Among 261 adults who had experienced a GLP-1 receptor agonist prescription gap exceeding 90 days, nearly half (49.7%) either waited more than 7 days for prior authorization or were never approved at all. A Continuity-of-Care Index (CCI, scaled 0–100) averaged 69.5 overall but diverged sharply by care setting — weight-management specialists scored a median 82.1 versus 60.7 at primary care. Cross-clinic coordination (54.1%) and visibility into required next steps (52.2%) were the weakest continuity elements. Among current medication users, 32.4% reported medication gaps of 14 days or longer.
This survey reframes GLP-1 discontinuation — widely attributed to side effects or patient motivation — as predominantly a systems failure: authorization bureaucracy, pharmacy stock-outs, and fragmented multi-clinic workflows. That reframing carries real weight. Clinical trials like SURMOUNT and STEP clearly demonstrate that stopping semaglutide or tirzepatide triggers rapid weight regain, making sustained access a physiological necessity, not a convenience. The finding that primary care continuity lags specialist care by over 20 CCI points is clinically significant given that most GLP-1 prescriptions originate in primary care settings. Limitations are notable: a 5.3% response rate from a single academic center introduces substantial selection bias, and the cross-sectional design cannot establish causality between process failures and regain outcomes. Still, the patient preference data — 89.5% wanting integrated refill and authorization tracking — offers actionable design targets for digital health tools. Confirmatory rather than paradigm-shifting, but practically urgent.