Medicare uptake, off-label prescribing and new safety questions are shaping the GLP-1 landscape. Here are five GLP-1 updates to know.
- People taking GLP-1s are more than four times as likely to report nail detachment as similar patients who do not take the drugs. In the first controlled study of GLP-1s and nail health, 39% of 575 users reported nail detachment, compared with 9% of 1,329 controls across the U.S., France, Brazil and Mexico. The gaps held among participants who had lost weight.
- Patients receiving injectable GLP-1 therapy through New York City-based NYU Langone Health Specialty Pharmacy had a 3.9% first-year discontinuation rate. Researchers evaluated 2,943 treatment-naive adults who received pharmacist onboarding on day 1, reassessments at months 1 and 6 and ongoing follow-up. Discontinuation rates were 1.8% for tirzepatide and 6.1% for semaglutide.
- Off-label GLP-1 use increased 15-fold between 2021 and 2025. Researchers analyzed medical records from more than 92 million U.S. adults and found more than 1.1 million patients taking GLP-1s without a documented condition that would make them eligible for the drugs. More than 1 in 3 off-label users had a normal BMI.
- Thousands of lawsuits, including at least 4,000 consolidated claims, allege GLP-1s such as Ozempic, Wegovy, Zepbound and Trulicity have caused vision loss, with a recent wave focused on nonarteritic anterior ischemic optic neuropathy. Novo Nordisk added a warning for the condition to its European labels in June, but not in the U.S., where the American Academy of Ophthalmology has said current evidence does not support one.
- About 700,000 new Medicare beneficiaries have started GLP-1 treatment since the Medicare GLP-1 Bridge launched in July, and 70% of those patients are taking Eli Lilly medicines. Lilly’s oral pill Foundayo now accounts for one-third of new patients starting oral GLP-1s.
