Independent GLP-1 journalism
The newsdesk
What actually happened this week in GLP-1 medicine — supply, pricing, policy and trial data, filtered for signal.
11 pieces
For three years the comparison between semaglutide and tirzepatide was made by holding two separate trials side by side, which is not a comparison. A direct trial changed that — and the result matters less to your decision than you would think.
Read the pieceA negotiated price, a direct-purchase channel and a Medicare pilot. It is the largest change to GLP-1 access in America since the drugs arrived — and the fine print decides whether any of it reaches you.
Fatty liver disease is common, largely undiagnosed, and now has a GLP-1 approved to treat it. For patients whose plans exclude weight-loss drugs, that is not a footnote — it is a different prescription.
Compounded semaglutide filled a real gap during a genuine shortage. The regulatory basis for that gap has narrowed — and the market has not gone anywhere. Here is how to reason about it.
A trial stopped early for efficacy, a label expanded, and a benefit that has almost nothing to do with weight. If you have type 2 diabetes and chronic kidney disease, this is the most important thing in your file.
Both makers now sell straight to patients, below list, outside the insurance machinery. For the uninsured it is the biggest practical change in years — and it quietly reprices the entire gray market.
An oral GLP-1 for obesity removes the needle, the fridge and a good deal of the friction. It also comes with rules about how you take it that people underestimate badly.
Tirzepatide can reduce the effectiveness of oral contraceptives — after the first dose and after every increase. It is printed on the label, it is rarely mentioned in the appointment, and it has a specific four-week window attached to it.
Patent expiry in several countries has produced generic semaglutide at a fraction of the American price. The US patent runs years longer, which is already driving people toward routes that carry real risk.
Having your GLP-1 covered today tells you very little about January. Employers are narrowing benefits, states are dropping them, and the people affected usually find out at the pharmacy counter.
If a quarter of the weight you lose is lean tissue, the obvious pharmaceutical response is a second drug to stop that happening. Several are now in trials, and the questions they raise are more interesting than the marketing.
On The Jab
The
GLP‑1
Handbook
Dr. Nick Robertson
MD
The book · 14 chapters
Everything I tell my own patients before their first injection. 214 pages of what actually matters in the first year — dosing, side effects, food, muscle, cost, and the part nobody prepares you for: maintenance.
Priced at four dollars because it should be affordable to everyone taking these drugs — not because it's worth four dollars. No upsell, no course, no supplement line.