Seventy-five dollars a month. A new study says that's about where people start walking away from their GLP-1. This is GLP-1 Daily. Today, the copay cliff, New Mexico's Medicaid bill for Ozempic, survodutide in the New England Journal, and the amylin drugs trading weight loss against tolerability. Plus Novo's numbers on switching from the shot to the pill. If the show's useful, follow us wherever you're listening. Georgia first.
The University of Georgia, in a release on EurekAlert!:
Even at the lowest cost tier, medication discontinuation was high, with three out of four patients stopping their GLP-1 within a year of filling their first prescription. But researchers saw a significant drop-off around the $75 mark. When monthly out-of-pocket costs exceeded this amount, nonadherence rose to more than 80%.
Published in JAMA Health Forum. Eight thousand nine hundred fourteen insured people who started a GLP-1 for weight loss. And the shape surprised the lead author, Eunhae Shin. She expected a straight line. Instead adherence is roughly flat until seventy-five dollars, then it falls off. Two caveats before this lands in a budget memo. Even in the cheapest tier, three out of four people stopped within a year, so cost isn't the whole story. Side effects and insurance hurdles are in the mix, and the study didn't measure those directly. It also doesn't name a funding source. Now look at the top tier. People paying a hundred sixty-eight dollars or more a month: adherence around seventeen percent. More likely in Southern states, more likely on a high-deductible plan, where you pay full price until you clear the deductible. And Shin is pointed about policy. Medicare's bridge caps eligible patients at fifty dollars a month. Commercial insurers haven't adopted similar caps. Her words: people who have employer-sponsored insurance may continue to face these financial barriers. So the seniors got the cap, and the working-age person on a high-deductible plan got the cliff. That's plan design. If cost is the reason you're thinking about stopping, say that out loud to your prescriber before a refill quietly lapses. It's a conversation worth having on purpose.
Margaret O'Hara, writing in the Santa Fe New Mexican:
New Mexico’s Medicaid program in 2025 spent $38.7 million on Ozempic, one drug in a class of medications used to treat Type 2 diabetes, obesity and other conditions, according to analysis presented Tuesday to the Legislative Health and Human Services Committee. That's up more than 34% since just the year before, and more than double from 2023.
The year-by-year chart is the story. About twenty-four thousand dollars in 2019. Thirty-eight point seven million last year. Context, because the headline says weight loss drug. Ozempic is FDA-approved for type 2 diabetes, and New Mexico Medicaid covers it for diabetes, sleep apnea and a handful of other conditions. For obesity alone, most patients need a BMI over forty to get a weight-loss drug approved. Over forty. That's not a coverage policy, that's a velvet rope. And state health data shows obesity rates run higher among Native American and Hispanic residents, in rural communities, and in households making under twenty-five thousand a year. Those are exactly the people advocates want covered. Meanwhile the money is tightening. The state Health Care Authority estimates last year's federal reconciliation law will cut enrollment by about eighty-eight thousand, and program costs are still expected to rise. And lawmakers can't see the other half of the ledger. State lawmaker Thomson said it plainly: they get a fiscal impact report that says what it costs, but there's no way to say what it's going to save. The JAMA Health Forum Medicaid study we covered yesterday made the same point from the other direction. Count the whole GLP-1 class, not one label. Massachusetts answered the cost question by cutting coverage. New Mexico is still asking it.
Zealand Pharma, in a company announcement carried by BioSpace:
In the SYNCHRONIZE-2 trial, which met its co-primary endpoints, participants achieved significant body weight reduction of up to 13.1% versus 3.1% in the placebo arm, after 76 weeks of treatment with survodutide in people with type 2 diabetes, a population in which weight loss is typically more challenging.
Survodutide is Boehringer Ingelheim's drug, Zealand's partner, and it works a little differently: glucagon plus GLP-1. Seventy-six weeks, everyone with type 2 diabetes, and published the same day in The New England Journal of Medicine. Peer-reviewed, good. Now read the 'up to.' Thirteen point one is the efficacy estimand, which estimates what happens if everyone takes the drug as directed. Journal-published trial, company-chosen headline number. Both are true at once. Blood sugar moved too. A1C down as much as one point two one points from a baseline of seven point four, versus essentially nothing on placebo. Survodutide's case was never going to be the biggest number. Zealand's chief medical officer is pointing to the cardiovascular outcomes trial, SYNCHRONIZE-CVOT, later this year. Which is the one a payer actually reads. Right now it's investigational: no price, no tier. I'll get interested when the heart data lands.
Dorothy Brooks, writing in Medical Daily:
The catch is tolerability. Up to 27% of people on the combination stopped treatment because of side effects, compared with 2.9% on tirzepatide alone. The trial was mid-stage and run by Lilly, and the full results have not yet appeared in a peer-reviewed journal.
The combination is Lilly's amylin drug eloralintide plus tirzepatide, called EloraTZP. Three hundred sixty-seven adults with obesity and type 2 diabetes. Twenty-three point three percent average weight loss at forty-eight weeks on the top dose, versus fourteen point eight on top-dose tirzepatide alone. And more than one in four quitting over side effects at the high end. That's the number I'd lead with, and it isn't peer-reviewed yet. Now flip to Zealand's petrelintide, an amylin drug on its own. Phase 2, published in The Lancet Diabetes and Endocrinology, people without diabetes. About ten percent weight loss, and only about one and a half percent stopped because of stomach side effects. The investigator, Timothy Garvey at the University of Alabama at Birmingham, said the quiet part. We have efficacy. What we don't have is tolerability. He also said half of people stop these medicines after a year. Put that next to the Georgia study. Cost and side effects, two different exits. Petrelintide is the drug we covered Tuesday starting Phase 3. Ten percent with few people quitting, or twenty-three percent with a lot more quitting. Those are different products for different patients, and I'd like plans to remember that when they write step therapy. Both are investigational. Neither is something you can ask your doctor for yet.
Annika Kim Constantino, writing for CNBC:
Real-world studies evaluate associations and can't determine causality. But the results suggest that the Wegovy pill may improve upon the initial weight loss people experience on blockbuster injections rather than simply maintain it. It also suggests that patients may not need to take weekly shots like Wegovy and Zepbound forever, and can instead opt for more convenient treatments such as Novo's pill.
This is Novo's OCTANE analysis, built on data from the telehealth company Ro. People switched from a semaglutide or tirzepatide shot to the Wegovy pill, and those who stayed on it for three months lost about four percent of body weight, eight point eight pounds on average. One hundred ninety-four people. Retrospective. A Novo and Ro collaboration, presented as a short talk at EASD in Milan, not a journal paper. And Novo lists the limits itself: self-reported data, and requiring people to stay on treatment could mean selection bias. And look at who's in it. One telehealth platform, nobody with a history of diabetes. Novo's own release says the results may not generalize to the broader population. I'd like to see who it works for outside Ro's customer base. Speaking as someone with a pen in my fridge, I get the appeal. But three months of company data is a reason to ask, not a reason to switch. If you're curious about the pill, bring it up with your prescriber, and don't change anything on your own.
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