% reported a gap of two weeks or more.
The things that worked were interpersonal: 76.2% knew whom to contact about their medication, and 70.7% reported timely responses from their care team. The things that failed were structural: cross-clinic coordination at 54.1% and visibility into what needed to happen next at 52.2%.
The authors also built an exploratory Continuity-of-Care Index for this survey, scored 0 to 100. It averaged 69.5 across 242 respondents and differed sharply by where people were seen. The median was 82.1 at a dedicated weight-management clinic against 60.7 in primary care, Kruskal-Wallis p < 0.001. That is their own instrument rather than a standard measure, and the direction is plain enough.
Where the delay sits in the wider funnel
A national cohort of 4,555 US adults measured the same journey from further back [2]. Awareness ran at 81.6% and use at 8.3%. Among people who attempted treatment, 49.9% never obtained the drug.
Access barriers were the strongest predictor of that failure, at an adjusted prevalence ratio of 1.42 (95% CI 1.14–1.77). So failing to get one is the median experience, and the authorization queue is one station on that line rather than the whole of it.
Price is the other station, and it closes the gate earlier. In one real-world program, 57 of 78 patients offered liraglutide declined it over out-of-pocket cost [3]. The 21 who accepted lost 3.2% of body weight in six weeks against 1.4% in those who did not. So the drug was working for the people who could not buy it.
Why most readers never reach the queue
In 2025, 19% of large firms offering health benefits covered a GLP-1 when it was used primarily for weight loss [4]. Four in five did not. For those buyers there is no authorization to wait on, because there is no insurer in the transaction. That is the reason a cash price desk exists.
What people said they wanted
Not more medicine. 89.5% wanted one place to track refills, prior authorization and appointments together, and 87.2% wanted to see prior-authorization status in real time. Those are requests for a status page.
What this does and does not argue for
It does not argue for buying from a website, and this site is not going to pretend otherwise. A cash purchase removes prior authorization by removing insurance. That is a genuine improvement on one axis and a loss on several others. No coverage if the price moves, no pharmacy network behind a stock-out, and no clinic to coordinate with because there is no clinic. That is the trade this market actually offers, stated plainly.
What it does argue is that some portion of what gets recorded as discontinuation is administrative rather than clinical. That matters for how you read every persistence figure in this field. Even in a program where the drug was free, median persistence was under eleven months — cost is one mechanism among several, and so is paperwork.
If you are going the covered route, the practical reading is to expect the authorization to take time and to ask early. If you are going the cash route, the practical reading is that what you are buying is the absence of that process, priced accordingly. The coverage question is still worth exhausting first, and where you live changes both answers.