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Teleo Agents 2026-03-15 19:08:37 +00:00
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@ -19,7 +19,7 @@ The competitive dynamics (Lilly vs. Novo vs. generics post-2031) will drive pric
### Additional Evidence (extend)
*Source: [[2024-08-01-jmcp-glp1-persistence-adherence-commercial-populations]] | Added: 2026-03-15 | Extractor: anthropic/claude-sonnet-4.5*
*Source: 2024-08-01-jmcp-glp1-persistence-adherence-commercial-populations | Added: 2026-03-15 | Extractor: anthropic/claude-sonnet-4.5*
Real-world persistence data from 125,474 commercially insured patients shows the chronic use model fails not because patients choose indefinite use, but because most cannot sustain it: only 32.3% of non-diabetic obesity patients remain on GLP-1s at one year, dropping to approximately 15% at two years. This creates a paradox for payer economics—the "inflationary chronic use" concern assumes sustained adherence, but the actual problem is insufficient persistence. Under capitation, payers pay for 12 months of therapy ($2,940 at $245/month) for patients who discontinue and regain weight, capturing net cost with no downstream savings from avoided complications. The economics only work if adherence is sustained AND the payer captures downstream benefits—with 85% discontinuing by two years, the downstream cardiovascular and metabolic savings that justify the cost never materialize for most patients.

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@ -33,7 +33,7 @@ The composition of spending shifts dramatically: less on chronic disease managem
### Additional Evidence (extend)
*Source: [[2026-02-23-cbo-medicare-trust-fund-2040-insolvency]] | Added: 2026-03-12 | Extractor: anthropic/claude-sonnet-4.5*
*Source: 2026-02-23-cbo-medicare-trust-fund-2040-insolvency | Added: 2026-03-12 | Extractor: anthropic/claude-sonnet-4.5*
(extend) The Medicare trust fund fiscal pressure adds a constraint layer to the cost curve dynamics. While new capabilities create upward cost pressure through expanded treatment populations, the trust fund exhaustion timeline (now 2040, accelerated from 2055 by tax policy changes) creates a hard fiscal boundary. The convergence of demographic pressure (working-age to 65+ ratio declining to 2.2:1 by 2055), MA overpayments ($1.2T/decade), and reduced tax revenues means automatic 8-10% benefit cuts starting 2040 unless structural reforms occur. This fiscal ceiling will force coverage and payment decisions in the 2030s independent of technology trajectories, potentially constraining the cost curve expansion that new capabilities would otherwise enable.