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domains/health/GLP-1 receptor agonists are the largest therapeutic category launch in pharmaceutical history but their chronic use model makes the net cost impact inflationary through 2035.md
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@ -103,13 +103,13 @@ Value in Health modeling study shows Medicare saves $715M over 10 years with com
### Additional Evidence (challenge)
*Source: [[2026-01-13-aon-glp1-employer-cost-savings-cancer-reduction]] | Added: 2026-03-18*
*Source: 2026-01-13-aon-glp1-employer-cost-savings-cancer-reduction | Added: 2026-03-18*
Aon's temporal cost analysis shows medical costs rise 23% in year 1 but grow only 2% after 12 months (vs 6% for non-users), with diabetes patients showing 6-9 percentage point lower cost growth at 30 months. This suggests the 'inflationary through 2035' claim may only apply to short-term payers, while long-term risk-bearers see net savings.
### Additional Evidence (challenge)
*Source: [[2026-03-19-glp1-price-compression-international-generics-claim-challenge]] | Added: 2026-03-19*
*Source: 2026-03-19-glp1-price-compression-international-generics-claim-challenge | Added: 2026-03-19*
International generic competition beginning January 2026 (Canada patent expiry, immediate Sandoz/Apotex/Teva filings) creates price compression trajectory faster than 'inflationary through 2035' assumes. Oral Wegovy launched at $149-299/month (5-8x reduction vs $1,300/month injectable). China/India generics projected at $40-50/month by 2030. Aon 192K patient study shows break-even timing is highly price-sensitive: at $1,300/month, multi-year retention required; at $50-150/month, Aon data suggests cost savings within 12-18 months under capitation. The 'inflationary through 2035' conclusion holds at current US pricing but becomes invalid if international generic arbitrage and oral formulation competition compress effective prices to $50-150/month range by 2030. Scope qualification needed: claim is valid conditional on pricing trajectory assumptions that are now challenged by G7 patent cliff precedent.

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domains/health/glp-1-persistence-drops-to-15-percent-at-two-years-for-non-diabetic-obesity-patients-undermining-chronic-use-economics.md
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@ -85,13 +85,13 @@ Weight regain data shows that even among patients who complete treatment, GLP-1
### Additional Evidence (extend)
*Source: [[2026-01-13-aon-glp1-employer-cost-savings-cancer-reduction]] | Added: 2026-03-18*
*Source: 2026-01-13-aon-glp1-employer-cost-savings-cancer-reduction | Added: 2026-03-18*
Aon data shows the 80%+ adherent cohort captures dramatically stronger cost reductions (9 percentage points lower for diabetes, 7 points for weight loss), confirming that adherence is the binding variable for economic viability. The adherence-dependent savings pattern means low persistence rates eliminate cost-effectiveness even when clinical benefits exist.
### Additional Evidence (extend)
*Source: [[2026-03-19-vida-ai-biology-acceleration-healthspan-constraint]] | Added: 2026-03-19*
*Source: 2026-03-19-vida-ai-biology-acceleration-healthspan-constraint | Added: 2026-03-19*
GLP-1 behavioral adherence failures demonstrate that even breakthrough pharmacology cannot overcome behavioral determinants: patients on GLP-1 alone show same weight regain as placebo without behavior change. This is direct evidence that the 'human constraints' factor (Amodei framework) limits pharmaceutical efficacy independent of drug quality.