• Midyear changes to insurance policies
• Prior authorization requirements — insurer approvals needed before a prescription is covered
• Step therapy, which forces patients to try a cheaper medication before moving to a more expensive one

The patients in the highest cost group — $168 or more per month — were more likely to live in Southern states and to be enrolled in high-deductible insurance plans.

The study did not directly analyze socioeconomic factors. But Shin notes that previous research suggests low-income populations are more likely to choose plans with low premiums and high cost sharing. In those plans, patients often pay the full price of GLP-1 medications out of pocket until they meet their deductible — which can run to several thousand dollars.

"That means more vulnerable people are in those high-spending zones, which can in turn lead to lower medication adherence," Shin said.

What does this mean for insurance policy?

Federal programs have already acted on the cost problem for one group: out-of-pocket spending on GLP-1s for eligible Medicare patients is capped at $50. Commercial insurers have not adopted similar price caps.

"That basically means people who have employer-sponsored insurance may continue to face these financial barriers," Shin said. "Policymakers, regulators and insurance companies should consider that."

The study's central conclusion, Shin said, is simple: "The key takeaway from our study is that out-of-pocket costs matter."

She argues that anyone hoping to maximize the number of people who benefit from these drugs should rethink how costs are structured. "If their goal is to improve medication adherence and have as many people benefit from these drugs as possible, we should start thinking about how to restructure out-of-pocket costs and insurance design," Shin said.

Could cheaper access pay for itself?

GLP-1s can produce substantial weight loss when patients take them as prescribed, and obesity raises the risk of heart disease, type 2 diabetes, high blood pressure and other chronic conditions. People with chronic disease face higher health costs overall, along with unexpected and expensive emergency room visits and hospitalizations.

That, Shin argues, is the case for looking beyond the upfront price tag. While the study did not measure long-term savings, she hopes future research can demonstrate the economic case for broader access.

"Although the out-of-pocket cost can be sizable in the short run, potentially in the long run we are able to better manage chronic conditions with these medications," Shin said. "If you can reduce emergency department visits and hospitalizations, that could lead to long-term cost savings."

What are the study's limits?

The findings come with caveats worth keeping in mind. The study covered only commercially insured adults, so the results may not transfer to uninsured patients or those on public coverage. Side effects and specific insurance practices were not directly measured, only suggested as plausible explanations. And the analysis captures behavior over an 18-month window, which may not predict longer-term adherence.

Still, the $75 threshold gives insurers and policymakers a concrete number to work with — and a clear warning that when the monthly bill climbs too high, patients simply stop filling it.

The study appears as Eunhae Shin et al., "Out-of-Pocket Costs and Adherence to Semaglutide for Obesity Among Commercially Insured Adults," JAMA Health Forum (2026), DOI: 10.1001/jamahealthforum.2026.3113.