diff --git a/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 b/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 index d6ad74a14..39c59b5ac 100644 --- a/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 +++ b/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 @@ -37,13 +37,13 @@ MA plans' near-universal prior authorization creates administrative friction tha ### Additional Evidence (extend) -*Source: [[2025-05-01-nejm-semaglutide-mash-phase3-liver]] | Added: 2026-03-16* +*Source: 2025-05-01-nejm-semaglutide-mash-phase3-liver | Added: 2026-03-16* MASH/NASH is projected to become the leading cause of liver transplantation. GLP-1s now demonstrate efficacy across three major organ systems (cardiovascular, renal, hepatic), which strengthens the multi-indication economic case for chronic use. The 62.9% MASH resolution rate suggests GLP-1s could prevent progression to late-stage liver disease and transplantation, though the Value in Health Medicare study showed only $28M MASH savings—surprisingly small given clinical magnitude, likely because MASH progression to transplant takes decades and falls outside typical budget scoring windows. ### Additional Evidence (extend) -*Source: [[2025-12-23-cms-balance-model-glp1-obesity-coverage]] | Added: 2026-03-16* +*Source: 2025-12-23-cms-balance-model-glp1-obesity-coverage | Added: 2026-03-16* The BALANCE Model directly addresses the chronic use inflation problem by requiring lifestyle interventions alongside medication. If lifestyle supports can sustain metabolic benefits after medication discontinuation, the model could demonstrate a pathway to positive net cost impact. The 6-year test window (through 2031) will provide empirical data on whether combined intervention changes the chronic use economics.