Integrated Care and the Keys to Successful GLP-1 Therapy

Getting patients started on a glucagon-like peptide-1 (GLP-1) is only half the battle, according to Brian Smith, PharmD, chief pharmacy officer at Shields Health Solutions, who says the coordinated work of physicians, pharmacists, dietitians, and nurses is what turns initiation into lasting outcomes.

“One of the most important things is making sure there are sufficient health care providers available, and that they have sufficient time to spend with patients,” Smith told Drug Topics®. “It's clear to me that when a health care professional has the time to work with a patient, develop the trust, the relationship, and then help that patient achieve their goals, GLP-1 or otherwise, you can have a lot of success.”

In this week’s episode of the Over the Counter podcast, Smith tapped into his experience both in pharmacy and the marketplace, offering a first-hand look at how GLP-1 therapies are evolving alongside new medication delivery pathways and more.

READ MORE: Model Finds NHS England–Style Diabetes Prevention Program Cost-Effective

Beyond the Initial Prescription and Direct-to-Consumer Models

Although direct-to-consumer (DTC) platforms have surged in popularity by offering speed and digital accessibility for initiating treatment, they often fail patients over the long term. According to Smith, focusing solely on the initial barriers of securing a prescription overlooks the ongoing maintenance challenges required for lasting success.

National data shows that between 45% and 65% of patients who begin GLP-1 therapy discontinue treatment within the first year. Continued research highlights that 3 of 4 patients stop by year 2, driven by unmanaged side effects, insurance hurdles, and steep out-of-pocket costs ranging from $900 to $1200 a month.¹

These adherence challenges extend globally, as demonstrated by a cross-sectional study of 500 community pharmacists in Türkiye. The study revealed that over 80% of patient requests for GLP-1 medications were driven by weight loss goals, with over 60% seeking them without a prescription.²

Furthermore, only about half of the surveyed pharmacists routinely counseled patients on proper injection techniques or side effect management, underscoring a pressing need for structured clinical oversight and pharmacist education to prevent misuse.

The Power of Multidisciplinary Care and High-Touch Counseling

To combat high discontinuation rates, Smith points out the necessity of connecting pharmacy services directly with prescribers to create a unified care plan.

In health system specialty pharmacy models, dedicated pharmacy teams work alongside providers to manage dose titrations and proactively address early gastrointestinal side effects. Through this personalized guidance, integrated models maintain over 80% of patients on therapy beyond 1 year while achieving adherence rates above 90%.¹

This proactive approach is mirrored at major academic institutions such as UCSF Health, where ambulatory care pharmacists fulfill a critical clinical role. As detailed by Lisa Kroon, PharmD, assistant chief pharmacy officer at UCSF Health, pharmacists maintain high-touch contact with patients during dose escalation to manage side effects and navigate insurer prior authorization requirements.³

Additionally, pharmacists collaborate with physicians, nurses, and dietitians to pair medication therapy with tailored exercise and nutrition plans. This holistic support prevents rapid muscle loss and helps patients sustain metabolic improvements long after initiating care.

Leveraging Technology and Expanding Indications for Sustainable Care

As health care systems face professional shortages and administrative burdens, technology offers a vital pathway to preserve face-to-face time.

Smith points out that artificial intelligence (AI) and machine learning solutions should not replace clinical judgment but rather eliminate administrative tasks so pharmacists can focus on patient relationships. Integrated specialty pharmacy solutions can streamline insurer approvals and reduce treatment start times to within 24 to 48 hours.¹

The tangible impact of this collaborative approach is already evident in practice. A pharmacist-led care coach program at a diabetes center of excellence successfully reduced emergency room visits by 30% while lowering overall care costs and significantly improving patient A1C levels.

As GLP-1 and dual-agonist therapies expand to address cardiovascular disease, sleep apnea, and liver conditions, pharmacists are positioned to lead metabolic care across multidisciplinary teams in cardiology, pulmonology, and primary care.^1,3

Stay tuned for weekly podcast episodes of Over the Counter powered by Drug Topics. Check out our most recent episode with Jennifer Hammons, PharmD, DrPH, director of rural health advancement at the Appalachian College of Pharmacy, to discuss the importance of rural pharmacies as essential health care infrastructure.

REFERENCES

1. Addressing GLP-1 access and adherence challenges with specialty pharmacy solutions. Shields Health Solutions. April 2, 2025. Accessed October 6, 2026. https://shieldshealthsolutions.com/insights/addressing-glp-1-access-and-adherence-challenges-with-specialty-pharmacy-solutions

2. Bayram-Ozgur D, Demirtürk E, Sar Y. Community pharmacists' knowledge and counseling competence on GLP-1 receptor agonists in obesity and type 2 diabetes care in Türkiye: a cross-sectional study. Diabetes Metab Syndr Obes. 2026 Mar 3;19:587750. doi: 10.2147/DMSO.S587750

3. Revah S. Q&A: How UCSF pharmacists are guiding safe and effective GLP-1 use. University of California San Francisco. November 26, 2025. Accessed October 6, 2026. https://pharmacy.ucsf.edu/news/2025/11/qa-how-ucsf-pharmacists-are-guiding-safe-and-effective-glp-1-use