Bureaucrats, Blood Sugar, and the Battle for Medicare’s Wallet
I’m back for Week 44 of my Mounjaro experiment—a strange week in which I unexpectedly shed some weight. While I’ve come a long way in taming my blood glucose and dealing with surplus flab, I’ve lately pivoted toward a new goal: clawing back some muscle mass lost during the early days of calorie-cutting. Yes, I’d still like to jettison the spare tire—but starving myself into a frail, wrinkled raisin of an old man doesn’t strike me as a smart trade.
As always, my goal here is to share the full range of what it’s like to use Mounjaro as a treatment for Type 2 diabetes. I throw in news, rants, and opinions to break up the play-by-play of what I ate, lifted, or avoided. I also encourage you, dear reader, to chime in with your own experiences—especially if you’ve got strong feelings or colorful language.
This week, we’re taking a detour into the foggy swampland of government price negotiations—specifically, Medicare’s recent decision to target some GLP-1 drugs for price negotiation while leaving others (notably Mounjaro) untouched. Yes, it’s time to point a crooked finger at Big Government. And as the old saying goes: “If you really want to screw something up, get the government involved.”
Administrivia
Before we get into the meat of the matter, here’s the usual legalistic eyewash: I’m not a doctor. I’m a 78-year-old Type 2 diabetic curmudgeon with strong opinions and a keyboard. That makes me dangerous, not qualified. So consult your own doctor before trying anything I mention here—especially if it sounds dumb or suspicious. If you disagree with my opinions, good. That just means you’re paying attention. Now on with the show.
Something Rotten in the State of Denmark?
Medicare recently published its inaugural list of drugs up for price negotiation, and wouldn’t you know it—Ozempic and Wegovy made the list. Missing in action? Eli Lilly’s Mounjaro and Zepbound. A bureaucratic oversight? Hardly. This looks a lot like a not-so-subtle tip of the cap to Lilly, the American pharmaceutical darling, while Denmark’s Novo Nordisk gets the shakedown.
Of course, the official explanation is that the IRA (Inflation Reduction Act—pause for laughter) only allows price negotiation for drugs that have been on the market for a set number of years: nine for pills, thirteen for biologics. Mounjaro and Zepbound are just too green. But hiding behind a rulebook is standard practice for bureaucrats doing something politically convenient. The result? Foreign-developed drugs get squeezed, while newer U.S.-made blockbusters skate.
Maybe They’ll Give Us a Better Deal on Greenland?
Here’s the kicker: by strong-arming Novo into offering Ozempic and Wegovy at Medicare-friendly discounts, the government may actually help the Danish firm—at least in the short term. Lower prices could make semaglutide the drug of choice for Medicare Part D plans, especially if Lilly insists on clinging to premium pricing. If that happens, Lilly might just cede the GLP-1 Medicare market to Novo Nordisk without firing a shot.
Yes, Mounjaro and Zepbound have outperformed semaglutide in most efficacy trials. But efficacy doesn’t help if the insurance gatekeepers make access a bureaucratic nightmare. Right now, insurers seem happy to steer folks toward the older, cheaper drug.
So what we may be witnessing is a slow-motion market share transfer, cloaked in the garb of populist price reform. Lilly will get its turn in the negotiation dunk tank eventually—but for now, Novo enjoys a politically manufactured edge. The irony? The haircut is being given to the foreign company while the American firm gets a fresh coat of hairspray.
In the meantime, Medicare patients looking to jump on the Mounjaro train may find themselves priced out. That’s not just market dynamics at play—it’s policy with side effects. While I hope to be off this stuff by the time all these moves take effect, you’ll certainly be the first to know if these political gyrations impact me!
In the News This Week
Regulatory and Legal Updates
- FDA Cracks Down on Compounding: With brand-name GLP-1 shortages resolved, the FDA is now telling compounding pharmacies to back off. Most compounded versions of tirzepatide and semaglutide are being shown the door.
- Court Ruling Upholds FDA Authority: A federal judge denied a compounding industry request to block the FDA’s directive. Translation: the FDA’s in charge, and compounded Mounjaro is out—at least for now.
Industry Moves
- Lilly Goes Global: Mounjaro has launched in India, adding a few billion more potential users to the GLP-1 pool.
- Novo Eyes the Future: Novo Nordisk just licensed a triple-agonist compound (GLP-1/GIP/glucagon) from The United Laboratories. Early-stage, but potentially a big deal.
Clinical Tidbits
- GLP-1s Not Linked to Suicide Risk: A meta-analysis of 27 trials found no increase in suicide-related events from GLP-1s. Score one for safety.
- T1 Diabetics Taking GLP-1s: A growing number of Type 1 diabetics are trying these meds for weight loss, but risks of hypoglycemia mean it’s not one-size-fits-all.
My Week on Mounjaro
A quiet week. Jenny was in Chicago for her dad’s 87th, so no Thursday cheat lunch. Between back and neck pain, I barely got to the gym—just a light session Tuesday and leg day Thursday. I redeemed myself Friday with a 6.2-mile (10 km) hike in the 90-degree Florida swamp oven. Summer’s here, and it’s not playing nice.
I’ve ramped up calories lately to support muscle gain—yes, even at 78, I’m still trying to stave off sarcopenia. If I gain a pound or two, I’m hoping it’s biceps, not belly. My sketchy Chinese body comp scale may not be gospel, but I’m watching for trends. This week, though, if it isn’t lying, I paradoxically lost weight.
The Mounjaro Numbers, Man!
I’m still at 7.5 mg per week and hoping to avoid going higher. This week, I somehow dropped four pounds (1.8 kg)—go figure—weighing in at a pseudo-svelte 182 lbs (82.6 kg). My fasting glucose averaged 102 mg/dL (5.67 mmol/L)—up slightly, while my flaky Dexcom Stelo CGM claims my weekly average was 90 mg/dL, which I view as fiction. Still, it’s great for tracking food responses and trends.
I Experimented with Sweeteners So You Needn’t Do So
Bonus experiment this week: I tested allulose and monk fruit/erythritol on an empty stomach to see if either spiked my glucose. Nada. Flatline. However, they did move the needle in the digestive department—if you catch my drift. Better than Miralax. You’re welcome.
So, now, that paradoxical weight loss might have a viable explanation, as it were.
Until next week—stay strong, stay salty, and don’t let Big Pharma or Big Government pick your pocket.
Until next week, stay healthy!
For an annotated catalog of all my Mounjaro updates, please visit my Mounjaro Update Catalog page.
