On page 67 of the ownerʻs manual, it states that the battery is designed to last for 5 years. But as I mentioned, mine as lasted more than 6x longer than that, and if you read further in that section of the manual, it states the battery is just a back up precaution when the main power pack (of 6 AA) is being replaced or the power grip is removed.
So it appears it the lithium is only being drained when the main power grip is removed or the AA batteries are dead or removed.
The ownerʻs manual does imply that if the lithium battery is dead (or missing) AND the power grip is removed, that the camera does have to be sent to Pentax and I doubt it is just to replace the lithium cell. The CR1220 3V lithium cell is inexpensive and not hard to find.
http://www.cameramanuals.org/pentax_pdf/pentax_645.pdf
In my experience, itʻs best to schedule to run at least one dummy roll through your 645 every 6-12 months. The electronics (and probably mechanical gears) doesnʻt like to sit idle for too long. Same with lenses setting them at various aperture settings now and then. Not quite like the human "use it or lose it" but a little use now and then will go a long way in its longevity.