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 in 2023, where she produces written content covering multiple disease states.

She has a BA in journalism from Seton Hall University. You can connect with Brooke on 

Articles

Individuals who transition from overweight to obese during adulthood may face a higher ovarian cancer risk, highlighting the importance of tracking body fat changes.

Overweight-to-Obese Trajectory in Adulthood May Raise Ovarian Cancer Risk

Rose is an associate editorial director at 

She has a BA in journalism & media studies and Spanish from Rutgers University. You can connect with Rose on 

Researchers are calling for more targeted efforts to improve health equity after a new analysis revealed that cancer symptom documentation and burden vary across certain demographics.

Symptom Documentation Differences in Acute Cancer Care Suggest Sociodemographic Disparities

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Although immunotherapies and biomarker-driven interventions have transformed lung cancer outcomes, Martin Edelman, MD, Fox Chase Cancer Center, highlighted the present challenge hindering clinicians' abilities to anticipate patients' treatment responses. 

Lingering Unknowns Amid Lung Cancer Breakthroughs: Martin Edelman, MD

Julia is an associate editor for The American Journal of Managed Care® (AJMC®) and joined AJMC® in 2022. She produces written and video content covering multiple disease states, and assists in the screening process for manuscripts submitted to AJMC®.

She has a BA in English language and literature from Rutgers University. You can connect with Julia on 

Benjamin K. Chen, MD, PhD, discussed the next steps after the results of his study in genetic tagging showed promise in targeting HIV cells.

HIV Cure the Goal of Future Study Into Genetic Tagging: Benjamin K. Chen, MD, PhD

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Compendium

On this episode of Managed Care Cast, we engage in a discussion with John M. Ostrominski, MD, fellow in cardiovascular medicine and 

 medicine, Brigham and Women’s Hospital and Harvard Medical School, and first author of a new study published in 

, “Trends in Utilization of Glucose- and Weight-Lowering Medications After Tirzepatide Approval in the United States.”

First approved on May 13, 2022, to treat adult patients with 

, the dual glucose-dependent insulinotropic polypeptide and glucagon-like peptide-1 receptor agonist has since been approved for chronic weight management and obstructive sleep apnea. Using commercial insurance claims data and the US launch of tirzepatide as their dividing point, Ostrominski and his team studied trends in the use of both glucose-lowering and weight-lowering medications, comparing outcomes between adults with and without type 2 diabetes. Overall, their findings show a significant uptick in tirzepatide dispensations, alongside other glucose- and weight-lowering medications, including semaglutide.

Speaking to the impact of their findings on health care providers who treat patients for type 2 diabetes and/or obesity, Ostrominski explains that these findings “underscore the need and importance of personalized and shared decisions around treatment.”

Listen above or through one of these podcast services:

Using commercial insurance claims data and the US launch of tirzepatide as their dividing point, John Ostrominski, MD, Harvard Medical School, and his team studied trends in the use of both glucose-lowering and weight-lowering medications, comparing outcomes between adults with and without type 2 diabetes.

Personalized Care Key as Tirzepatide Use Expands Rapidly

On this episode of Managed Care Cast, we speak with George Jones, chief operating officer at UpScript Health, an online pioneer of eprescribing 20 years ago, to learn how telemedicine has progressed from asynchronous conferencing to real-time video consultation, enabling the treatment of complex conditions beyond primary care. Although technology access remains a challenge for some, Jones emphasizes telemedicine’s potential to reduce wait times and improve efficiency, especially for conditions requiring specialist care.

A major theme in the telemedicine space is access to 

 treatments, particularly glucagon-like peptide-1 (GLP-1) medications like semaglutide, which was recently included on the second 

 under the Inflation Reduction Act. We also discuss how Medicare’s limited obesity coverage may reduce the impact of these negotiations, advocating for policies and step therapy models that can help to lower patient costs, and the regulatory concerns associated with compounded GLP-1s as an alternative, knowing that these medications are prepared outside FDA oversight.

George Jones of UpScript Health discusses telemedicine's evolution from basic e-prescribing to real-time video consultations, expanding treatment beyond primary care.

Telemedicine’s Evolution and Expanding Access to Obesity, Specialty Care

Unhealthy Sleep Patterns, Duration Linked With Obesity

Tirzepatide is approved for 3 indications in the US: type 2 diabetes, chronic weight management, and obstructive sleep apnea.

Tirzepatide Surges, Overtakes Older Drugs in Diabetes, Obesity Care

Findings from the interviews offer insight into potential strategies for reducing binge eating among patients who experience food insecurity.

Identifying Binge Eating Triggers Among Adults With Food Insecurity

Researchers warned that to achieve such reductions, greater uptake of the medication among indicated patients is needed.

Semaglutide Use Could Prevent Up to 2 Million MACE in 10 Years, Model Suggests

Weight loss drugs like tirzepatide and semaglutide are growing in popularity and offer significant health benefits, but they are not cost-effective at their current prices, according to a new evaluation, placing economic burdens on patients with obesity in the US.

Tirzepatide and Semaglutide Improve Weight Loss, Cardiovascular Conditions, but Deemed Too Expensive

Interview with UT Southwestern's Jaime Almandoz, MD, MBA

Discussing Tirzepatide’s Rise in Diabetes, Obesity Care: Jaime Almandoz, MD, MBA

Tirzepatide was first approved for use in the US in May 2022, when it received an indication for adult patients with type 2 diabetes.

 and sleep apnea quickly followed over the next 2-plus years.

 The dual glucagon-like peptide-1 receptor agonist and glucose-dependent insulinotropic polypeptide receptor agonist has been praised for its safety and efficacy,

 while also being called out for its cost.

 examined trends in the use of tirzepatide vs other glucose-lowering medications and weight-lowering medications,

 with the authors explaining that ongoing evaluation of these medications is necessary to keep patients and providers informed with the most up-to-date data.

In this first part of a recent interview with 

), UT Southwestern Medical Center’s Jaime Almandoz, MD, MBA, speaks to the 

findings, which are the results of a  study that investigated tirzepatide uptake trends by examining commercial claims data for January 1, 2021, to December 31, 2023.

This transcript has been lightly edited for clarity; captions were auto-generated.

What are the most important takeaways from this article for clinicians working in obesity medicine, type 2 diabetes, and metabolic health?

This study highlights the rapid and significant uptake of tirzepatide across populations with and without type 2 diabetes, within 18 months of its approval. Among adults with type 2 diabetes, tirzepatide comprised over 12% of all glucose-lowering medications by the end of 2023. In individuals without diabetes, it quickly became the most commonly used weight-loss medication, surpassing semaglutide. These findings reinforce that new and emerging incretin-based therapies are transforming care paradigms, not just because of their effectiveness for reducing body weight and blood sugars, but because they're being embraced widely in clinical practice.

How do the findings presented align, or conflict, with what you are seeing in clinical practice?

The observed trends are very, very much aligned with what we're seeing clinically. Demand for incretin-based therapies, particularly tirzepatide, has grown tremendously. Patients are increasingly informed about how these medications work and are actively requesting them, often by name. Clinicians are also more comfortable prescribing them due to the strong data on both weight reduction and cardiometabolic improvements. However, access and affordability remain significant barriers. Many of the patients with obesity or cardiometabolic issues who would benefit from treatment face insurance denials or high out-of-pocket costs, which can prevent initiation or lead to discontinuation.

It's a never-ending thing where you spend most of your days trying to convince people that your patients need evidence-based care. It's a thing. Price is also a thing. We live in the real world, and so we can't be too naive, but also we've just got to keep fighting.

Are there gaps or limitations in the article for readers and experts to consider?

While the study provides excellent insights into prescription trends among commercially insured adults, its generalizability is limited. It doesn't capture Medicaid, uninsured, or other publicly insured populations where obesity and diabetes burdens are disproportionately high. Dispensing data reveal valuable trends in prescribing, but we need additional information on clinical outcomes, adherence, or long-term effectiveness. We also lack data on reasons for discontinuation or barriers to access, which are critical for informing policy and coverage decisions. Finally, the study period ends in December 2023, which is just a month after tirzepatide’s FDA approval for weight management.

 Longer-term data on this population is really needed.

1. FDA approves Lilly’s Mounjaro (tirzepatide) injection, the first and only GIP and GLP-1 receptor agonist for the treatment of adults with type 2 diabetes. News release. Eli Lilly; May 13, 2022. Accessed April 22, 2025. 

https://investor.lilly.com/news-releases/news-release-details/fda-approves-lillys-mounjarotm-tirzepatide-injection-first-and

2. FDA approves new medication for chronic weight management. News release. FDA; November 8, 2023. Accessed April 22, 2025. 

https://www.fda.gov/news-events/press-announcements/fda-approves-new-medication-chronic-weight-management

3. Joszt L. Weight loss drug tirzepatide now approved for sleep apnea in adults with obesity. 

. December 20, 2024. Accessed April 22, 2025. 

https://www.ajmc.com/view/weight-loss-drug-tirzepatide-now-approved-for-sleep-apnea-in-adults-with-obesity

4. Santoro C. Tirzepatide and semaglutide improve weight loss, cardiovascular conditions, but deemed too expensive. 

. March 14, 2025. Accessed April 22, 2025.

https://www.ajmc.com/view/tirzepatide-and-semaglutide-improve-weight-loss-cardiovascular-conditions-but-deemed-too-expensive

5. Shaw M. Top GLP-1 agonists balance weight loss efficacy, safety. 

 January 6, 2025. Accessed April 22, 2025. 

https://www.ajmc.com/view/top-glp-1-agonists-balance-weight-loss-efficacy-safety

6. Griauzde DH, Carter EW, Oshman L, et al. Understanding insurance coverage policies for incretin mimetics for weight management. 

https://www.ajmc.com/view/understanding-insurance-coverage-policies-for-incretin-mimetics-for-weight-management

7. Shao WL. Contributor: how can the US health care system affordably and fairly expand GLP-1 access for the millions of people who need it? 

. March 5, 2025. Accessed April 22, 2025. 

https://www.ajmc.com/view/contributor-how-can-the-us-health-care-system-affordably-and-fairly-expand-glp-1-access-for-the-millions-of-people-who-need-it-

8. Shaw M. Tirzepatide surges, overtakes older drugs in diabetes, obesity care. 

. April 14, 2025. Accessed April 22, 2025. 

https://www.ajmc.com/view/tirzepatide-surges-overtakes-older-drugs-in-diabetes-obesity-care

Jaime Almandoz, MD, MBA, of UT Southwestern Medical Center, speaks on results of a study that investigated tirzepatide uptake trends in commercial claims data.

GLP-1 Agonists and the Gut-Brain Axis: A New Era in Obesity Management

In January 2023, Robert Kushner, MD, MS, professor of medicine and medical education at Northwestern University Feinberg School of Medicine, and Ania Jastreboff, MD, PhD, professor of medicine and pediatrics at Yale School of Medicine, 

 of glucagon-like peptide 1 (GLP-1) receptor agonists and the future of nutrient-stimulated hormone-based antiobesity therapeutics.

American Society for Preventive Cardiology (ASPC) 2024 Congress on CVD Prevention

, Kushner presented on the “new era” of obesity management, emphasizing the therapeutic targeting of the gut-brain axis with GLP-1 and glucose-dependent insulinotropic polypeptide (GIP)–mimicking hormones. According to Kushner, these advanced treatments not only facilitate significant weight loss, but also offer broader health benefits, such as improved 

What are you focusing on in your ASPC Congress session on GLP-1 agonists for obesity management?

In my session, I'm going to be highlighting a major theme, and that is that we are at an inflection point regarding treatment of obesity, and I qualify the inflection point by 3 major areas. One is that we are shifting the therapeutic target of obesity—I actually call that a paradigm shift—and we're shifting it to the gut-brain axis, which we really haven't seen before. What we're doing now is mimicking the naturally occurring gut hormones, such as GLP-1 or GIP, and give them back as synthesized versions at hyperpharmacological levels to cause significant benefits. The second major area is that we have highly effective medications that are born out of these mimicking hormones, such as semaglutide or tirzepatide, again highly effective, more than we've seen before. And the last is that these incretin hormones like GLP-1 or GIP have pleiotropic effects, and that is beyond weight loss, they have effects in multiple organs of the body, which is improving the overall health of our patients that are living with obesity.

What are some major updates to the obesity management landscape you’ve seen in the past year, especially around nutrient-stimulated hormone-based antiobesity therapeutics?

Building off of these highly effective medications that have pleiotropic effects, what we're seeing now published in highly reputable journals which we haven't seen before—like 

, and so forth—are the effects of these medications on reducing cardiovascular disease and outcomes; improving the symptoms of individuals with obstructive sleep apnea; improving kidney function in those with overweight, obesity, and diabetes; improving the risk of developing diabetes; and lastly, improving what we call now metabolic [dysfunction]–associated steatotic liver disease or MASLD. These are these weight-independent effects that are really involving the health of our patients that we treat and we're getting a lot of play and so many more articles, they're going to be coming out soon as well.

“We are at an inflection point regarding treatment of obesity,” said Robert Kushner, MD, MS, Northwestern University Feinberg School of Medicine.

Dr Ian Neeland Explores Semaglutide Alternatives and Strategies in Cases of Nonresponse

According to Ian Neeland, MD, both patients and physicians should recognize the importance of comprehensive weight management beyond medication, as the conversation with patients not responding to semaglutide may involve dose escalation, a potential medication switch, or modifying behavior and lifestyle patterns depending on individual context and reasons for lack of success.

Neeland serves as director of cardiovascular prevention and codirector of the Center for Integrated and Novel Approaches in Vascular-Metabolic Disease at the University Hospitals Harrington Heart & Vascular Institute, as well as associate professor of medicine at Case Western Reserve University School of Medicine.

For patients with obesity who are looking to lose weight and feel like they’ve tried everything, what would you advise them to do if you could not ensure they would have consistent access to semaglutide?

There are other anti-obesity medications out there on the market. Semaglutide is not the only one. Certainly, it's very effective and one of the most effective ones, but there are other options. So, I'd encourage patients to speak with their doctor about those options, and if their primary care doctor is not educated about those options or proficient, then a referral to a chronic weight management program or an obesity medicine specialist—for which those are increasing in number of that specialty—is really important. Obesity medicine specialists, beyond just prescribing the drug, can do many, many more things in terms of access to behavior modification plans, access to lifestyle modification counseling, and resources.

So, I would say comprehensive weight management is such an important aspect beyond just the drug itself. I've had plenty of patients who are on the drug and have not lost weight because all the other aspects of weight management have not been utilized by that patient, whereas I've had patients who are very involved and are kind of doing all the lifestyle issues and behavioral changes and being very successful. It's not just the drug that's going to help the patient, it's everything surrounding it. And I would say, even if you can't get semaglutide or a GLP-1 [glucagon-like peptide-1] receptor agonist, there are other anti-obesity medications that are FDA approved and can be effective for weight management for patients.

How does the conversation go with patients who are not responding to semaglutide?

It depends on why we think it may not be working and what we can try to do about it. So, one could be that the dose achieved is not high enough for the patient, so dose escalation may be an option. Another potentiality is that they're just not responsive to this particular brand of medication, so potentially a switch to a different GLP-1 or GIP [glucose-dependent insulinotropic polypeptide] agonist would be appropriate for that. And sometimes, it's kind of modifying the behavior and the diet. Sometimes people will be on the drug but not change their dietary patterns or lifestyle, so that would cause an issue in terms of the efficacy of weight loss they can achieve.

It really just depends on the context and the reasons why patients may not be as successful on the drugs. But now we have different options, and that's one area where potentially switching from one to a different agent can be beneficial.

Aside from semaglutide, alternate weight loss routes include other anti-obesity medications, chronic weight management programs, or obesity medicine specialists, said Ian Neeland, MD.

Obesity

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