For several years, glucagon-like peptide-1 (GLP-1) medications seemed to dominate conversations in community pharmacy. Patients called asking whether specific products were available, prescriptions were transferred between pharmacies, and pharmacy staff spent considerable time checking inventories and monitoring shortages. It was not unusual for patients to call multiple times or travel significant distances in search of a medication that was difficult to obtain.
GLP-1 receptor agonists, including semaglutide (Ozempic and Wegovy) and tirzepatide (Mounjaro and Zepbound), were originally introduced for the treatment of type 2 diabetes. Their effectiveness in weight management dramatically expanded demand, and newer indications have continued to increase interest in this class of medications.
At the height of the shortages, access was the primary issue. Patients wanted the medication. Prescribers wanted patients to receive the medication. Pharmacies simply could not obtain sufficient supply to meet demand.
Today, at least from what I am seeing in community pharmacy, the conversation has changed. The medications are available.
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What has surprised me is that improved availability has not necessarily translated into the same level of urgency from patients. We have gone from patients routinely calling pharmacies looking for these medications to pharmacy staff calling patients because prescriptions are ready and waiting to be picked up. In some cases, products that were almost impossible to obtain a year or two ago are sitting in pharmacy refrigerators waiting for a patient to come and get them. That change has made me think about how much of the public conversation focused on obtaining therapy and how little attention has been paid to maintaining therapy.
The shortage story was relatively straightforward. Demand exceeded supply. The solution appeared equally straightforward: increase supply.
The reality is more complicated.
Obtaining a medication and remaining on a medication are two very different things. Patients still face insurance restrictions, prior authorizations, changing formularies, high out-of-pocket costs, side effects, dose adjustments, and the practical realities of long-term treatment. While the shortages often dominated headlines, these challenges never disappeared.
As pharmacists, we spend a great deal of time discussing medication adherence. We know that initiating therapy is only one step. Long-term success depends on whether patients can continue treatment consistently and whether the treatment remains accessible, affordable, and worthwhile from the patient’s perspective.
What I think we are beginning to see now is the next phase of the GLP-1 story. The initial surge in demand has been followed by the realities of long-term use. Some patients remain highly motivated and continue therapy successfully. Others encounter barriers that make continuation difficult. Some patients may reach their goals and reevaluate treatment. Others may find that the cost, side effects, or ongoing commitment are different from what they initially expected.
None of this diminishes the clinical value of GLP-1 medications. These therapies have transformed treatment options for many patients with diabetes and obesity and continue to show promise in additional disease states. However, improved supply has highlighted a reality that pharmacists have always understood: Access alone does not guarantee long-term success.
Pharmacies spent years helping patients navigate shortages. We may now spend the next several years helping patients navigate sustainability.
From where I stand, the most interesting question is no longer whether patients can get these medications. For many patients, that challenge is improving.
The more important question may be what happens after they do.
Danielle Lightsey is a pharmacist.
