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The Drug Changing Medicine

By EMANUEL SARKEES

The United States is in the middle of what researchers are calling one of the most significant pharmacological developments in modern medicine. GLP-1 receptor agonists, the drug class behind Ozempic and Wegovy, have become able to reduce obesity, lower cardiovascular risk, control blood sugar, and show signals improving areas like addiction and dementia. It is backed by large scale clinical trials and is actively reshaping how physicians think about chronic disease management. The accessibility, however, is not keeping up with the science. The people who will benefit most from GLP-1s are the same people who have no path to receiving them.

This is not a coincidence. It is the outcome of a pricing structure, an insurance system, and a policy environment that have consistently made the same choice, which is to let cost determine who receives care.

What GLP-1s Actually Do

GLP-1s were originally developed to treat Type 2 diabetes. They work by acting similarly to a hormone the gut naturally produces after eating, which signals the brain to reduce appetite, slows digestion, and stabilizes blood sugar levels. The effects have been significant enough that the medical community’s interest has expanded well beyond diabetes management.

A 2023 clinical trial, known as the SELECT trial, found that semaglutide, the active ingredient in Wegovy, reduced the risk of cardiovascular issues like heart attacks and strokes by 20% in patients with obesity who did not have diabetes. That finding alone drew serious attention from cardiologists. Early research is also exploring GLP-1s in alcohol use disorder, sleep apnea, chronic kidney disease, and Alzheimer’s. The amount of potential application is unlike anything seen from a single drug class in recent times.

The Price Problem

The issue is not whether these drugs work. It is whether the system is built to let people use them. Wegovy, the FDA approved version specifically made for weight management, holds a price of around $1,300 per month in the United States without insurance coverage. Ozempic, technically approved for Type 2 diabetes but widely prescribed off label for obesity, runs at a similar cost. As one analysis noted, GLP-1 pricing “increased 442% between 2021 and 2023, creating a market three times larger than cancer spending, with list prices reaching $1,400”. Novo Nordisk and Eli Lilly, the two companies that dominate this market, charge American patients prices that are dramatically higher than what patients pay for the same medications in other countries.

The actual price a patient pays has very little to do with that $1,349 list price and almost everything to do with how they access the drug. With commercial insurance that covers obesity, costs can fall to around $25 a month, though that requires a plan that actually covers weight loss medications and prior authorization that actually gets approved. The Wegovy pill is available directly through NovoCare at $149 per month, the lowest price point ever for an FDA-approved GLP-1 weight loss medication. Zepbound starts at $299 per month through LillyDirect for patients who pay out of pocket. The government’s TrumpRx platform offers GLP-1s at around $350 per month for cash-paying patients who do not have coverage. Compounded versions through telehealth platforms like Ro and Hers run anywhere from $99 to $349 per month, though the FDA is actively restricting that market. And as of July 1, 2026, eligible Medicare beneficiaries can access Wegovy, Zepbound, and Foundayo at a flat $50 per month through the new Medicare GLP-1 Bridge program. That is a 27-times spread between the lowest and highest price for the exact same drug, determined not by what the medicine costs to make, but almost entirely by who you are when you walk up to the pharmacy counter. And for the uninsured, low income patient with no Medicare, no qualifying commercial plan, and no compounding option, none of those prices are on the table at all. 

At $1,300 per month, the annual cost of Wegovy exceeds $15,000. For millions of Americans, that number is not just high, but is completely out of reach. That gap in pricing is not accidental. In countries where governments negotiate drug prices directly, the same medication costs a fraction of what Americans pay. The United States remains one of the only developed nations that does not regulate pharmaceutical pricing at the federal level, and patients suffer the difference.

Insurance coverage for GLP-1s follows a path that is both frustrating and familiar.

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The price of Ozempic is a meaningless phrase

By JOHN SAMARAS

Ask what Ozempic costs. The honest answer runs from $25 a month to $1,100 a month, and every number in that range is real, published, and defensible. A phrase that covers a forty-four-fold spread is not a price. It is a fog, and patients make four-figure annual decisions inside it.

I run GLP Chart, an independent GLP-1 price index. The index shows that “the price of Ozempic” fails as a concept for three stacked reasons. The molecule sells in five forms under four names. Each form sells through different channels at different prices. And the advertised price rarely survives to month four.

One molecule, five forms

Ozempic is semaglutide, branded for type 2 diabetes. The same molecule is Wegovy when approved for weight loss, sold as a weekly pen and, since 2026, a daily pill. It is Rybelsus in the older oral form. And 503A compounding pharmacies still sell it as compounded semaglutide where the rules allow, though the FDA’s compounding restrictions and the manufacturer lawsuits thinned that market through 2025 and 2026.

When someone says “Ozempic price,” they almost always mean “what will semaglutide cost me.” Those are different questions with different answers.

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Value Is in the Eye of the Beholder

By KIM BELLARD

The most (unintentionally) amusing story I read this week was Tim Higgin’s Wall Street Journal article Alex Karp Is Saying What Every Angry CEO Is Thinking About AI. Dr. Karp (yes, he has a Ph.D.), co-founder and CEO of Palantir Technologies, is upset about how AI companies are using relationships with their business customers to harvest data and business insights from those customers. “Something has gone completely wrong,” he fumed.

Now, this is Palantir, mind you; it may not have invented surveillance capitalism but it might have perfected it. It has become essential to government and large corporations across the world. Most of us are aware of how tech companies like Meta or Google give us “free” services that exist primarily to collect more data on us, which they then use to target ads to us, but Palantir’s data collection and analysis operate at a level we often don’t recognize.  But make no mistake; it is using our data, and not necessarily in our best interests.

Mr. Higgins quotes former White House AI czar David Sacks in support of Dr. Karp’s concerns:

Anthropic has launched Claude Science, Claude Security, Claude Legal, and of course Claude Code—each expanding into categories previously served by companies building on top of their models. The pattern is consistent: Watch where value is being created, then move in directly. Dominate the model layer, then use that position to capture the most lucrative verticals.

So it is delicious irony that Dr. Karp and others are finding themselves at the wrong end of the power inequality with their data.

I find myself thinking about healthcare when I think above this new wave of data collectors/ synthesizers. It seems pretty clear that the AI companies aren’t going anywhere, and are expected to reshape most industries, including healthcare. Lots has been written about AI’s use in healthcare, including by me. It is both inevitable and, in many cases, desirable. Now this issue of AI’s insatiable appetite for data makes me wonder if we’re looking at things wrong.

I’ve worked in healthcare for longer than I care to admit, and at no point did people not complain that healthcare in general, and health insurance in particular, was too expensive. And yet, costs have kept rising. We’re closing in on $6 trillion in U.S. healthcare expenditures. No matter what kind of health insurance you have – large employer, small employer, ACA Marketplace, Medicare Advantage, even Medicare Supplements for traditional Medicare – your premiums (and/or out-of-pocket costs) are likely going up at rates we haven’t seen in years.

Two well known facts about rising costs are, one, that it is not so much we’re using too many services as it is that Americans pay way higher prices for healthcare than in most countries, and, two, that a relatively small percentage of people account for the vast majority of healthcare spending. The latter has an insidious effect on health insurance premiums, as people with fewer expenses are less likely to have or keep health insurance, making premiums for the remaining people higher. Nobody wants to pay for the people who use a lot of health care, but they want other people to help pay if they end up being one of those people. It’s a conundrum.

Now, optimists hope that AI can do a better job of identifying all the wasted, unnecessary, or inappropriate care we use – estimated as much as one-third – and help make administration more efficient; current levels are estimated as 15-30% of spending. Good goals, both of them, and it is entirely plausible that AI can help with both. But it would still remain that sick people are the “problem” with our health care spending and health insurance premiums, and I want to propose a different way of looking at them.

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The wrong people are scared of clinical AI

By CRAIG HAUBEN

Ask anyone outside healthcare who resists clinical AI and you’ll get a confident answer. The older doctors. The ones who spent thirty years building expertise and now see a machine coming for it. The story writes itself, which should have been the first clue it was wrong.

I’ve spent thirty years in healthcare, and I now run a company that builds and runs AI inside provider and payer organizations. At Clutch we use AI’s data analysis to solve engagement challenges. Who is the patient today? What message will land with them? When do they want to read it? Get those right and you can drive the kind of sustained behavior change that moves clinical outcomes like drug adherence, care plan adherence, and gap closure.

So I’m not working from theory. I watch this land in real workflows, and here’s what I see. The clinicians most enthusiastic about AI are usually the ones who’ve done the job the longest. The resistance comes from somewhere else. If you run a health system, that difference should change how you plan your next deployment.

Start with the adoption numbers, because they already break the resistance story. The AMA’s latest survey found four in five physicians now use AI in practice, up from 38 percent in 2023. That’s not a profession digging in against a threat. That’s a profession that found something useful.

Now the veterans. A doctor with three decades in a specialty can see, better than anyone, what these systems are good at. Pattern recognition at scale. Catching the thing that should have been flagged two visits ago. Surfacing what was already sitting in the data: the missed finding in last year’s imaging, the lab trend across eighteen months that looked unremarkable one value at a time, the three ED visits in six weeks nobody had the time to connect.

This isn’t hypothetical. The Nature study of Google’s breast cancer screening system showed a 9.4 percent drop in false negatives for US patients, the cancers human readers missed. The largest NHS evaluation to date, across 175,000 women, found AI caught more invasive cancers with fewer false positives than human readers. The harm these systems go after, information that existed and never got connected, is one experienced clinicians know cold. They’ve spent careers watching its absence hurt people.

Here’s one from our own work. We’re working with a national government programs payer on some of their hardest members to engage, the high intensity ones who need contact four or five times a day for six months or more. We got engagement to 95 percent, measured by the customer, and adherence to 93 percent. The result was a 0.8 average drop in HbA1c and an 18 percent reduction in symptoms.

When a system takes the mechanical load off so the judgment work gets more attention, the thirty-year clinician doesn’t feel threatened. They feel relieved. Their expertise is the judgment, not the data retrieval, and they’ve always known the difference.

Now look at where the fear actually lives. It comes from the middle.

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Future of AI and Telehealth in primary care — Panel discussion

A couple of months back I hosted a conversation about my favorite topics, primary care and how telehealth and AI are changing it. The panel was Timm Schneider — Co-Founder & COO, Third Way Health, Jamie Reddick — COO, Graybill Medical Group & Erin Parks, Ph.D. — Co-Founder, Equip. The panel was at a tech heavy conference called TechCon Global in San Diego. Sadly the weather stopped us getting Matt Siegler from Akido Labs. We got into it about tech. incentives, specialty care and the role of AI in access and patient support–Matthew Holt

How Online Prescription Services Are Closing the Access Gap for Patients Who Skip the Doctor’s Office

By DAMIAN WONJO

Every clinician keeps a private list of the patients they don’t see. Not the ones who cancel, the ones who never book. The shift worker who reschedules the same appointment three times and then quietly gives up. The parent who can’t justify half a day off and a waiting-room afternoon for a routine refill. The patient whose condition carries enough stigma that the friction of a face-to-face visit becomes, in itself, a reason to do nothing. These people don’t show up in no-show statistics. They show up later, as complications, as emergencies, as avoidable deterioration.

This is the access gap, and from where I sit as a physician in Europe, it has less to do with the raw supply of doctors than with the cost of reaching one, measured not only in money but in time, distance, and effort. When that cost climbs higher than a patient’s tolerance, care simply doesn’t happen. Online prescription services and remote consultation won’t fix every part of this problem. But they target precisely the variable that most reforms ignore, which is friction.

The patients who fall through

It is tempting to frame telemedicine as a convenience for the already-healthy and already-connected. In practice, the people who benefit most are often those with the least slack in their lives. A patient stabilised on the same antihypertensive for three years does not need a fresh diagnostic odyssey to continue it, they need a prescription before they run out. A working adult who recognises a recurring, familiar problem does not always need a physical examination to be helped safely. Forcing every such encounter through the narrow door of an in-person appointment does not raise the standard of care, it raises the rate at which people abandon it.

Continuity is where this matters most. Chronic conditions are managed in refills, and a missed refill is not a clerical event but a gap in treatment with real physiological consequences. Lowering the barrier to that refill is not a luxury. It is, quietly, one of the highest-yield interventions available.

What changed in Europe

The pandemic did not invent telemedicine, but it normalised it, and it accelerated the infrastructure underneath it. Poland is a useful case study. Electronic prescriptions became the national standard in 2020, and today essentially every prescription is issued digitally, retrievable by the patient through a government health account and dispensable at any pharmacy with a code. The clinical encounter and the prescription were decoupled from a single physical location without being decoupled from a licensed prescriber.

That distinction is the whole argument. A responsible online prescription service is not a vending machine. It is a licensed physician, working within the same legal and ethical framework as any clinic, using a different channel to reach the patient. The technology is mundane. The consequence, that a patient who would otherwise have gone without is now seen, is not.

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A ridiculously stupid letter from a health insurer

By MATTHEW HOLT

It’s hard to imagine but I may now be in possession of the stupidest letter I’ve ever received from an American health insurance company–-and I’m the guy who got five identical letters on one day from Blue Shield of California telling me that they had changed my primary care doctor when I had initiated the change.

A little backstory.  As those you’ve been following along with my various telenovelas may remember that last year I was diagnosed with a failing heart valve.  I also have a failing left knee due mostly to snowboarding into a tree 24 years ago.

I was attempting to put off doing anything about the heart valve for as long as possible because it sounds painful and unpleasant, and I was hoping that I could go ahead with a knee replacement so that my snowboarding can continue apace. My doctors are at UC San Francisco and they agreed that I should have the knee replacement on July 6th, assuming that my heart valve had not got much worse. On June 16th I went into UCSF for a bunch of knee replacement pre-workup and they also checked my heart.

However, my new insurance company, thanks to my wife’s new job, is Cigna. Those of you in California may know that Cigna was having a big dispute with the University of California Health system and that its contract with them was due to expire on June the 30th of this year. Why a health plan and a big provider organization have contracts that expire in the middle of the year when the employers and people who use the health plan network buy them on an annual basis starting in January I don’t know –  and it’s ridiculously stupid. But let’s not get distracted cause I’m not talking about that here!

Because of the fact that they’d be out of network, the ortho team made the obvious suggestion that I move the knee replacement a little earlier, In fact it was planned for June the 22nd. This did not upset me too much as you may have seen that some corrupt Italians have organized a soccer tournament that would give me plenty of games on TV to be entertained by while I was lying around recovering.

Sadly one of the pretests I had on June 16th was an echocardiogram that indicated that my heart valve was in even worse shape than it had been earlier in the year.  After quite a lot of back and forth between the cardiac team, the knee team and the anesthesia team, everyone agreed to put off the knee surgery until we figured out my heart.

Meanwhile sometime late on Thursday the 25th or early on Friday the 26th of June, UC Health and Cigna stepped back from the brink and came to an agreement that will continue the UC system being in Cigna’s network.

Which all brings me to July 6th when I received a letter from Cigna

This is the one that contains more stupidity per square inch than any other communication I’ve had from an insurance company.

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Life Not As We Know It

By KIM BELLARD

Well, let’s see. Last week much of the U.S. and parts of Europe were under a crippling heat dome. The U.S. celebrated its 250th birthday. And there’s something called the World Cup going on, for those of you who care about such things. But, I mean, really, the news of the week? SpudCell.

OK, maybe you missed that one. If you are not a fan of science, or of synthetic biology in particular, news about it might not have shown up in your feeds, or perhaps you thought it was another ploy by the Potato Association of America to get you to buy even more potatoes. SpudCell is something truly new: “the world’s first synthetic cell with a complete life cycle, built entirely from non-living chemical components.”

Take a minute to take that description in.

“SpudCell performs the behaviors often used to tell the living from the inert — it feeds, grows, replicates its genome, divides and undergoes selection — yet it is far simpler than any natural cell and was assembled, part by part, by hand,” the project researchers wrote in a statement.

It was designed and built by researchers at the University of Minnesota, announced last week along with a preprint of their paper.The team was led by Professor Kate Adamala, and the name is either due to its supposed resemblance to a potato or it’s a play on “Sputnik.”

“This is likely the most exciting project I’ve ever worked on,” said Professor Adamala. “We’ve replicated in chemistry what only used to be possible in biology: the complete set of behaviors of a cell. It proves that the most fundamental functions of life, like growth and replication, do not need a mysterious magical spark.”

Scientists have been working for decades on stripping away genetic material from living cells to try to find the minimum necessary for life, but Professor Adamala and her team went the other way, gradually building up genetic material until it started behaving in ways we’d expect cells to.

The impressive thing is that the team engineered everything SpudCell does. As The Economist put it: “Everything the resulting cells do, they do because of molecules that Dr Adamala’s team put there. That leaves no room for mysteries.” That’s not true when researchers start with living cells.

Drew Endy, a synthetic biologist at Stanford University, told Carl Zimmer of The New York Times, “It’s a cell that was built, not born. It’s constructed, but it does what cells do.”

SpudCell is very basic.

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AI and Professional Nursing: On a Collision Course

By JEFF GOLDSMITH

In his wonderful and pragmatic new book, A Giant Leap, Dr. Robert Wachter cautions his professional colleagues that simply confiscating potential administrative and clinical staffing savings created by AI could foster a whirlwind of negative consequences for healthcare enterprises.

Nowhere is the explosive potential for reaction to AI incursions into care delivery greater than in nursing, hospitals’ largest single professional expense category. Hospitals employ more than 1.8 million Registered Nurses (RNs) and another 400 thousand non-RN nursing personnel. RNs alone are more than 30% of the hospital salaried workforce, and more than 40% of overall staff costs.

Nursing productivity is a central issue in overall hospital performance, and a key intervening variable both in clinical quality and patient satisfaction. So the capacity of AI to improve nursing productivity will be a core issue in determining AI’s effect on overall hospital operating performance.

There is clearly room for improvement. Studies have shown that nurses spend only 25-30% of their work hours in direct patient care activities. AI’s potential for alleviating the huge administrative burden damaging nursing productivity might be the biggest benefit AI could provide. AI could materially increase nursing time at the bedside, increasing both patient and nursing satisfaction.

However, AI could also reduce hospitals’ nurse headcount, a factor which could, in turn, reduce nursing union membership, the largest and fastest growing single category of hospital employees’ union membership. Almost 18% of all hospital employed RNs are members of labor unions (AFSCME, AFT Healthcare, National Nurses Union, etc. and their local affiliates). Union dues from nurses represent hundreds of millions in annual income to the unions that represent them.

Nursing unions’ most visible public policy initiative, which appeared first in California twenty years ago, was getting its state legislature to mandate nurse to patient staffing ratios in hospitals. These were designed to compel hospitals to hire more nurses with the intention of improving patient safety. What the ratios actually did was throw more nursing bodies at broken processes and systems. These laws had the important collateral benefit of assuring a “guaranteed income” in union dues from more nurses employed by hospitals subject to these ratios!

Formal (though less comprehensive) mandates for nurse staffing ratios have since spread to Oregon, Massachusetts and New York, with legislation pending in Maine, New Jersey, Pennsylvania. Michigan, Minnesota and Washington State. The research on the intended qualitative benefits of California’s state-mandated ratios confirm the expected benefits to patients, though the studies relied upon correlational analyses vs. states without the ratio mandate, not pre- and post- studies of the ratios’ effects on patient care.

Other studies concluded that the ratios pushed up both RN numbers and compensation vs other job categories as well as damaging hospitals’ operating margins relative to states lacking the mandates. The point-counterpoint of these studies gives one a sense of an issue rapidly becoming politicized.

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July 4, 1862

By MIKE MAGEE

When I asked my brilliant literary agent, Jill Kneerim, when I would know that my book proposal  was ready for submission, she replied directly, “It will be ready when I say it is ready.” Eleven months later, in April, 2018, she finally green lit the project, and two weeks after that, in an orchestrated two-round public auction, it “sold” to Grove/Atlantic Press.

I passed over the highest bidder in choosing to earn the opportunity to be associated with a literary and cultural publication – The Atlantic Monthly– that dates back to November, 1857, when it “quickly became known for the quality of its fiction and general articles, contributed by a long line of distinguished editors and authors that includes James Russell Lowell, Ralph Waldo Emerson, Henry Wadsworth Longfellow, and Oliver Wendell Holmes.”

Their book publishing arm, the Atlantic Monthly Press, was incorporated in 1917. A merger in 1993 with Grove Press gave birth to Grove/Atlantic. Grove was no slouch when it came to social activism. Founded in 1951, it purposefully republished D. H. Lawrence’s Lady Chatterley’s Lover: Complete and Unexpurgated, and Henry Miller’s Tropic of Cancer as a challenge to U.S. obscenity laws at the time. And in 1965, they were the original and first publisher of The Autobiography of Malcolm X.

The Atlantic Monthly’s name change to The Atlantic officially occurred in 2007 and signaled a broader and more modern editorial platform, a digital presence and engagement with multi-platform modern media. At around this time, corporate offices were moved to Washington, D.C., and the magazine focused down on politics featuring a longtime journalist, Jeffrey Goldberg. A decade later, noted philanthropist, Laurene Powell Jobs, purchased a majority stake in the growing empire, and Goldberg was elevated to editor-in-chief.

Now a decade later, with America’s 250th birthday upon us, the very same Jeffrey Goldberg penned an opening editorial – “America’s Promise” – in the July, 2026 edition. Meant to provoke, it opens with “It is quite interesting, and somewhat chastening, to realize that the most important piece of journalism published across the 169-year history of this magazine was not journalism at all, but a poem…”

That poem appeared on page 10 of Vol. IX – February, 1862. -No. LII. It had five stanzas, and no title when it was submitted. The author, an abolitionist poet and pacifist, Julia Ward Howe was a contributor and friend to then editor, James J. Fields. In November, 1861, while visiting Washington, D.C. with her husband Samuel, she was drawn to a group of Union soldiers who had joined voices to sing a familiar tune titled “John Brown’s Body” with the original hymn credited to John William Steffe, a South Carolina born Philadelphia bookkeeper in 1856, and lyrics added five years later by Mass 2nd Infantry Battalion.

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