Back in July, Medicare opened a fifty-dollar-a-month path to the weight-loss versions of these drugs. So did older patients actually walk through it? We finally have outside numbers. Welcome to GLP-1 Daily. It's Friday, October 30. First, how prescribing to older adults has moved since the Medicare GLP-1 Bridge began. Then South Korea's first homegrown obesity drug reaches clinics with a price aimed at Mounjaro, and a pooled look at three large semaglutide trials and the kidneys. If today's show was useful, follow us wherever you're listening — the next one will be waiting.
The research team at Truveta, a health-data company, in an analysis posted Thursday:
GLP-1 prescribing among adults aged 65 years and older increased from June to July following implementation of the Medicare GLP-1 Bridge and remained relatively stable thereafter, with prescribing 20.6% higher three months after implementation than in June. The initial increase may reflect pent-up demand among patients who previously faced barriers to treatment.
In plain terms: among adults sixty-five and up in Truveta's data, the share with a GLP-1 prescription went from 5.6 percent in June to 6.8 percent in September. Younger age groups barely moved. First-time prescriptions in the older group rose about 21 percent. The growth sits in the drugs the Bridge covers. From June to September, Zepbound prescribing to older adults rose almost 72 percent and Wegovy about 33 percent, while the diabetes-labeled versions stayed relatively stable. Most of the jump came in July, the launch month, then it held. Pent-up demand is the polite phrase for people who wanted treatment and couldn't get it until July 1. Truveta's own caveats: preliminary, not peer reviewed, covering everyone sixty-five and up rather than Part D enrollees, and unable to tell which prescriptions the Bridge actually paid for. A pattern, not proof of cause. The rest comes from Eli Lilly's earnings call Thursday, as reported by Fierce Pharma, so treat it as company-reported. Lilly's U.S. president, Ilya Yuffa, said roughly seven in ten Bridge patients are on a Lilly medicine, about three-quarters are choosing injections over pills, and about 80 percent are new to this class of drugs. We walked through how Bridge claims work on Wednesday. One date to hold onto: Truveta notes the program expires at the end of next year unless it's renewed. If you started through the Bridge, ask your prescriber now what happens after that.
Choi Mun-hee, writing for Businesskorea:
Eppe’s main competitive advantage is its price. According to pharmaceutical industry sources, the supply price for the first four weeks of treatment is approximately 129,800 won ($97.20), about half the roughly 270,000 won for Eli Lilly’s Mounjaro and around 40% less than the approximately 210,000 won for Novo Nordisk’s Wegovy.
Eppe, generic name efpeglenatide, is Hanmi Pharmaceutical's weekly GLP-1 shot and the first developed in South Korea. We covered its approval on October 8. Hanmi said prescriptions would start at select clinics on Thursday, October 29. Shipments began a week earlier, but supply is limited, so nationwide distribution will lag. Ngetnews reported Wednesday that those first batches are going to clinics, and pharmacies hadn't been told when stock would arrive. Hanmi calls that temporary. Now the fine print on the price. The half-of-Mounjaro figure is the first four weeks, at the starting dose. Patients step up to ten milligrams, and from week thirteen a four-week course runs 299,200 won at the supply price. There's no matching maintenance price given for the rivals, so the long-run gap is unclear. And with no national insurance coverage, patients will likely pay more than supply price. On results, it's company-reported. Hanmi says a phase 3 trial of 448 Korean patients with obesity found average weight loss of 9.75 percent over 40 weeks. Businesskorea notes that looks more modest than the global brands, but the trials enrolled different populations, so a direct comparison doesn't hold. Connect it to Tuesday's episode, when Korea's health minister put obesity drugs up for review under a scheme with a 95 percent patient co-pay. If patients pay nearly all of it either way, price is the access story. And a cheaper drug only helps if your pharmacy can actually get it.
Lisa Kuhns, writing in Endocrinology Advisor:
Semaglutide reduces clinically important kidney outcomes and slows kidney function decline, with benefits generally consistent across baseline kidney function, diabetes status, adiposity, and type of administration, according to results of a study published in The Lancet Diabetes & Endocrinology.
Timing first: the paper went online in August, and Endocrinology Advisor wrote it up this week. It's a prespecified pooled analysis of individual patients from three randomized, double-blind, placebo-controlled trials. SELECT used the 2.4 milligram weekly shot, FLOW the 1 milligram shot, and SOUL the 14 milligram daily pill. Over roughly three to four years of follow-up, the main kidney outcome, a combination of a major drop in kidney function, kidney failure, or death from kidney or heart causes, occurred in 6.3 percent of people on semaglutide versus 7.4 percent on placebo. Yearly decline in kidney function was slower, including in people whose kidneys were already impaired. Kidney failure alone was 1.3 versus 1.6 percent, a borderline difference. And the line I always look for: the study was supported by Novo Nordisk, which makes semaglutide. Peer reviewed, yes, but the manufacturer's own trials, on the manufacturer's dime. The limits listed include populations that differ across the trials, FLOW stopping early for efficacy, and no correction for multiple testing. On safety, serious adverse events were a bit less common on semaglutide, 39.8 versus 42.8 percent. But more people stopped because of side effects, 15.9 versus 9.7 percent, mostly gastrointestinal. If you live with kidney disease alongside diabetes, heart disease or obesity, bring this to your next visit. Ask your prescriber how your kidney numbers figure into your treatment choices, and don't change anything on your own.
A question for listeners on Medicare. If you've tried to get a GLP-1 through the Bridge, tell us how it went, from that first rejected claim to the pharmacy counter. Write to glp1daily at lantern podcasts dot com.
So the week closes with older patients starting treatment, a cheaper starter price in Korea, and a kidney finding with the manufacturer on the funding line. None of this is medical advice, so take your questions to your own clinician. GLP-1 Daily comes to you from Lantern Podcasts, and our next episode is Monday, November 2.