Ten and a half points. That is how much further pressure inside the heart fell on semaglutide than on placebo during exercise, in a small trial out over the weekend. Also today: Lilly's brand-name obesity drugs land on Hims & Hers, and Medicare's GLP-1 Bridge has hundreds of thousands of approved seniors who still haven't filled a prescription. It's Monday, November 9, and you're listening to GLP-1 Daily. We begin with the heart.
Barry Borlaug of the Mayo Clinic and colleagues, in a trial published Sunday in Nature Medicine:
The results from this trial indicate that, in patients with HFpEF and obesity, treatment with semaglutide reduced left heart filling pressures during exercise and at rest and was associated with hemodynamic HFpEF remission in over half of treated patients.
HFpEF is heart failure with preserved ejection fraction. Semaglutide was known to ease its symptoms, but the authors say the mechanism was unclear. So they measured pressure inside the heart directly. The design: 81 people with HFpEF and obesity, double-blind, semaglutide 2.4 milligrams weekly or placebo for 52 weeks, with invasive pressure tests during low-intensity exercise. Exercise pressure fell 9.8 points on semaglutide and rose 0.9 on placebo. About 54 percent on the drug reached what the authors define as hemodynamic remission, versus about 7 percent on placebo. More than half versus seven percent. That's a striking gap. It is. Now the caveats. It's small, and 70 people had a usable week-52 measurement. The main outcome is a pressure reading, not hospital stays or survival. It's peer-reviewed and funded by a Defense Department research program. Novo Nordisk supplied the drug and placebo, and Borlaug reports Novo research funding and consulting for Novo and Lilly. If you live with heart failure and obesity, this is a good paper to bring to your cardiologist. Ask whether it applies to you. Don't start anything on your own.
From the joint announcement Eli Lilly and Hims & Hers released Friday:
Hims & Hers has never offered access to compounded copies of Lilly’s GLP-1s, and has committed not to do so in the future. Additionally, as part of the agreement, the companies have committed to protecting independent clinical decision-making, so that providers on the Hims & Hers platform continue to prescribe the treatment they determine is right for each patient.
The deal itself: if a licensed provider on Hims & Hers prescribes Zepbound or Foundayo, the patient gets the same self-pay price as anyone else and the drug ships home. The companies say pricing starts at 149 dollars a month for Foundayo and 299 for Zepbound. Starts at. Ask what your dose costs, and what the whole monthly bill is once any membership is included. And read that compounding pledge closely. It covers compounded copies of Lilly's drugs. That's the companies' own wording, and it's what they've committed to. My bigger issue: this is a price, not coverage. With employers dropping weight-loss coverage for 2027, a cleaner cash route helps some people, but 299 dollars a month is a lot for many households. In its favor, these are FDA-approved products from the manufacturer. Weighing a telehealth route? Talk it through with your prescriber.
Joshua P. Cohen, writing in Forbes, in a piece updated Sunday:
Nevertheless, challenges lie ahead, illustrated in part by the sizable gap between the more than 1.1 million beneficiaries who've signed up for Bridge and the 700,000 or so who've successfully filled a prescription. Prior authorization hurdles, strict clinical criteria at the time of initiation of treatment and delays in claims processing may stand in the way of better alignment between the two numbers.
We last checked on the Bridge on October 30, when early data showed prescribing to older adults climbing. It's the 50 dollar a month Medicare demonstration that runs through December 2027. Cohen lays out the plumbing. Humana processes claims centrally, every patient goes through prior authorization, and eligibility depends on BMI when treatment began. That can trip up people who started on cash-pay platforms with patchy records. And that 50 dollars is flat. People on Part D's low-income subsidy, who usually pay little or nothing, get no break. That's a choice about who the program is for. Separately, USC Schaeffer research released Friday in Health Affairs Scholar found no standalone Part D plan listed Wegovy or Zepbound from 2024 to 2026, even for heart, liver or sleep apnea uses. And Cohen notes that if Bridge expires without a replacement, patients face a coverage cliff in 2028. If you were approved but never got the drug, call your prescriber's office and ask where the prior authorization stands and whether your starting BMI is documented.
Been through the Bridge paperwork, or a telehealth cash route? Tell us how it went at glp1daily at lantern podcasts dot com.
This is news, not medical advice, so take your questions to whoever prescribes for you. GLP-1 Daily is a Lantern Podcast, and we're back tomorrow, Tuesday.