27 ms·

GLP-1s are breaking life insurance

441 points by alexslobodnik 1y ago

jollyllama 1y ago
Can't the insurance companies just look for stretch marks?
toomuchtodo 1y ago
It sounds like aligning incentives here is requiring the weight stay off for the policy to remain in effect with an annual physical for monitoring, similar to what employers require for health insurance premium reductions. Point in time underwriting is suboptimal considering current state of the art of GLP-1s (unless newer protocols that can update metabolic profiles are delivered soon).
- prasadjoglekar 1y ago
  Or life insurers paying for ongoing GLP-1s instead of potentially the health insurer. But to your broader point, at least in the US, incentive mis-alignment on all healthcare and health insurance is possibly irredeemably broken.
  - toomuchtodo 1y ago
    Nailed my broader point. Could we go through contortions to see who is going to pay unreasonable costs for GLP-1s (health insurance, life insurance)? We could, but that's silly accounting to see who still gets to make the profit and who has to end up with the bill for empowering the human to fix their reward center. The shortcut is to provide GLP-1s to everyone who needs them at scale, as inexpensively as possible (to pull forward the improvement in health and quality of life outcomes until improved protocols arrive). The semaglutide patent is about to expire in Canada, China, India, and Brazil, for example. https://www.labiotech.eu/in-depth/novo-nordisk-semaglutide-patent-expiration-canada/ https://www.labiotech.eu/in-depth/novo-nordisk-semaglutide-p...
jgalt212 1y ago
I guess, but this is sort of the same as going on a statin to get your cholesterol down for a better insurance rate. Then going off because of reasons...
arn3n 1y ago
Obesity is highly correlated with other medical conditions, from cancer to diabetes to heart disease. I wonder if there is a point at which it is cheaper for health insurance companies to offer subsidized or even free GLP-1s to patients than pay out for other specialized medications. For example, my insurance covers flu shots in my community every year because it's presumably less expensive to pay for the shots compared to the increased rate of hospitalization that the flu causes.
- aqme28 1y ago
  You’re thinking too highly about the incentives of the US healthcare system. Since insurance is tied to your employer (and therefore changing every few years), and most people die on Medicare, there’s not much incentive for insurance companies to pay for preventative care that won’t actually help you for several decades.
  - ethbr1 1y ago
    That’s one reason the ACA shifted it to a mandatory (in most cases) category: https://www.healthcare.gov/preventive-care-adults/ https://www.healthcare.gov/preventive-care-adults/ Minimal, but minimal progress in the US was/is still progress.
    - eru 1y ago
      It's a shame the contracts you'd need to set the right incentives are probably illegal.
  - helicalmix 1y ago
    hmm...doesn't this possibly incentivize ozempic subsidies even more? If you know a "customer" of yours (an individual employee) is only going to be with you until they either change jobs or go on Medicare, then it seems the name of the game then is to make sure that nothing catastrophic happens to them until you can hand them off to someone else. In which case, they should definitely go on ozempic. Even if the effects of ozempic immediately come off after usage, it's a short-term enough solution that benefits the insurance company, no?
llm_nerd 1y ago
This is a fun read, however- "Life insurers can predict when you'll die with about 98% accuracy." This conclusion isn't supported by the linked document. The document instead is talking about expected vs actual deaths among demographic groups as a whole, not individual people. And that expected vs actual is just history + trends. This doesn't mean that insurance can say that Joe Blow is going to die in June of 2027 with "98% accuracy", obviously.
- PaulDavisThe1st 1y ago
  Put a little differently, they can predict that of your cohort (defined somehow), after June 2027, only X percent of you will still be alive. Will you be one of them? Click here to find out!
  - etothepii 1y ago
    For mortality tables age and sex are pretty much sufficient to get to 98% accuracy.
    - adgjlsfhk1 1y ago
      You definitely (at least in the US) need income (or an income proxy like zip code). Mississippi has a life expectancy ~10 years less than Massachusettes.
      - etothepii 1y ago
        This typically has surprisingly little impact on force of mortality. Men under 40 essentially have incredibly low mortality. Once you exclude cars and suicide it drops basically to zero. Even things that are very very bad for you, like being very obese (BMI>40), are factors that scale a mortality that is massively dominated by age and sex. Even 3x mortality at 25 rounds to zero. At 60 background become 1% per year and a 3x increase would make a huge difference. I would wager $50 that there are no contiguous collection of zip codes in the USA where the average 40 year old has a higher life expectancy than the average 30 year old in any other contiguous set of zip codes assuming there are over 1000 people of that age in both.
vslira 1y ago
I've always felt that there's some trade to be done here, with life and health insurers basically giving glp-1 et all for free bc they lower the cost of everything else edit: and then Big Annuity lobbying to oppose this
- lesam 1y ago
  Aren’t “Big Life Insurance” and “Big Annuity” pretty much the same companies?
  - hiAndrewQuinn 1y ago
    They are, they're basically mathematical inverses of the same product. Big Annuity can charge you more, in fact, if it has reason to believe you're going to live unusually long, so playing the GLP-1 dance with them would only be profitable in reverse. Pretend to be the unhealthiest person on the planet, lock in an annuity, then get on the drip stat.
    - neaden 1y ago
      I think the difference is people generally get Life Insurance when they are younger (I'm guessing frequently when they have kids, that is when I got it at least) but get Annuities when they are a senior. I don't know anyone my age who is purchasing an annuity now, though I suppose there must be someone who would be willing to sell it.
      - hiAndrewQuinn 1y ago
        I think the deal would have to be very sweet for eg a 30 year old like yours truly to forgo 35 years of index fund gains to pick up an annuity instead. That's also 35 years where the annuity firm itself night shutter its doors - a risky play, but right for the right price.
meltyness 1y ago
Well I guess a GLP-1 pacemaker would address this. A lifetime of doses weighs at much as a nickel?
- MPSimmons 1y ago
  I believe it has to be kept at refrigerated temperatures over its relatively short shelf-life (1 year, I believe).
foota 1y ago
I realize this is a fraught question, because not everyone is overweight by choice (whether due to a subsisting on whatever they can afford, time, genetics, injury, etc,.) but I believe that insurers are able to consider whether someone smokes cigarettes when setting premiums for ACA based healthcare. With the above caveats that would make this difficult, it would be nice if we could treat "voluntary" obesity similarly.
- etothepii 1y ago
  I think the article is making the point that that is what they have traditionally been able to do but they no longer can. Since the magic drugs are giving people the will power to be able to make these changes.
  - foota 1y ago
    The article is about life insurance, not health insurance (I should have made it clear I was talking about health insurance).
artursapek 1y ago
[flagged]
- leptons 1y ago
  Have you ever met a human before?
  - artursapek 1y ago
    hahahaha
- bee_rider 1y ago
  We’re not evolved to turn down cheap, easy calories by default.
- the__alchemist 1y ago
  Primate brain want sugar! I am a disciplined, rational being, and will not eat these 3 donuts. The research indicates it will contribute to the health and aesthetic problems which already ail me. Primate brain want sugar!
  - artursapek 1y ago
    maybe the issue is too many people just have fucked up gut flora. if I ate 3 donuts I'd feel like complete shit
- nemomarx 1y ago
  You eat less unhealthy foods on the drugs, so that is actually changing the diet?
  - artursapek 1y ago
    you are still eating unhealthy foods, so no the diet has not changed.
romaaeterna 1y ago
The problem (not new with GLP-1s) is that people lose weight, get life insurance, and then regain. The biggest part of that equation is regain part. Most people quit GLP-1s because of costs. Let's fix that.
- beepbopboopp 1y ago
  Get ready for health/weight based credit scores, Its probably a genuinely good idea.
- paulpauper 1y ago
  I think they quit also because they see it is working and no longer feel like they need to use it
- apwell23 1y ago
  i have hard time believing ppl go through all that only to sign up for cheap life insurance.
- cm2187 1y ago
  I don't know, I tend to notice the effect wears off over time. Not sure it's a good idea to consume it permanently. Perhaps a better use would be for short periods to course correct.
  - romaaeterna 1y ago
    Anecdotally, the dose required to maintain a stable weight seems to be lower than the dose required to lose weight. Most people tend to regain some weight when going cold turkey. The safety profile of the drugs with diabetics, and the health benefits that come from the associated weight loss may make permanent use a net benefit for most people. There appears to be little, if any, "course correction" effect from taking it for short periods of time.
    - cm2187 1y ago
      It depends how you define "short period of time". When I started, I lost 40kg in a matter of 5 months. Is that short? If you develop a tolerance to the product, then it doesn't protect you long term from gaining back weight, combined with you losing the option to do a rapid descent. I am not saying that those variations are great from a health point of view, but they are certainly not as bad as staying obese.
paul7986 1y ago
I believe AI along with smart glasses that shows and calculates your daily caloric intake will be a SUBSTITUTE (another option) to the Ozempics. With AI glasses doing this automatically for you upon seeing what your eating without u having to do anything some people may be shocked to learn how many calories they consume daily. Currently, it's too time consuming now for the majority to do (i use GPT via texting it or talking to it to keep track as I eat out daily at healthy chains) but if it was done automagically I believe it definitely would be a substitute to Ozempic. I bet some or more would use that easily captured data that's shown to them (in the glasses or on their mobile device) to strive, make and possibly compete with their friends/family to eat less calories and carry less weight on them (be healthier). You can train your body to eat less to a lot less and for some that would definitely help them shed weight. The glasses could as well deduct calories burned from your daily walk, jog, etc. *Being downvoted hmmm do you think AI by seeing it can't via an image calculate the calories of a burrito bought from Chipolte and other chains? All chains have nutrition information on their websites now that GPT goes and fetches. As for home cooked prepared meals I have taken pics of my food via GPT and it seemed to come close.
- __turbobrew__ 1y ago
  I don’t think awareness of caloric intake is the problem, there are standardized labels on most foods (especially the bad ones). Most people who are obese know that the calories make them overweight, but they still have the need to eat food — which is what makes obesity a result of addiction. Similarly meth addicts know that meth is bad for them, but they still do it anyways.
  - astrange 1y ago
    How often do people control their own diets? That assumes they buy and cook all their own food, which is only true if you live on your own.
    - __turbobrew__ 1y ago
      > How often do people control their own diets Maybe I live in a bubble, but I don’t put stuff in my body unwillingly, so yes I control my diet. It also isn’t rocket science, I know doughnuts have a shit ton of calories and vegetable shortening which will clkg your arteries, so I don’t eat doughnuts. I don’t have to look at the packaging. Maybe the missing part is a proper education on nutrition in school, but we live in the age of the internet. All the information is there, you can get meal plans, you can figure out what foods are more likely to put you at risk. Again, I don’t believe awareness is an issue. People know that chips and doughnuts are bad, but they eat them anyways because they are addicted to food which is engineered to be addictive.
hiAndrewQuinn 1y ago
So... There's a miracle drug powerful enough to robustly lower people's all cause mortality, but since health insurance and life insurance are industries with vastly different time preferences, this is not a good thing for the life insurers because people just keep getting off the magic longevity drug and screwing up their predictions. Because, admittedly, it kind of sucks in the moment to be on. And I'm guessing just based on my own experience paying for term life that the actual premia differences aren't actually enough in most cases for the life insurer to simply pay out of pocket themselves; the differences probably add up to a few hundred per year per customer, whereas a year's worth of a GLP-1 agonist probably costs a couple thousand (for now, in 2025, and probably dropping rapidly). Huh. Second order implementation details aside, this is an extremely fortunate turn of events for us.
- ramoz 1y ago
  Can you explain what sucks about being on the prescriptions?
  - hiAndrewQuinn 1y ago
    I'm just reporting my cached knowledge of people saying they experienced some adverse side effects. Also injections are not fun, even though they are probably a lot less annoying than they look.
    - nwienert 1y ago
      In the 10 or so people I know who are on it, nearly all actually seem to enjoy it - reduced addictive tendencies/bad habits, appetite control, and reduced allergies seem to pretty well outweigh the minor side effects.
      - wormius 1y ago
        I was a heavy alcoholic, and the ability to quite drinking was... amazing. Now that I'm off, I just remind myself I never want to get back at that dark place, but I'm so very glad it made quitting just... happen. It's wild how easy it was. A little mental control in terms of "no, don't go to the liquor store" but it was habit more than physical addition at that point. This was with Rybelsus. Sober 4.5 years now. It was definitely not an intended side effect but I'm glad I was rx'd when I was. I was not in a good state.
firesteelrain 1y ago
I was on Mounjaro for two months. I was also dieting and walking 10k steps a day. I lost 25 lb and my A1C went down to 5.0 from 5.7. All my cholesterol numbers were in range. I stopped taking it and lost 25 more. I haven’t regained the weight. People who gain it back did not learn the lesson and did not effectively change their habits. You need the discipline - and a good support system. But if you don’t have that and continue old habits then you will gain weight back. The original problem isn’t solved.
- Sparkle-san 1y ago
  [flagged]
  - 44520297 1y ago
    Why is obesity the only disease that taking medicine for is “cheating”? Which is more important: instilling your particular version of “discipline” into people, or saving billions in healthcare costs and millions of lives from suffering?
    - throwawaybob420 1y ago
      [flagged]
      - 44520297 1y ago
        Taking medicine is a lifestyle choice.
        throwawaybob420 1y ago
        [flagged]
    - Group_B 1y ago
      It’s usually a self inflicted disease. Your own actions cause it most of the time
almosthere 1y ago
so surreal reading comments... a month after non-stop threads about glp causing a billion issues, everyone is talking about how wonderful they are again. humanity
- brokensegue 1y ago
  billion issues? i saw some reporting on rare cases of blindness. what else?
  - paulpauper 1y ago
    1-2 years ago there was considerable skepticism about "taking the easy way out" or unforeseen risks like like with Fenfluramine/phentermine. Now sentiment has changed given that more people realize these drugs are safe and effective.
  - octo888 1y ago
    Pancreas issues and hair loss IIRC?
    - adgjlsfhk1 1y ago
      Hair loss is 1. Exactly the type of "side effect" that people will report because they lost hair (because lots of people experience hair loss whether they are on a GLP1 or not) 2. A fairly minor side effect that wouldn't be a strong reason to not prescribe. Pancreas issues were worried about, but those worries (so far) appear to be unfounded. https://pmc.ncbi.nlm.nih.gov/articles/PMC6382780/ https://pmc.ncbi.nlm.nih.gov/articles/PMC6382780/ is a meta-analysis of 12 studies (36k patients) over 2 years that showed no evidence of increased pacreatic issues, and https://pubmed.ncbi.nlm.nih.gov/38175642/ https://pubmed.ncbi.nlm.nih.gov/38175642/ is a 7 year analysis of ~33k patients that also shows no increase in issues.
- nwienert 1y ago
  It's a once in a generation drug with less side effects than most OTC, likely net positive even for healthy weight people. I'd bet within the decade it'll be approved for a whole basket of other benefits - at the least a whole array of immune system disfunctions and a cure-all for addiction. Likely protective of a wide array of internal organs, likely life extending.
throwaway019254 1y ago
Is there any research on whether GLP-1s are also beneficial for generally healthy and not overweight people?
paulpauper 1y ago
More sensationalism. Insurers can simply adjust the policy accordingly to account for patients discontinuing the drug. They can also raise premiums if patients go off the drug, and there can be a cluse that stipulates this. This is literally the job of an actuary to reprice premiums . Insurers take a short-term hit and then adjust premiums to ensure it never happens again. This happened with California fire risk for example. Moreover, this drug will not increase life expectancy by that much even with lifetime patient compliance. The majority of obese people ,especially men, who take these drugs will still be overweight or obese, but just not as much as before.
- bagacrap 1y ago
  The idea is that the insurer doesn't even know the customer is on glp1, and I guess doesn't require a full physical often enough to reprice frequently.
wjnc 1y ago
The article is missing some key points about insurance. An ideal book balances mortality and longevity risks. This cancels out the risk GLP-1s or many other actuarial shifts in mortality. Insurers swap risks, reinsure risks etc to move towards an ideal book. Nice products to balance are pensions and longevity. Problem is that the scale is quite different on a per policy basis, and also very location specific. The article also misses regarding slippage is that Swiss Re in the link calls it a modest increase And that is mainly due to insurers Not performing the same level of medical intake (accelerated versus full underwriting). Increased competition leads to less profits. That’s pretty straightforward and not per se GLP-1s related. And then the kicker. For not diversified portfolios of mortality risks. Those have been massively profitable for decades, in line with the general increase in age and health. GLP-1s just expands on that profitable aspect. Did I mention that the long term expected rate of return on an insurers book is quite good? Insurers can weather a bit of slippage. Reinsurers will kick the worst offenders back in line with their AUC performance, because without diversification Or reinsurance it’s hard to stay in the market. (Capital requirements strongly favor diversification. Mono line is very hard.) That’s why Swiss Re is bringing out such rigorous studies of detailed policy events. Signaling to the reinsurance markets and the insurance companies and their actuaries!
mcherm 1y ago
If insurers are suffering from "mortality slippage" because some of their customers purchased insurance while on GLP-1s then later discontinue the medication, then there must also be "mortality slippage" in the opposite direction. There must be customers who were not on GLP-1s when they purchased insurance, but could go on them, extending their lives in a way that is very profitable to the life insurance companies. Furthermore, there are more people not on GLP-1s than on them (even with the recent surge in popularity) so this population that can give life insurance companies "excess" profits must outnumber those the article describes where the insurance company takes a loss. Why can't they focus on this profit opportunity?
- hobom 1y ago
  At least in part, according to the article, because the not-yet-on-GLP1 folks are NOT customers since they are often denied coverage in the first place.
poulpy123 1y ago
[flagged]
jakubmazanec 1y ago
> When someone stops the medication, they'll usually regain the weight they lost Source? I agree that some people will regain the weight, but "usually" is an unfounded (without some data) generalization.
- arp242 1y ago
  It's linked in the article.
- paulpauper 1y ago
  It's variable. some regain all, other regain less. But they basically all regain some.
- catdog 1y ago
  It probably depends if they also change eating habits. If they change nothing regaining the weight is no surprise.
- alluro2 1y ago
  I don't mean to be overly harsh, but saying "just changing their diet" is quite ignorant. There's been a huge amount of research into the challenges of weight loss, so it should be (more) common knowledge by now that it's not just about deciding to do it and "having discipline" - it takes much more than that, both physically and psychologically. I understand where you're coming from, though, I used to think the same - I remember a specific situation where an obese person next to me was breathing heavily from doing something easy and me thinking "how do you hear yourself breathing audibly from doing almost nothing and not decide and just change it". Unfortunately, I got into a situation where I now understand the issue and am struggling to lose weight, despite hearing myself breathing audibly after picking up something from the floor and all the rational understanding and knowledge of what I need to do. IMO, in a lot of cases, the first step should be going to a therapist.
jamesgill 1y ago
In 2023, the life insurance industry took in >$3 trillion dollars in premiums. That same year, it paid out roughly $800B in claims. TL;DR: there's no violin tiny enough for me to play for the life insurance industry's 'woes'.
- paulpauper 1y ago
  yes, there is a reason why BRK.A/B stock has done so well ,even while sitting in tons of cash. Geico is a cash cow.
kylecordes 1y ago
Seems like insurers should be rating based on your worst health markers, including weight, over the last N years rather than just a current point-in-time snapshot. Someone who somehow has no medical records over the last few years at all that would capture any of that data would be priced on the assumption the past was possibly worse than current.
- _9ptr 1y ago
  I don't know the situation in the USA, but in Europe you wouldn't find many young (up to ~35) people who have data on any health markers. And these are the main market.
refulgentis 1y ago
Is the slippage graph just for net life increase slippage? Or any slippage? It caught my eye this explosion in slippage happened years before GLP-1s, and exactly in the year of a global pandemic that had sky-high mortality rates for older people.
loeg 1y ago
I think it's unlikely that the quoted 65% of GLP-1 users will go off the drug and resume their unhealthy lifestyle as the drugs go off patent and become more affordable. It's not super inconvenient to stay on, just expensive (today, using the name brand formulations). Users benefit from good health more than they benefit from deceiving life insurers.
stego-tech 1y ago
Now expand this to other treatments: HIV, PreP, depression/anxiety, ADD, ADHD, you name it. We’ve had data for decades that adherence is the key factor in successfully lowering mortality and increasing quality of life, which in turn increases duration of productive life, which in turn lowers costs in the long run as more people live healthier, longer, more productive lives. The problem continues to be the pharmaceutical and health insurance industries, particularly in the West. Under pressure to deliver infinite growth forever to shareholders on a quarterly basis, companies have a vested interest in making less medication at a higher price, and lobbying the government to prohibit price negotiations while mandating insurance coverage for many of these drugs. GLP-1s might be the proverbial straw that broke the camel’s back, but there’s decades of research - and bodies - saying this over, and over, and over again. Which reminds me: I need to call my new health insurance company to get them to cover my medication, and hopefully extend it to 90 day supplies. Because god forbid that just be an automatic thing for someone who’s taken the same medication daily in some form for a decade without adherence issues.
- neaden 1y ago
  I don't think this is addressing the thrust of the article, which is that Life Insurance companies are getting "fooled" by patients who on paper are healthier then they are in reality. Someone on PreP to prevent getting HIV is as healthy on paper as they are in reality as far as I can see.
jeremynixon 1y ago
This blog post is flawed. "Life insurers can predict when you'll die with about 98% accuracy." Is not even properly framed and is found nowhere in the cited report. Predictions of when you will die need a range in order to be attached to a number like accuracy. The attached report is not about this but about population-level mortality trends.
- dzhiurgis 1y ago
  Yeah was skimming that report too and it doesn't look even related to that claim.
Jimmc414 1y ago
If GLP-1s are working for people, why do they quit taking them?
- 44520297 1y ago
  Cost.
- technocratius 1y ago
  They are very expensive
- degamad 1y ago
  It is well known that people are bad at taking drugs that work for them. This is particularly well studied when it comes to heart medication, the kind where you take it regularly or you die, and yet adherence is often around 50%. From a quick search, Jarrah et al. (2023) "Medication Adherence and Its Influencing Factors among Patients with Heart Failure: A Cross Sectional Study" [0] discusses some of the relevant details. [0] https://pmc.ncbi.nlm.nih.gov/articles/PMC10224223/ https://pmc.ncbi.nlm.nih.gov/articles/PMC10224223/
- bagacrap 1y ago
  I know a couple who self identify as foodies and they started taking it for weight loss. They now complain that date night is no fun because they don't enjoy the food. They have not yet dropped the meds but I can see it happening soon.
theideaofcoffee 1y ago
And nothing of value was lost. These industries, insurance in particular, pharma coming in a close second, are just parasites, sucking the vitality out of everything by their sick rent seeking and giving crumbs, if that, in return. The faster they can be torn down and liquidated, the better. Maybe helping the overall population boost their wellness with more-or-less miracle drugs like GLP-1s can hasten that.
fnord77 1y ago
> Life insurers can predict when you'll die with about 98% accuracy. I saw this: https://media.nmfn.com/tnetwork/lifespan/index.html#0 https://media.nmfn.com/tnetwork/lifespan/index.html#0 is there anything better?
- arp242 1y ago
  Looking at the link they give for it, the 98% accuracy isn't for individuals but for aggregate data. That is: they can't predict with 98% accuracy when you or I will die, but they can with a sufficiently large group which averages out all the noise. The phrasing in the article is somewhat unfortunate.
  - popupeyecare 1y ago
    Look at the url source. Ifs ChatGPT generated hallucination
jtrn 1y ago
Clinical psychologist here in Norway, and just my subjective experience: People stop GLP1 agonists for the following reasons, in descending order: - They want to enjoy eating again. - Medications are a hassle. - Worry about long-term effects, even if there is no alarming evidence for now. - Price (we are a spoiled/rich country). - Other (like hating needles, feeling bad for taking medications that others need more, being aggressively lazy). Often, I think that it’s a bad move, as the clinical effect of losing around 20 kg would have to be matched by some extremely high frequency and severe side effects. Overweight is still not sufficiently appreciated for how dangerous it is, especially after they ramped up production so much that there isn't a real shortage anymore. Ironically, most of the people who respond well to Ozempic and stay on it have few psychiatric problems. But those who almost desperately want to get off it after a while might be those who have a psychological component to their overeating. The obvious suspect then is eating as emotional regulation. So one could extrapolate, at least as a hypothesis, that the ones who have worse life expectancy due to regained weight after a year of usage are the ones who have a double set of problems stacked against them: overweight and emotional problems. That would have a huge effect on longevity. This is PURE free association though, no deep analysis behind it.
- k__ 1y ago
  How much does it cost right now? Are there any alternatives coming out soon or generics?
  - jtrn 1y ago
    For semaglutide, the newest and most potent GLP1. United States: The main patent is expected to expire around 2032. Monthly Price: $950 - $1,350+ (cash price without insurance) Norway: The main patent is expected to expire around 2031. Monthly Price: $109 - $301 (cash price equivalent in USD)
    - thatnerdyguy 1y ago
      I'll note that in the US that 1000+ is the "list price". For those paying out of pocket, both zepbound and wegovy offer coupons available to anyone taking it down to $500 (and I'll note that discounted price keeps coming down, slowly, as well)
Neywiny 1y ago
No mention of Common Side Effects in the discussion? It was pretty predictable (at least for someone healthcare-field [discovery + regulation]-adjacent all my life), but touched on the notion that the miracle wonder drugs are a provider's worst nightmare. It's a business
aredox 1y ago
Mortality slippage has also exploded since the COVID pandemic started... And again, nobody seems to wonder if somehow, a virus that invades the whole body (not just a respiratory virus), repeatedly, is causing death by a thousand cuts... The blind spot related to COVID is huge. There are lots of health data going haywire since 2020 and everyone seems to find any other reason but COVID for it.
brap 1y ago
Just want to share my own experience since were doing it: Took Wegovy (Semaglutide) for about 6 months. Barely lost any weight, would occasionally get nauseous. Then the doc switched me to Mounjaro (Tirzepatide) + Phentermine, and holy shit, I just don’t feel like eating, almost ever. Lost 20kg in 6 months, which is all I needed to lose, never had any side effects. None. I did feel a little weird/buzzed the first time I took Phentermine, but it went away the next day. I feel like for many people it’s not really the physical hunger that makes them fat, it’s that annoying voice in your head telling you to snack something for no reason at all. It sometimes felt almost like drug addiction. Tirz+Phent are great for that.
- glp1guide 1y ago
  It varies case by case, but just want to point out that the research agrees with you here, Tirzepatide is more effective than Sema!
- potamic 1y ago
  Did you lose any muscle mass?
  - staringback 1y ago
    They most certainly did, these drugs stop you from eating, not magically burn fat and leave muscle mass alone. It has the same effect as starving yourself. Go look up pictures of "ozempic face"
    - brap 1y ago
      I wouldn't say "starving yourself", there's no reason to believe it's different from any other diet (except it's easier to stick to). If you get enough calories, prioritize protein, do some resistance training and get proper sleep, you can minimize muscle loss and in some cases even gain muscle while losing fat.
    - Sohcahtoa82 1y ago
      "Ozempic face" is just the result of excessive weight loss. The term is basically putting the blame on the drug for people wanting to continue to lose weight even after achieve a healthy weight. It's completely unrelated to GLP-1s. 5+ years ago, we would have just called it "Anorexic face".
twilo 1y ago
“mortality slippage” coincides with Sars2 circulating within our population so I bet it has a lot to do with it
deleted 1y ago
[deleted]
peteforde 1y ago
I know that many of the claims are based on clinical data and retention studies, but I find the entire thrust of the post to be incredibly cynical. Fat people often fight the not subtle sensation that a lot of people see them as either a problem/herd to be managed and/or maximally profited from. This is one of those accounts that seems to say the inside part out loud. The idea that a few pharmas artificially juicing a desperate population [who just want to feel good about themselves and live longer, happier lives for more than many can comfortably afford] is interfering with insurance adjustors ability to maximize profits doesn't leave me heartbroken. It's precisely this shit that leads to people celebrating when pharma CEOs get tapped.
deleted 1y ago
[deleted]
glp1guide 1y ago
Note that right now there's a problem with people staying on GLP1s[0] so it's not quite clear how this could go any other way. Considering the rate of rebound from other lifestyle methods, GLP1 is among the most effective alternatives we have. GLP1 significantly reduces the risk of many mobidities and is increasingly prescribed to older people. Also, this is incredibly likely to resolve itself once the drugs become common place after patent expiries, the actuaries will update their tables and the curve will smoothe out. [0]: https://glp1.guide/content/if-glp1-is-so-great-why-dont-people-stick-with-it https://glp1.guide/content/if-glp1-is-so-great-why-dont-peop... [1]: https://glp1.guide/content/patent-expirations-for-glp1-receptor-agonists/ https://glp1.guide/content/patent-expirations-for-glp1-recep...
- mctt 1y ago
  Can someone explain what is being said here in literal terms please. Can you also identify any dark humour or social commentary because I don't know enough to be sure.
  - glp1guide 1y ago
    Let me try again: 1. People do not stay on GLP1s for long, despite how effective they are 2. People often rebound harder from other forms of weight loss (dieting, temporary lifestyle changes, etc) 3. GLP1 reduces a LOT of health risks linked to obesity (heart disease being the most important IMO) 4. Older people are taking GLP1s in droves 5. Once these drugs are everywhere (they will be soon IMO in < 7 years obesity will probably be ~gone), the effects will get "priced in" to actuary tables. No social commentary or dark humor intended -- GLP1s aren't miracle drugs but the effects (and relative lack of side effects) is miraculous.
cobertos 1y ago
> Lost around 14kg using GLP-1s from a D2C provider (no detail on their electronic health record) Huh? How would one get these electronic health records? I thought each provider keeps these and there's no public database except for vaccines? And it doesn't exist because HIPAA would make it hard?
kbos87 1y ago
GLP-1s have legitimately changed my life for the better. I've always been very active but have consistently been moderately overweight. A relatively low dose of Semaglitide has helped me lose 40lbs and keep it off. I'm a year and a half in and have had very few side effects, no loss of efficacy, and my muscle mass has increased slightly despite all the negative press about muscle loss. My diet is similar in composition to what it was before, but I probably eat 25% less by volume. Recognizing I'm a sample of one, but my experience is reflected in the research. I plan on being a GLP-1 for the rest of my life. Perfectly fine with that. It seems like society has more problems with GLP-1s than its users do.
- itake 1y ago
  > my muscle mass has increased slightly how was this measured?
  - kbos87 1y ago
    Day to day I use a home body composition scale (Withings Body Scan), the results of which have been corroborated by two Dexascans I've done at my gym a little less than a year apart. For me personally, the little bit of help in the form of forward progress on weight loss has given me a reason to be a little more methodical in my strength training, and I'm seeing a slow but consistent payoff. And as far as I can tell, I'm not fighting an uphill battle in terms of adding muscle mass at all because of the GLP-1.
- rsyring 1y ago
  > A relatively low dose of Semaglitide Can you share what dose?
atleastoptimal 1y ago
The solution is for life insurance companies to pay people to stay on ozempic
- zaptrem 1y ago
  The “payment” can come in the form of lower rates, with penalties if you stop.
  - const_cast 1y ago
    We already do something similar with smoking cessation. They, essentially, pay you to quit smoking. The social difference is that we frame smoking as an addiction, and smokers as victims of the Tobacco industry. But we frame obesity as a moral failing. So, the former we're ready to jump in and help. But, the latter, we are much more hesitant. Theoretically, economic outcomes would override these social and moral effects. But leadership is often stupid, so we'll see.
gitfan86 1y ago
Not really, they can just stop insuring people who take them at all.
blindriver 1y ago
The last thing I will ever give a rats ass about is insurance companies. They are the scourge of this earth but they have used legislation to embed themselves in our every day lives. I live in California and have no claims ever. My home insurance has doubled in 4 years to almost $4000 a year. My car insurance is about $2800/yr. So I hope insurance companies break. Like Danerys said in Gamr of Thrones, I hope someone breaks the wheel.
- slyall 1y ago
  $4000/year might be a lot or a little. If you own a $5m house up against a forest it's probably a bargain. The car price could reflect a bunch of factors. Pay some broker for a one-off consultation to advise you on how to save money. Reality is insurance companies are now going though a cycle of "price in the actual risk" rather than "drop prices to gain customers"
- ReverseCold 1y ago
  > I live in California Car insurance companies in CA actually lose money on the state, if that makes you feel better: https://money.com/car-insurance-policies-problems-california/ https://money.com/car-insurance-policies-problems-california... There are laws that prevent them from charging enough to even break-even on the policies.
- timerol 1y ago
  So you pay less than 1% of the cost to rebuild your home per year in home insurance, in a state that regularly has fires, floods, and earthquakes? That seems fair to me
jbs789 1y ago
The reason insurers ask about weight loss is that it could be a sign of a (severe) undiagnosed medical condition - e.g. they should be contacting a doctor(!)
potato3732842 1y ago
Call me cynical but it wouldn't surprise me if insurers somehow tried to leverage this "crisis" into some sort of "get written into law, guaranteed profits forever" play the way that health, home and auto have.
johndhi 1y ago
Can't they just adjust their model based on whether the patient is on a GLP-1 and account for the likelihood they'll stop taking it?
- kccqzy 1y ago
  The article addressed this. The person could have gotten GLP-1 from a D2C provider and insurance has no record of this person ever taking GLP-1.
popupeyecare 1y ago
Anyone read the source and find the 98% accuracy stat? The source link has a UTM source of ChatGPT. Could it be a hallucination?
- astrea 1y ago
  I believe it’s seeing the 98% mortality rate in 2020 vs 2019 for the same month.
- yesfitz 1y ago
  Maybe more of a misinterpretation by AI and/or author than full on hallucination. "Life insurers can predict when you'll die with about 98% accuracy." "98%" appears in the citation[1], but as the ratio of actual deaths to expected deaths. (i.e. 98% of the deaths they expected actually occurred.) Some months that figure was ~104%, so it's not a measure of accuracy. 1: https://www.soa.org/4aa060/globalassets/assets/files/resources/research-report/2024/rpec-mort-improvement-update.pdf https://www.soa.org/4aa060/globalassets/assets/files/resourc...
- nrenegar 1y ago
  It's extremely incorrect. 98% accuracy on when "you'll" die would imply an R^2 of 0.98 for individual-level lifespan predictions. We are nowhere close to that.
  - neaden 1y ago
    It could mean a lot of things. It could mean "We think you'll die at 87+-5 years" and counting it as a success if you die anywhere in that age range for instance which I could believe they can predict the vast majority of the time. I doubt they are referring to the R Squared.
- subarctic 1y ago
  I saw that too and thought the utm_source=chatgpt was pretty funny, since I only noticed it when I was pasting the link into chatgpt myself to get it to tell me where the "98% accurate" claim was coming from. Anyway, it's a pretty vague statement. What it sounds like it's saying is for the average person they can predict when they will die, and you have to decide if they mean the day, the year or the decade. But chatgpt gave me an interpretation that seems to make more sense: > The 98 % figure is about aggregate forecasting, not clairvoyance. It means that when an insurer predicts, say, 10 000 deaths across its book in 2024, the actual count typically falls within roughly ±200. For any single customer, the prediction is still just a probability curve, not a calendar appointment with the Grim Reaper.
oger 1y ago
The topic of per-country pricing was mentioned several times. I was wondering how big the price differences would be so I set up a quick form to collect some data points from several countries and for several products. It would be cool if you could provide some data - I would then share it back as a reply to this thread within 1-2 days after closing the survey. The latest data entry will be possible on Sunday. https://forms.cloud.microsoft/e/DjDgH62s21 https://forms.cloud.microsoft/e/DjDgH62s21
adolph 1y ago
Is the rise of GLPs yet another case of Neal Stephenson called it again? I'm rereading Anathem and struck by similarities of Allswell and the psychoactive components of GLPs. In the book, Allswell is a drug that gives people a sense of calm and well being, and is genetically engineered into food in a way that puts water fluoridation to shame. Otoh, the lower-caste slines of Arbre are also overweight so maybe the parallels are limited.
skissane 1y ago
> They switched from 30-day to 90-day refills. Suddenly, patients had to think about their medication four times a year instead of twelve. Adherence rates shot up almost immediately. When I have a “refill” (here in Australia we call them “repeats”) due, my pharmacy sends me an SMS… I just reply “yes please” and that goes straight to the pharmacist who dispenses, and I get another SMS telling me the dispensed medication is ready to pick up I’m on tirzepatide and I’m committed but I’m “going a bit slow” because the side effects started to get a bit too much. Still, my base expectation is I’m taking a GLP-1 agonist for the rest of my life, unless my doctor tells me I have to stop for some reason, or I somehow go bankrupt and can’t afford it any more.

441 points by alexslobodnik 1y ago

Can't the insurance companies just look for stretch marks?

It sounds like aligning incentives here is requiring the weight stay off for the policy to remain in effect with an annual physical for monitoring, similar to what employers require for health insurance premium reductions. Point in time underwriting is suboptimal considering current state of the art of GLP-1s (unless newer protocols that can update metabolic profiles are delivered soon).

prasadjoglekar 1y ago
Or life insurers paying for ongoing GLP-1s instead of potentially the health insurer. But to your broader point, at least in the US, incentive mis-alignment on all healthcare and health insurance is possibly irredeemably broken.
- toomuchtodo 1y ago
  Nailed my broader point. Could we go through contortions to see who is going to pay unreasonable costs for GLP-1s (health insurance, life insurance)? We could, but that's silly accounting to see who still gets to make the profit and who has to end up with the bill for empowering the human to fix their reward center. The shortcut is to provide GLP-1s to everyone who needs them at scale, as inexpensively as possible (to pull forward the improvement in health and quality of life outcomes until improved protocols arrive). The semaglutide patent is about to expire in Canada, China, India, and Brazil, for example. https://www.labiotech.eu/in-depth/novo-nordisk-semaglutide-patent-expiration-canada/ https://www.labiotech.eu/in-depth/novo-nordisk-semaglutide-p...

jgalt212 1y ago

I guess, but this is sort of the same as going on a statin to get your cholesterol down for a better insurance rate. Then going off because of reasons...

arn3n 1y ago

Obesity is highly correlated with other medical conditions, from cancer to diabetes to heart disease. I wonder if there is a point at which it is cheaper for health insurance companies to offer subsidized or even free GLP-1s to patients than pay out for other specialized medications. For example, my insurance covers flu shots in my community every year because it's presumably less expensive to pay for the shots compared to the increased rate of hospitalization that the flu causes.

aqme28 1y ago
You’re thinking too highly about the incentives of the US healthcare system. Since insurance is tied to your employer (and therefore changing every few years), and most people die on Medicare, there’s not much incentive for insurance companies to pay for preventative care that won’t actually help you for several decades.
- ethbr1 1y ago
  That’s one reason the ACA shifted it to a mandatory (in most cases) category: https://www.healthcare.gov/preventive-care-adults/ https://www.healthcare.gov/preventive-care-adults/ Minimal, but minimal progress in the US was/is still progress.
  - eru 1y ago
    It's a shame the contracts you'd need to set the right incentives are probably illegal.
- helicalmix 1y ago
  hmm...doesn't this possibly incentivize ozempic subsidies even more? If you know a "customer" of yours (an individual employee) is only going to be with you until they either change jobs or go on Medicare, then it seems the name of the game then is to make sure that nothing catastrophic happens to them until you can hand them off to someone else. In which case, they should definitely go on ozempic. Even if the effects of ozempic immediately come off after usage, it's a short-term enough solution that benefits the insurance company, no?

llm_nerd 1y ago

This is a fun read, however- "Life insurers can predict when you'll die with about 98% accuracy." This conclusion isn't supported by the linked document. The document instead is talking about expected vs actual deaths among demographic groups as a whole, not individual people. And that expected vs actual is just history + trends. This doesn't mean that insurance can say that Joe Blow is going to die in June of 2027 with "98% accuracy", obviously.

PaulDavisThe1st 1y ago
Put a little differently, they can predict that of your cohort (defined somehow), after June 2027, only X percent of you will still be alive. Will you be one of them? Click here to find out!
- etothepii 1y ago
  For mortality tables age and sex are pretty much sufficient to get to 98% accuracy.
  - adgjlsfhk1 1y ago
    You definitely (at least in the US) need income (or an income proxy like zip code). Mississippi has a life expectancy ~10 years less than Massachusettes.
    - etothepii 1y ago
      This typically has surprisingly little impact on force of mortality. Men under 40 essentially have incredibly low mortality. Once you exclude cars and suicide it drops basically to zero. Even things that are very very bad for you, like being very obese (BMI>40), are factors that scale a mortality that is massively dominated by age and sex. Even 3x mortality at 25 rounds to zero. At 60 background become 1% per year and a 3x increase would make a huge difference. I would wager $50 that there are no contiguous collection of zip codes in the USA where the average 40 year old has a higher life expectancy than the average 30 year old in any other contiguous set of zip codes assuming there are over 1000 people of that age in both.

vslira 1y ago

I've always felt that there's some trade to be done here, with life and health insurers basically giving glp-1 et all for free bc they lower the cost of everything else edit: and then Big Annuity lobbying to oppose this

lesam 1y ago
Aren’t “Big Life Insurance” and “Big Annuity” pretty much the same companies?
- hiAndrewQuinn 1y ago
  They are, they're basically mathematical inverses of the same product. Big Annuity can charge you more, in fact, if it has reason to believe you're going to live unusually long, so playing the GLP-1 dance with them would only be profitable in reverse. Pretend to be the unhealthiest person on the planet, lock in an annuity, then get on the drip stat.
  - neaden 1y ago
    I think the difference is people generally get Life Insurance when they are younger (I'm guessing frequently when they have kids, that is when I got it at least) but get Annuities when they are a senior. I don't know anyone my age who is purchasing an annuity now, though I suppose there must be someone who would be willing to sell it.
    - hiAndrewQuinn 1y ago
      I think the deal would have to be very sweet for eg a 30 year old like yours truly to forgo 35 years of index fund gains to pick up an annuity instead. That's also 35 years where the annuity firm itself night shutter its doors - a risky play, but right for the right price.

meltyness 1y ago

Well I guess a GLP-1 pacemaker would address this. A lifetime of doses weighs at much as a nickel?

MPSimmons 1y ago
I believe it has to be kept at refrigerated temperatures over its relatively short shelf-life (1 year, I believe).

foota 1y ago

I realize this is a fraught question, because not everyone is overweight by choice (whether due to a subsisting on whatever they can afford, time, genetics, injury, etc,.) but I believe that insurers are able to consider whether someone smokes cigarettes when setting premiums for ACA based healthcare. With the above caveats that would make this difficult, it would be nice if we could treat "voluntary" obesity similarly.

etothepii 1y ago
I think the article is making the point that that is what they have traditionally been able to do but they no longer can. Since the magic drugs are giving people the will power to be able to make these changes.
- foota 1y ago
  The article is about life insurance, not health insurance (I should have made it clear I was talking about health insurance).

artursapek 1y ago

[flagged]

leptons 1y ago
Have you ever met a human before?
- artursapek 1y ago
  hahahaha
bee_rider 1y ago
We’re not evolved to turn down cheap, easy calories by default.
the__alchemist 1y ago
Primate brain want sugar! I am a disciplined, rational being, and will not eat these 3 donuts. The research indicates it will contribute to the health and aesthetic problems which already ail me. Primate brain want sugar!
- artursapek 1y ago
  maybe the issue is too many people just have fucked up gut flora. if I ate 3 donuts I'd feel like complete shit
nemomarx 1y ago
You eat less unhealthy foods on the drugs, so that is actually changing the diet?
- artursapek 1y ago
  you are still eating unhealthy foods, so no the diet has not changed.

romaaeterna 1y ago

The problem (not new with GLP-1s) is that people lose weight, get life insurance, and then regain. The biggest part of that equation is regain part. Most people quit GLP-1s because of costs. Let's fix that.

beepbopboopp 1y ago
Get ready for health/weight based credit scores, Its probably a genuinely good idea.
paulpauper 1y ago
I think they quit also because they see it is working and no longer feel like they need to use it
apwell23 1y ago
i have hard time believing ppl go through all that only to sign up for cheap life insurance.
cm2187 1y ago
I don't know, I tend to notice the effect wears off over time. Not sure it's a good idea to consume it permanently. Perhaps a better use would be for short periods to course correct.
- romaaeterna 1y ago
  Anecdotally, the dose required to maintain a stable weight seems to be lower than the dose required to lose weight. Most people tend to regain some weight when going cold turkey. The safety profile of the drugs with diabetics, and the health benefits that come from the associated weight loss may make permanent use a net benefit for most people. There appears to be little, if any, "course correction" effect from taking it for short periods of time.
  - cm2187 1y ago
    It depends how you define "short period of time". When I started, I lost 40kg in a matter of 5 months. Is that short? If you develop a tolerance to the product, then it doesn't protect you long term from gaining back weight, combined with you losing the option to do a rapid descent. I am not saying that those variations are great from a health point of view, but they are certainly not as bad as staying obese.

paul7986 1y ago

I believe AI along with smart glasses that shows and calculates your daily caloric intake will be a SUBSTITUTE (another option) to the Ozempics. With AI glasses doing this automatically for you upon seeing what your eating without u having to do anything some people may be shocked to learn how many calories they consume daily. Currently, it's too time consuming now for the majority to do (i use GPT via texting it or talking to it to keep track as I eat out daily at healthy chains) but if it was done automagically I believe it definitely would be a substitute to Ozempic. I bet some or more would use that easily captured data that's shown to them (in the glasses or on their mobile device) to strive, make and possibly compete with their friends/family to eat less calories and carry less weight on them (be healthier). You can train your body to eat less to a lot less and for some that would definitely help them shed weight. The glasses could as well deduct calories burned from your daily walk, jog, etc. *Being downvoted hmmm do you think AI by seeing it can't via an image calculate the calories of a burrito bought from Chipolte and other chains? All chains have nutrition information on their websites now that GPT goes and fetches. As for home cooked prepared meals I have taken pics of my food via GPT and it seemed to come close.

__turbobrew__ 1y ago
I don’t think awareness of caloric intake is the problem, there are standardized labels on most foods (especially the bad ones). Most people who are obese know that the calories make them overweight, but they still have the need to eat food — which is what makes obesity a result of addiction. Similarly meth addicts know that meth is bad for them, but they still do it anyways.
- astrange 1y ago
  How often do people control their own diets? That assumes they buy and cook all their own food, which is only true if you live on your own.
  - __turbobrew__ 1y ago
    > How often do people control their own diets Maybe I live in a bubble, but I don’t put stuff in my body unwillingly, so yes I control my diet. It also isn’t rocket science, I know doughnuts have a shit ton of calories and vegetable shortening which will clkg your arteries, so I don’t eat doughnuts. I don’t have to look at the packaging. Maybe the missing part is a proper education on nutrition in school, but we live in the age of the internet. All the information is there, you can get meal plans, you can figure out what foods are more likely to put you at risk. Again, I don’t believe awareness is an issue. People know that chips and doughnuts are bad, but they eat them anyways because they are addicted to food which is engineered to be addictive.

hiAndrewQuinn 1y ago

So... There's a miracle drug powerful enough to robustly lower people's all cause mortality, but since health insurance and life insurance are industries with vastly different time preferences, this is not a good thing for the life insurers because people just keep getting off the magic longevity drug and screwing up their predictions. Because, admittedly, it kind of sucks in the moment to be on. And I'm guessing just based on my own experience paying for term life that the actual premia differences aren't actually enough in most cases for the life insurer to simply pay out of pocket themselves; the differences probably add up to a few hundred per year per customer, whereas a year's worth of a GLP-1 agonist probably costs a couple thousand (for now, in 2025, and probably dropping rapidly). Huh. Second order implementation details aside, this is an extremely fortunate turn of events for us.

ramoz 1y ago
Can you explain what sucks about being on the prescriptions?
- hiAndrewQuinn 1y ago
  I'm just reporting my cached knowledge of people saying they experienced some adverse side effects. Also injections are not fun, even though they are probably a lot less annoying than they look.
  - nwienert 1y ago
    In the 10 or so people I know who are on it, nearly all actually seem to enjoy it - reduced addictive tendencies/bad habits, appetite control, and reduced allergies seem to pretty well outweigh the minor side effects.
    - wormius 1y ago
      I was a heavy alcoholic, and the ability to quite drinking was... amazing. Now that I'm off, I just remind myself I never want to get back at that dark place, but I'm so very glad it made quitting just... happen. It's wild how easy it was. A little mental control in terms of "no, don't go to the liquor store" but it was habit more than physical addition at that point. This was with Rybelsus. Sober 4.5 years now. It was definitely not an intended side effect but I'm glad I was rx'd when I was. I was not in a good state.

firesteelrain 1y ago

I was on Mounjaro for two months. I was also dieting and walking 10k steps a day. I lost 25 lb and my A1C went down to 5.0 from 5.7. All my cholesterol numbers were in range. I stopped taking it and lost 25 more. I haven’t regained the weight. People who gain it back did not learn the lesson and did not effectively change their habits. You need the discipline - and a good support system. But if you don’t have that and continue old habits then you will gain weight back. The original problem isn’t solved.

Sparkle-san 1y ago
[flagged]
- 44520297 1y ago
  Why is obesity the only disease that taking medicine for is “cheating”? Which is more important: instilling your particular version of “discipline” into people, or saving billions in healthcare costs and millions of lives from suffering?
  - throwawaybob420 1y ago
    [flagged]
    - 44520297 1y ago
      Taking medicine is a lifestyle choice.
      - throwawaybob420 1y ago
        [flagged]
  - Group_B 1y ago
    It’s usually a self inflicted disease. Your own actions cause it most of the time

almosthere 1y ago

so surreal reading comments... a month after non-stop threads about glp causing a billion issues, everyone is talking about how wonderful they are again. humanity

brokensegue 1y ago
billion issues? i saw some reporting on rare cases of blindness. what else?
- paulpauper 1y ago
  1-2 years ago there was considerable skepticism about "taking the easy way out" or unforeseen risks like like with Fenfluramine/phentermine. Now sentiment has changed given that more people realize these drugs are safe and effective.
- octo888 1y ago
  Pancreas issues and hair loss IIRC?
  - adgjlsfhk1 1y ago
    Hair loss is 1. Exactly the type of "side effect" that people will report because they lost hair (because lots of people experience hair loss whether they are on a GLP1 or not) 2. A fairly minor side effect that wouldn't be a strong reason to not prescribe. Pancreas issues were worried about, but those worries (so far) appear to be unfounded. https://pmc.ncbi.nlm.nih.gov/articles/PMC6382780/ https://pmc.ncbi.nlm.nih.gov/articles/PMC6382780/ is a meta-analysis of 12 studies (36k patients) over 2 years that showed no evidence of increased pacreatic issues, and https://pubmed.ncbi.nlm.nih.gov/38175642/ https://pubmed.ncbi.nlm.nih.gov/38175642/ is a 7 year analysis of ~33k patients that also shows no increase in issues.
nwienert 1y ago
It's a once in a generation drug with less side effects than most OTC, likely net positive even for healthy weight people. I'd bet within the decade it'll be approved for a whole basket of other benefits - at the least a whole array of immune system disfunctions and a cure-all for addiction. Likely protective of a wide array of internal organs, likely life extending.

throwaway019254 1y ago

Is there any research on whether GLP-1s are also beneficial for generally healthy and not overweight people?

paulpauper 1y ago

More sensationalism. Insurers can simply adjust the policy accordingly to account for patients discontinuing the drug. They can also raise premiums if patients go off the drug, and there can be a cluse that stipulates this. This is literally the job of an actuary to reprice premiums . Insurers take a short-term hit and then adjust premiums to ensure it never happens again. This happened with California fire risk for example. Moreover, this drug will not increase life expectancy by that much even with lifetime patient compliance. The majority of obese people ,especially men, who take these drugs will still be overweight or obese, but just not as much as before.

bagacrap 1y ago
The idea is that the insurer doesn't even know the customer is on glp1, and I guess doesn't require a full physical often enough to reprice frequently.

wjnc 1y ago

The article is missing some key points about insurance. An ideal book balances mortality and longevity risks. This cancels out the risk GLP-1s or many other actuarial shifts in mortality. Insurers swap risks, reinsure risks etc to move towards an ideal book. Nice products to balance are pensions and longevity. Problem is that the scale is quite different on a per policy basis, and also very location specific. The article also misses regarding slippage is that Swiss Re in the link calls it a modest increase And that is mainly due to insurers Not performing the same level of medical intake (accelerated versus full underwriting). Increased competition leads to less profits. That’s pretty straightforward and not per se GLP-1s related. And then the kicker. For not diversified portfolios of mortality risks. Those have been massively profitable for decades, in line with the general increase in age and health. GLP-1s just expands on that profitable aspect. Did I mention that the long term expected rate of return on an insurers book is quite good? Insurers can weather a bit of slippage. Reinsurers will kick the worst offenders back in line with their AUC performance, because without diversification Or reinsurance it’s hard to stay in the market. (Capital requirements strongly favor diversification. Mono line is very hard.) That’s why Swiss Re is bringing out such rigorous studies of detailed policy events. Signaling to the reinsurance markets and the insurance companies and their actuaries!

mcherm 1y ago

If insurers are suffering from "mortality slippage" because some of their customers purchased insurance while on GLP-1s then later discontinue the medication, then there must also be "mortality slippage" in the opposite direction. There must be customers who were not on GLP-1s when they purchased insurance, but could go on them, extending their lives in a way that is very profitable to the life insurance companies. Furthermore, there are more people not on GLP-1s than on them (even with the recent surge in popularity) so this population that can give life insurance companies "excess" profits must outnumber those the article describes where the insurance company takes a loss. Why can't they focus on this profit opportunity?

hobom 1y ago
At least in part, according to the article, because the not-yet-on-GLP1 folks are NOT customers since they are often denied coverage in the first place.

poulpy123 1y ago

[flagged]

jakubmazanec 1y ago

> When someone stops the medication, they'll usually regain the weight they lost Source? I agree that some people will regain the weight, but "usually" is an unfounded (without some data) generalization.

arp242 1y ago
It's linked in the article.
paulpauper 1y ago
It's variable. some regain all, other regain less. But they basically all regain some.
catdog 1y ago
It probably depends if they also change eating habits. If they change nothing regaining the weight is no surprise.
alluro2 1y ago
I don't mean to be overly harsh, but saying "just changing their diet" is quite ignorant. There's been a huge amount of research into the challenges of weight loss, so it should be (more) common knowledge by now that it's not just about deciding to do it and "having discipline" - it takes much more than that, both physically and psychologically. I understand where you're coming from, though, I used to think the same - I remember a specific situation where an obese person next to me was breathing heavily from doing something easy and me thinking "how do you hear yourself breathing audibly from doing almost nothing and not decide and just change it". Unfortunately, I got into a situation where I now understand the issue and am struggling to lose weight, despite hearing myself breathing audibly after picking up something from the floor and all the rational understanding and knowledge of what I need to do. IMO, in a lot of cases, the first step should be going to a therapist.

jamesgill 1y ago

In 2023, the life insurance industry took in >$3 trillion dollars in premiums. That same year, it paid out roughly $800B in claims. TL;DR: there's no violin tiny enough for me to play for the life insurance industry's 'woes'.

paulpauper 1y ago
yes, there is a reason why BRK.A/B stock has done so well ,even while sitting in tons of cash. Geico is a cash cow.

kylecordes 1y ago

Seems like insurers should be rating based on your worst health markers, including weight, over the last N years rather than just a current point-in-time snapshot. Someone who somehow has no medical records over the last few years at all that would capture any of that data would be priced on the assumption the past was possibly worse than current.

_9ptr 1y ago
I don't know the situation in the USA, but in Europe you wouldn't find many young (up to ~35) people who have data on any health markers. And these are the main market.

refulgentis 1y ago

Is the slippage graph just for net life increase slippage? Or any slippage? It caught my eye this explosion in slippage happened years before GLP-1s, and exactly in the year of a global pandemic that had sky-high mortality rates for older people.

loeg 1y ago

I think it's unlikely that the quoted 65% of GLP-1 users will go off the drug and resume their unhealthy lifestyle as the drugs go off patent and become more affordable. It's not super inconvenient to stay on, just expensive (today, using the name brand formulations). Users benefit from good health more than they benefit from deceiving life insurers.

stego-tech 1y ago

Now expand this to other treatments: HIV, PreP, depression/anxiety, ADD, ADHD, you name it. We’ve had data for decades that adherence is the key factor in successfully lowering mortality and increasing quality of life, which in turn increases duration of productive life, which in turn lowers costs in the long run as more people live healthier, longer, more productive lives. The problem continues to be the pharmaceutical and health insurance industries, particularly in the West. Under pressure to deliver infinite growth forever to shareholders on a quarterly basis, companies have a vested interest in making less medication at a higher price, and lobbying the government to prohibit price negotiations while mandating insurance coverage for many of these drugs. GLP-1s might be the proverbial straw that broke the camel’s back, but there’s decades of research - and bodies - saying this over, and over, and over again. Which reminds me: I need to call my new health insurance company to get them to cover my medication, and hopefully extend it to 90 day supplies. Because god forbid that just be an automatic thing for someone who’s taken the same medication daily in some form for a decade without adherence issues.

neaden 1y ago
I don't think this is addressing the thrust of the article, which is that Life Insurance companies are getting "fooled" by patients who on paper are healthier then they are in reality. Someone on PreP to prevent getting HIV is as healthy on paper as they are in reality as far as I can see.

jeremynixon 1y ago

This blog post is flawed. "Life insurers can predict when you'll die with about 98% accuracy." Is not even properly framed and is found nowhere in the cited report. Predictions of when you will die need a range in order to be attached to a number like accuracy. The attached report is not about this but about population-level mortality trends.

dzhiurgis 1y ago
Yeah was skimming that report too and it doesn't look even related to that claim.

Jimmc414 1y ago

If GLP-1s are working for people, why do they quit taking them?

44520297 1y ago
Cost.
technocratius 1y ago
They are very expensive
degamad 1y ago
It is well known that people are bad at taking drugs that work for them. This is particularly well studied when it comes to heart medication, the kind where you take it regularly or you die, and yet adherence is often around 50%. From a quick search, Jarrah et al. (2023) "Medication Adherence and Its Influencing Factors among Patients with Heart Failure: A Cross Sectional Study" [0] discusses some of the relevant details. [0] https://pmc.ncbi.nlm.nih.gov/articles/PMC10224223/ https://pmc.ncbi.nlm.nih.gov/articles/PMC10224223/
bagacrap 1y ago
I know a couple who self identify as foodies and they started taking it for weight loss. They now complain that date night is no fun because they don't enjoy the food. They have not yet dropped the meds but I can see it happening soon.

theideaofcoffee 1y ago

And nothing of value was lost. These industries, insurance in particular, pharma coming in a close second, are just parasites, sucking the vitality out of everything by their sick rent seeking and giving crumbs, if that, in return. The faster they can be torn down and liquidated, the better. Maybe helping the overall population boost their wellness with more-or-less miracle drugs like GLP-1s can hasten that.

fnord77 1y ago

> Life insurers can predict when you'll die with about 98% accuracy. I saw this: https://media.nmfn.com/tnetwork/lifespan/index.html#0 https://media.nmfn.com/tnetwork/lifespan/index.html#0 is there anything better?

arp242 1y ago
Looking at the link they give for it, the 98% accuracy isn't for individuals but for aggregate data. That is: they can't predict with 98% accuracy when you or I will die, but they can with a sufficiently large group which averages out all the noise. The phrasing in the article is somewhat unfortunate.
- popupeyecare 1y ago
  Look at the url source. Ifs ChatGPT generated hallucination

jtrn 1y ago

Clinical psychologist here in Norway, and just my subjective experience: People stop GLP1 agonists for the following reasons, in descending order: - They want to enjoy eating again. - Medications are a hassle. - Worry about long-term effects, even if there is no alarming evidence for now. - Price (we are a spoiled/rich country). - Other (like hating needles, feeling bad for taking medications that others need more, being aggressively lazy). Often, I think that it’s a bad move, as the clinical effect of losing around 20 kg would have to be matched by some extremely high frequency and severe side effects. Overweight is still not sufficiently appreciated for how dangerous it is, especially after they ramped up production so much that there isn't a real shortage anymore. Ironically, most of the people who respond well to Ozempic and stay on it have few psychiatric problems. But those who almost desperately want to get off it after a while might be those who have a psychological component to their overeating. The obvious suspect then is eating as emotional regulation. So one could extrapolate, at least as a hypothesis, that the ones who have worse life expectancy due to regained weight after a year of usage are the ones who have a double set of problems stacked against them: overweight and emotional problems. That would have a huge effect on longevity. This is PURE free association though, no deep analysis behind it.

k__ 1y ago
How much does it cost right now? Are there any alternatives coming out soon or generics?
- jtrn 1y ago
  For semaglutide, the newest and most potent GLP1. United States: The main patent is expected to expire around 2032. Monthly Price: $950 - $1,350+ (cash price without insurance) Norway: The main patent is expected to expire around 2031. Monthly Price: $109 - $301 (cash price equivalent in USD)
  - thatnerdyguy 1y ago
    I'll note that in the US that 1000+ is the "list price". For those paying out of pocket, both zepbound and wegovy offer coupons available to anyone taking it down to $500 (and I'll note that discounted price keeps coming down, slowly, as well)

Neywiny 1y ago

No mention of Common Side Effects in the discussion? It was pretty predictable (at least for someone healthcare-field [discovery + regulation]-adjacent all my life), but touched on the notion that the miracle wonder drugs are a provider's worst nightmare. It's a business

aredox 1y ago

Mortality slippage has also exploded since the COVID pandemic started... And again, nobody seems to wonder if somehow, a virus that invades the whole body (not just a respiratory virus), repeatedly, is causing death by a thousand cuts... The blind spot related to COVID is huge. There are lots of health data going haywire since 2020 and everyone seems to find any other reason but COVID for it.

brap 1y ago

Just want to share my own experience since were doing it: Took Wegovy (Semaglutide) for about 6 months. Barely lost any weight, would occasionally get nauseous. Then the doc switched me to Mounjaro (Tirzepatide) + Phentermine, and holy shit, I just don’t feel like eating, almost ever. Lost 20kg in 6 months, which is all I needed to lose, never had any side effects. None. I did feel a little weird/buzzed the first time I took Phentermine, but it went away the next day. I feel like for many people it’s not really the physical hunger that makes them fat, it’s that annoying voice in your head telling you to snack something for no reason at all. It sometimes felt almost like drug addiction. Tirz+Phent are great for that.

glp1guide 1y ago
It varies case by case, but just want to point out that the research agrees with you here, Tirzepatide is more effective than Sema!
potamic 1y ago
Did you lose any muscle mass?
- staringback 1y ago
  They most certainly did, these drugs stop you from eating, not magically burn fat and leave muscle mass alone. It has the same effect as starving yourself. Go look up pictures of "ozempic face"
  - brap 1y ago
    I wouldn't say "starving yourself", there's no reason to believe it's different from any other diet (except it's easier to stick to). If you get enough calories, prioritize protein, do some resistance training and get proper sleep, you can minimize muscle loss and in some cases even gain muscle while losing fat.
  - Sohcahtoa82 1y ago
    "Ozempic face" is just the result of excessive weight loss. The term is basically putting the blame on the drug for people wanting to continue to lose weight even after achieve a healthy weight. It's completely unrelated to GLP-1s. 5+ years ago, we would have just called it "Anorexic face".

twilo 1y ago

“mortality slippage” coincides with Sars2 circulating within our population so I bet it has a lot to do with it

deleted 1y ago

[deleted]

peteforde 1y ago

I know that many of the claims are based on clinical data and retention studies, but I find the entire thrust of the post to be incredibly cynical. Fat people often fight the not subtle sensation that a lot of people see them as either a problem/herd to be managed and/or maximally profited from. This is one of those accounts that seems to say the inside part out loud. The idea that a few pharmas artificially juicing a desperate population [who just want to feel good about themselves and live longer, happier lives for more than many can comfortably afford] is interfering with insurance adjustors ability to maximize profits doesn't leave me heartbroken. It's precisely this shit that leads to people celebrating when pharma CEOs get tapped.

deleted 1y ago

[deleted]

glp1guide 1y ago

Note that right now there's a problem with people staying on GLP1s[0] so it's not quite clear how this could go any other way. Considering the rate of rebound from other lifestyle methods, GLP1 is among the most effective alternatives we have. GLP1 significantly reduces the risk of many mobidities and is increasingly prescribed to older people. Also, this is incredibly likely to resolve itself once the drugs become common place after patent expiries, the actuaries will update their tables and the curve will smoothe out. [0]: https://glp1.guide/content/if-glp1-is-so-great-why-dont-people-stick-with-it https://glp1.guide/content/if-glp1-is-so-great-why-dont-peop... [1]: https://glp1.guide/content/patent-expirations-for-glp1-receptor-agonists/ https://glp1.guide/content/patent-expirations-for-glp1-recep...

mctt 1y ago
Can someone explain what is being said here in literal terms please. Can you also identify any dark humour or social commentary because I don't know enough to be sure.
- glp1guide 1y ago
  Let me try again: 1. People do not stay on GLP1s for long, despite how effective they are 2. People often rebound harder from other forms of weight loss (dieting, temporary lifestyle changes, etc) 3. GLP1 reduces a LOT of health risks linked to obesity (heart disease being the most important IMO) 4. Older people are taking GLP1s in droves 5. Once these drugs are everywhere (they will be soon IMO in < 7 years obesity will probably be ~gone), the effects will get "priced in" to actuary tables. No social commentary or dark humor intended -- GLP1s aren't miracle drugs but the effects (and relative lack of side effects) is miraculous.

cobertos 1y ago

> Lost around 14kg using GLP-1s from a D2C provider (no detail on their electronic health record) Huh? How would one get these electronic health records? I thought each provider keeps these and there's no public database except for vaccines? And it doesn't exist because HIPAA would make it hard?

kbos87 1y ago

GLP-1s have legitimately changed my life for the better. I've always been very active but have consistently been moderately overweight. A relatively low dose of Semaglitide has helped me lose 40lbs and keep it off. I'm a year and a half in and have had very few side effects, no loss of efficacy, and my muscle mass has increased slightly despite all the negative press about muscle loss. My diet is similar in composition to what it was before, but I probably eat 25% less by volume. Recognizing I'm a sample of one, but my experience is reflected in the research. I plan on being a GLP-1 for the rest of my life. Perfectly fine with that. It seems like society has more problems with GLP-1s than its users do.

itake 1y ago
> my muscle mass has increased slightly how was this measured?
- kbos87 1y ago
  Day to day I use a home body composition scale (Withings Body Scan), the results of which have been corroborated by two Dexascans I've done at my gym a little less than a year apart. For me personally, the little bit of help in the form of forward progress on weight loss has given me a reason to be a little more methodical in my strength training, and I'm seeing a slow but consistent payoff. And as far as I can tell, I'm not fighting an uphill battle in terms of adding muscle mass at all because of the GLP-1.
rsyring 1y ago
> A relatively low dose of Semaglitide Can you share what dose?

atleastoptimal 1y ago

The solution is for life insurance companies to pay people to stay on ozempic

zaptrem 1y ago
The “payment” can come in the form of lower rates, with penalties if you stop.
- const_cast 1y ago
  We already do something similar with smoking cessation. They, essentially, pay you to quit smoking. The social difference is that we frame smoking as an addiction, and smokers as victims of the Tobacco industry. But we frame obesity as a moral failing. So, the former we're ready to jump in and help. But, the latter, we are much more hesitant. Theoretically, economic outcomes would override these social and moral effects. But leadership is often stupid, so we'll see.

gitfan86 1y ago

Not really, they can just stop insuring people who take them at all.

blindriver 1y ago

The last thing I will ever give a rats ass about is insurance companies. They are the scourge of this earth but they have used legislation to embed themselves in our every day lives. I live in California and have no claims ever. My home insurance has doubled in 4 years to almost $4000 a year. My car insurance is about $2800/yr. So I hope insurance companies break. Like Danerys said in Gamr of Thrones, I hope someone breaks the wheel.

slyall 1y ago
$4000/year might be a lot or a little. If you own a $5m house up against a forest it's probably a bargain. The car price could reflect a bunch of factors. Pay some broker for a one-off consultation to advise you on how to save money. Reality is insurance companies are now going though a cycle of "price in the actual risk" rather than "drop prices to gain customers"
ReverseCold 1y ago
> I live in California Car insurance companies in CA actually lose money on the state, if that makes you feel better: https://money.com/car-insurance-policies-problems-california/ https://money.com/car-insurance-policies-problems-california... There are laws that prevent them from charging enough to even break-even on the policies.
timerol 1y ago
So you pay less than 1% of the cost to rebuild your home per year in home insurance, in a state that regularly has fires, floods, and earthquakes? That seems fair to me

jbs789 1y ago

The reason insurers ask about weight loss is that it could be a sign of a (severe) undiagnosed medical condition - e.g. they should be contacting a doctor(!)

potato3732842 1y ago

Call me cynical but it wouldn't surprise me if insurers somehow tried to leverage this "crisis" into some sort of "get written into law, guaranteed profits forever" play the way that health, home and auto have.

johndhi 1y ago

Can't they just adjust their model based on whether the patient is on a GLP-1 and account for the likelihood they'll stop taking it?

kccqzy 1y ago
The article addressed this. The person could have gotten GLP-1 from a D2C provider and insurance has no record of this person ever taking GLP-1.

popupeyecare 1y ago

Anyone read the source and find the 98% accuracy stat? The source link has a UTM source of ChatGPT. Could it be a hallucination?

astrea 1y ago
I believe it’s seeing the 98% mortality rate in 2020 vs 2019 for the same month.
yesfitz 1y ago
Maybe more of a misinterpretation by AI and/or author than full on hallucination. "Life insurers can predict when you'll die with about 98% accuracy." "98%" appears in the citation[1], but as the ratio of actual deaths to expected deaths. (i.e. 98% of the deaths they expected actually occurred.) Some months that figure was ~104%, so it's not a measure of accuracy. 1: https://www.soa.org/4aa060/globalassets/assets/files/resources/research-report/2024/rpec-mort-improvement-update.pdf https://www.soa.org/4aa060/globalassets/assets/files/resourc...
nrenegar 1y ago
It's extremely incorrect. 98% accuracy on when "you'll" die would imply an R^2 of 0.98 for individual-level lifespan predictions. We are nowhere close to that.
- neaden 1y ago
  It could mean a lot of things. It could mean "We think you'll die at 87+-5 years" and counting it as a success if you die anywhere in that age range for instance which I could believe they can predict the vast majority of the time. I doubt they are referring to the R Squared.
subarctic 1y ago
I saw that too and thought the utm_source=chatgpt was pretty funny, since I only noticed it when I was pasting the link into chatgpt myself to get it to tell me where the "98% accurate" claim was coming from. Anyway, it's a pretty vague statement. What it sounds like it's saying is for the average person they can predict when they will die, and you have to decide if they mean the day, the year or the decade. But chatgpt gave me an interpretation that seems to make more sense: > The 98 % figure is about aggregate forecasting, not clairvoyance. It means that when an insurer predicts, say, 10 000 deaths across its book in 2024, the actual count typically falls within roughly ±200. For any single customer, the prediction is still just a probability curve, not a calendar appointment with the Grim Reaper.

oger 1y ago

The topic of per-country pricing was mentioned several times. I was wondering how big the price differences would be so I set up a quick form to collect some data points from several countries and for several products. It would be cool if you could provide some data - I would then share it back as a reply to this thread within 1-2 days after closing the survey. The latest data entry will be possible on Sunday. https://forms.cloud.microsoft/e/DjDgH62s21 https://forms.cloud.microsoft/e/DjDgH62s21

adolph 1y ago

Is the rise of GLPs yet another case of Neal Stephenson called it again? I'm rereading Anathem and struck by similarities of Allswell and the psychoactive components of GLPs. In the book, Allswell is a drug that gives people a sense of calm and well being, and is genetically engineered into food in a way that puts water fluoridation to shame. Otoh, the lower-caste slines of Arbre are also overweight so maybe the parallels are limited.

skissane 1y ago

> They switched from 30-day to 90-day refills. Suddenly, patients had to think about their medication four times a year instead of twelve. Adherence rates shot up almost immediately. When I have a “refill” (here in Australia we call them “repeats”) due, my pharmacy sends me an SMS… I just reply “yes please” and that goes straight to the pharmacist who dispenses, and I get another SMS telling me the dispensed medication is ready to pick up I’m on tirzepatide and I’m committed but I’m “going a bit slow” because the side effects started to get a bit too much. Still, my base expectation is I’m taking a GLP-1 agonist for the rest of my life, unless my doctor tells me I have to stop for some reason, or I somehow go bankrupt and can’t afford it any more.