5 ms·

And it's under-commented upon because it's counterintuitive, but most people stop taking it. Like, two year continuation of use is about 25%. That's kinda wil

And it's under-commented upon because it's counterintuitive, but most people stop taking it. Like, two year continuation of use is about 25%. That's kinda wild, because it seems like holy shit if you're taking a drug that lets you drop 10-20% of your body weight from obese down to normal why would you stop taking it, but people do.

catdog 1y ago
Side effects? Also many might not be able to afford it long term as it's quite expensive.
AndrewDucker 1y ago
Cost is a big factor. When it becomes generic then I suspect people will stay on it for a lot longer.
decimalenough 1y ago
Because they're now "normal", so why would they continue paying for it, taking unpleasant injections, and enduring the side effects? In this sense it's like any diet: they "work", but if you don't permanently modify your food intake, the weight comes back as soon as you go off the diet.
- sroussey 1y ago
  Another way of putting it is that people achieve their goals and wind down the usage of the drug that got them there. I think that in a few more years the number may stay at 25% (or whatever) but that the makeup of the 25% may be different. That is, people will go off it and back on it if they see their progress reverse but that will happen to different people at different times.
subscribed 1y ago
Because the pharmacy will refuse to sell it to you. Source: UK based friend who says the pharmacy will refuse to sell them once they fall under BMI 25 (still overweight). They'd prefer to be on the tiny maintenance dose but it seems to be very hard to achieve (unless you're going off the market completely).
- stavros 1y ago
  I'll dispute that, I work for one of the online pharmacies and we won't stop selling it to you once you've reached BMI 25. We do have criteria to guard against sudden or extreme weight loss, but I think the BMI criterion for that is something like < 20 BMI (don't quote me on that, as I'm not sure, but it's not 25). We'll also keep you on a small maintenance dose if you want, that's a conversation you'll have with your clinician and they'll judge whether it's medically appropriate. As far as I know, there's usually no reason to prevent you, though.
  - subscribed 1y ago
    My friend orders from Medexpress - could you maybe share at least the first letter of your pharmacy or a hint so we can try to guess the name of the helpful one? I don't think it's possible to send dms here....
    - stavros 1y ago
      Oh, it's Numan. If your friend has a different experience with us than what I describe, please email me and I'll look into it (email in profile or just username at Numan.com). As far as I know, though, you can move to us from another pharmacy even with a BMI of < 25, as maintenance has different criteria than new prescription. I'm not a clinician, though, so I may be wrong. If you want to email me, I can ask the clinicians and tell you for sure.
      - subscribed 1y ago
        Thank you so much. Well try to reach out the normal way. Thank you, you've been so helpful already.
kistaro 1y ago
Because it costs $1000/mo and insurance wants to make it as hard as possible to get that covered because they cannot afford to pay $1000/mo * 45% of Americans without doing things to their rates that are forbidden by the ACA and, for that matter, any approximation of good sense. If people cannot afford an additional $450/mo each on average for their health care, how do you cover a critical long-term $1000/mo drug that 45% of the population needs? Gating it behind mandatory expensive, difficult-to-schedule appointments with a specialist who is in abruptly short supply where the insurance company is doing their damndest to kick as many of them off their network as they can without getting caught to keep the shortage going is certainly part of that strategy. And the result is “people do not stay on the drug”, which is their goal, and if they don’t meet that goal they have an even bigger problem and can’t continue to exist as a functioning company.
- oger 1y ago
  Is that the cost in the U.S.??
  - Sohcahtoa82 1y ago
    Yup. Without insurance, GLP-1s can be up to $1,200/month. The simple fact is, when it comes to drugs, the development is basically paid for by Americans.
tsimionescu 1y ago
You can also think about it the other way - if a drug caused you to lose 10-20% of your body weight, and you're now at a good body weight after 2 years, why would you want to lose another 10-20% body weight? I understand that's not really how it works, but people often go very much by feel more than anything else.

catdog 1y ago

Side effects? Also many might not be able to afford it long term as it's quite expensive.

AndrewDucker 1y ago

Cost is a big factor. When it becomes generic then I suspect people will stay on it for a lot longer.

decimalenough 1y ago

Because they're now "normal", so why would they continue paying for it, taking unpleasant injections, and enduring the side effects? In this sense it's like any diet: they "work", but if you don't permanently modify your food intake, the weight comes back as soon as you go off the diet.

sroussey 1y ago
Another way of putting it is that people achieve their goals and wind down the usage of the drug that got them there. I think that in a few more years the number may stay at 25% (or whatever) but that the makeup of the 25% may be different. That is, people will go off it and back on it if they see their progress reverse but that will happen to different people at different times.

subscribed 1y ago

Because the pharmacy will refuse to sell it to you. Source: UK based friend who says the pharmacy will refuse to sell them once they fall under BMI 25 (still overweight). They'd prefer to be on the tiny maintenance dose but it seems to be very hard to achieve (unless you're going off the market completely).

stavros 1y ago
I'll dispute that, I work for one of the online pharmacies and we won't stop selling it to you once you've reached BMI 25. We do have criteria to guard against sudden or extreme weight loss, but I think the BMI criterion for that is something like < 20 BMI (don't quote me on that, as I'm not sure, but it's not 25). We'll also keep you on a small maintenance dose if you want, that's a conversation you'll have with your clinician and they'll judge whether it's medically appropriate. As far as I know, there's usually no reason to prevent you, though.
- subscribed 1y ago
  My friend orders from Medexpress - could you maybe share at least the first letter of your pharmacy or a hint so we can try to guess the name of the helpful one? I don't think it's possible to send dms here....
  - stavros 1y ago
    Oh, it's Numan. If your friend has a different experience with us than what I describe, please email me and I'll look into it (email in profile or just username at Numan.com). As far as I know, though, you can move to us from another pharmacy even with a BMI of < 25, as maintenance has different criteria than new prescription. I'm not a clinician, though, so I may be wrong. If you want to email me, I can ask the clinicians and tell you for sure.
    - subscribed 1y ago
      Thank you so much. Well try to reach out the normal way. Thank you, you've been so helpful already.

kistaro 1y ago

Because it costs $1000/mo and insurance wants to make it as hard as possible to get that covered because they cannot afford to pay $1000/mo * 45% of Americans without doing things to their rates that are forbidden by the ACA and, for that matter, any approximation of good sense. If people cannot afford an additional $450/mo each on average for their health care, how do you cover a critical long-term $1000/mo drug that 45% of the population needs? Gating it behind mandatory expensive, difficult-to-schedule appointments with a specialist who is in abruptly short supply where the insurance company is doing their damndest to kick as many of them off their network as they can without getting caught to keep the shortage going is certainly part of that strategy. And the result is “people do not stay on the drug”, which is their goal, and if they don’t meet that goal they have an even bigger problem and can’t continue to exist as a functioning company.

oger 1y ago
Is that the cost in the U.S.??
- Sohcahtoa82 1y ago
  Yup. Without insurance, GLP-1s can be up to $1,200/month. The simple fact is, when it comes to drugs, the development is basically paid for by Americans.

tsimionescu 1y ago

You can also think about it the other way - if a drug caused you to lose 10-20% of your body weight, and you're now at a good body weight after 2 years, why would you want to lose another 10-20% body weight? I understand that's not really how it works, but people often go very much by feel more than anything else.