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Your Checkup: Health Education Podcast
Ever leave the doctor’s office more confused than when you walked in? Your Checkup: Health Conversations for Motivated Patients is your health ally in a world full of fast appointments and even faster Google searches. Each week, a board certified family medicine physician and a pediatric nurse sit down to answer the questions your doctor didn’t have time to.
From understanding diabetes and depression to navigating obesity, high blood pressure, and everyday wellness—we make complex health topics simple, human, and actually useful. Whether you’re managing a condition, supporting a loved one, or just curious about your body, this podcast helps you get smart about your health without needing a medical degree.
Because better understanding leads to better care—and you deserve both.
Your Checkup: Health Education Podcast
87: GLP-1 Price Cuts: Will It Improve Access?
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We unpack new GLP-1 pricing, coverage hurdles, and whether cash-pay programs make these meds more reachable for diabetes, obesity, and sleep apnea care. Along the way we share candid pros and cons of injections, tease future oral options, and weigh real tradeoffs.
• current cash-pay pricing from major manufacturers
• differences between Wegovy, Ozempic, and Zepbound
• tighter insurance coverage and prior authorization burden
• fears about injections and route-of-administration bias
• potential oral GLP-1 timelines and cost impact
• framing obesity as a chronic, treatable disease
• practical tips to explore HSA or FSA options
• how to decide if the monthly cost is worth it
Production and Content: Edward Delesky, MD & Nicole Aruffo, RN
Artwork: Olivia Pawlowski
Hi, welcome to your checkup. We are the patient education podcast, where we bring conversations from the doctor's office to your ears. On this podcast, we try to bring medicine closer to its patients. I'm Ed Delesky, a family medicine doctor in the Philadelphia area. And I'm Nicola Rufo. I'm a nurse. And we are so excited you were able to join us here again today. I have it on good authority after our last week's What are you gonna say? That the Michelin stars, the Michelin people, is the same as the tire selling company. Good authority.
SPEAKER_00:Who told you that? Mike from his basement?
SPEAKER_01:Yes. Exactly him. He sent me a picture and all. And it's probably not doctored. And that Michelin guy, you know, the guy with the white rolls. Yeah, he's up there. He's on that stage.
SPEAKER_00:Oh, really? Yeah. That's cool. Yep. Well, Mike is good with RD, so.
SPEAKER_01:I told you. Well, he said that and he's like, I have an idea how the uh December.
SPEAKER_00:Is this what you were gonna light me up about on the podcast?
SPEAKER_01:Yeah, that's about it. The Michelin is like too big of a it's so niche of a name that like it can't possibly be like used there's Michelin tires and separately Michelin stars.
SPEAKER_00:How did the tire people like get into raiding restaurant business? Um I uh what else are they up to?
SPEAKER_01:Oh, that I don't that I don't know.
SPEAKER_00:Now we're you are like the Michelin family. Do you know?
SPEAKER_01:Well is there no I I didn't come that prepared.
SPEAKER_00:Like heirs to the Michelin throne.
SPEAKER_01:We're not gonna talk you know, Michelin people, but we're gonna talk about it.
SPEAKER_00:I'll do some research. It'll be part of Nikki's Corner next week.
SPEAKER_01:Yes, yeah. Please do. Um catch us up for Nikki's Corner, which you can look forward to next week.
SPEAKER_00:Um there was only like one little thing I wanted to talk about.
SPEAKER_01:Yeah, no, I think you know, it can't be every week because then it's not special.
SPEAKER_00:No like breaking news of the world, except that everyone's mad that Robert Irwin won Dancing with the Stars and not Alex Earl, but people think that it's rigged because um Bindi won like 10 years ago, which I didn't realize there was I don't know what that age gap is between the two of them. Hmm. Anyway, yeah, people are mad about it, and I can't stop watching Alex Earl's like finale dance. It was so good, don't you think?
SPEAKER_01:I do.
SPEAKER_00:Uh I think we watched both of them and Alex was better.
SPEAKER_01:Yeah, uh her is the star.
SPEAKER_00:Crawl slide thing.
SPEAKER_01:That was funny. Yeah, that was great. Yeah, I gotta try that. But uh the you know, like both dancers were great, but she looked like she was doing more of the work.
SPEAKER_00:And then when he came to watch- I mean, the girl is always doing more of the work, and then the guy is just like they're supporting.
SPEAKER_01:Like when he was doing his, like she was doing all the stuff, and he's the one.
SPEAKER_00:Well, that's why it's also like not fair because the professional dancer in that duo was the girl who's always doing more work, and then the professional dancer in the Alex Val duo was the man who just like inherently does less work. Right.
SPEAKER_01:Yeah, I don't know. It looked like she had the better performance. Yeah, maybe there's like there's something technical.
SPEAKER_00:She's the people's mirror ball winner, that's what everyone is saying.
SPEAKER_01:Is that the award? Mirror ball. Yeah. This has been on for a while.
SPEAKER_00:I know, I never actually watched it. Like, I feel like I watched this season just via TikTok. Like, I've seen all the dances, I feel like, but I never actually sat down to watch the show.
SPEAKER_01:I mean, like, I pulled it up for us to take a look at, and then then I was like, I mean, there's like 23 seasons, like it's a big commitment.
SPEAKER_00:That's maybe next season we'll depending who's on it. They had a lot of good people this season.
SPEAKER_01:They did. It was very like uh let's see, cohesive with our content plate, if you will.
SPEAKER_00:Yeah.
SPEAKER_01:So it made a lot of sense. Um yeah, shout out to Steve Irwin. I think he died, right? He died from touching a stingray. Is that the thing? Yeah, that's tragic. Yeah. Do what you love until it kills you. That's damn. If I say damn, is it gonna put us as an explicit podcast on Apple Podcasts again? That that was that was crazy. Um, well, that, you know, to each their own. Thank you for sharing. Um, Christmas gifts. You know, it's tricky to decide what someone gets. Um, you know, some people say like you should write out what you want, like you should put your what you want on a list to let people know. But it hasn't always been like that. Um, you know, what did Jesus do?
SPEAKER_00:Oh my god. I was like, where is he going with this? Did Jesus ask for for all that? Okay. So what happened was we were at Thanksgiving, had a great Thanksgiving, and we're all talking about like Christmas and Christmas gifts and da-da-da. And my one brother, for some reason, is just like a weirdo about receiving gifts. And he hasn't like let anyone know anything that well, he actually has, he added to the list. But on Thanksgiving, he was like, I don't know, I don't need anything, whatever, like I don't want anything. Or did he say I don't need anything or I don't want anything? Whichever one he said.
SPEAKER_01:He said, I don't need anything. Because then we were like, no, you you're allowed to want things.
SPEAKER_00:Yeah, and we're like, Well, what do you want? He's like, Well, nothing, I don't really want anything. And then I was like, Do you think baby Jesus wanted gold frankincense and myrrh? No, but he got it. And he was dying laughing. It's like the funniest thing. Probably had to be there. I think it probably had to be there.
SPEAKER_01:I, you know, we um the greatest, I'll put it this way, the greatest compliment either one of us could receive is that we're funny. Um, I think that's one thing we always at the risk of our like, you know, professionalism, always chase.
SPEAKER_00:And yeah, so always strive to be the personality higher.
SPEAKER_01:Yeah. So at whatever, at what at what whatever it costs. And we um we do this at home. Like we go back and forth. And like I objectively think we like serve each other great material all the time. But you know, when you live with someone, it's like and you're laying there and you're like, whip out a good one, and maybe like you don't laugh the way I hope you laugh. And I'm like, you know what? If this was a set of people who didn't know us, this would have killed.
SPEAKER_00:Yeah. I know, or sometimes I'll say something and I'll be like, that was funny. Why aren't you laughing?
SPEAKER_01:I know. And I'm like, objectively, it was hilarious. And I it doesn't, it's not fair. It's not fair, is what it is. Um got a house of comedians over here. We'd like to think so. I'm not sure if that's the case. Um, you tell us if you're listening. But yeah, gold, frankincense, and myrrh. We know what gold is, but I don't know what frankincense or myrrh are.
SPEAKER_00:Myrrh.
SPEAKER_01:Myrrh. Frankincense. So hit us up. Um, you can send us an email or send us some fan mail. It's in the show notes how to access that if you um have a burning understanding of what frankincense and myrrh are. Because we already understand what gold is. Um, we watched a good show this week.
SPEAKER_00:Oh, yeah. This was a good one. We did it. It's on Peacock and it's called All Her Fault. Dakota Fannings in it. It was so good.
SPEAKER_01:And Shivroy. Uh she has a name, but Shivroy from um the business like show.
SPEAKER_00:Huh? Uh the business like succession.
SPEAKER_01:Yeah. Oh like I didn't watch it. She hasn't she has a name. I'm I'm being bad right now. But that's a bit of a. Yeah, the mom. Oh. The redhead mom. Marissa. Marissa, correct. Marr.
SPEAKER_00:Marr.
SPEAKER_01:Um, and then that other guy who's like in a lot of things now.
SPEAKER_00:Yeah, with the chin. Yeah, if he He was in White the first season of White Lotus, he was like the kind of like annoying husband.
SPEAKER_01:He seems to be typecast in that role. If there was a fairly odd parents remake, he could definitely be the Crimson Chin.
SPEAKER_00:Oh my god.
SPEAKER_01:Uh no, this was good.
SPEAKER_00:Um Yeah, it's about a boy who goes missing, and then like within the first like two minutes of the show, and then everything that happens after, and there's like a twist, and then you think that that's the twist, and then there's another twist, and then there's another twist on that twist.
SPEAKER_01:Yeah.
SPEAKER_00:It's crazy. It was so good.
SPEAKER_01:It was entertaining.
SPEAKER_00:Even up until like the very end, and then that like final scene with the detective and the mom.
SPEAKER_01:Right. And it was good. And there was like uh it was a lot too.
SPEAKER_00:Like we it was like eight or nine episodes, and they were all like 45-ish minutes.
SPEAKER_01:Maybe even a little longer. It was good. I kept I was entertained and it kept me coming back for more. Yeah. And then we get into a lull, and I'm like, oh, like, you know, where are we gonna find the next thing? Like, are we?
SPEAKER_00:What's that other one on Netflix I want to watch?
SPEAKER_01:Oh, you mentioned this. Yeah. Tonight we're gonna watch a Christmas movie, though.
SPEAKER_00:We're having Crab Capitelli.
SPEAKER_01:I feel like a la Eddie. We record this Crab Cabotelli.
SPEAKER_00:Even though we probably should have just had like salad tonight, it's okay. We had Thanksgiving, then we went to dinner on Saturday.
unknown:I know, yeah.
SPEAKER_00:Lots of leftovers. It's okay. We didn't really eat today, I feel like.
SPEAKER_01:So no, we were skinny legends. We um spasos in media. It was good.
SPEAKER_00:Yeah.
SPEAKER_01:Shocked that you could walk into a restaurant after living in center city for so long. You just say, Hey, do you have a table? And they say, Yes. Like this way. Follow me. I'm like, oh my God. Wow. It was good. Um I got essentially what felt like a bolognaise, which was good, but you had a very unique dish, this like brown, brown sugar sage.
SPEAKER_00:Yeah, it was barata stuffed tortellone in like a brown butter sage sauce thing situation. Yeah. It was delicious.
SPEAKER_01:It was good. It was great. And the muscles were also delicious. They like the actual muscle itself was meaty. It was good, but it made me very proud of the muscles I make.
SPEAKER_00:Yeah, your your muscles are better.
SPEAKER_01:Yeah, like if you could give if I could get those muscles, like the actual muscle, but like the gravy and the sauce, yeah. It was cool. I'm like, wow, I feel good about this. And they had a nice, and now this is gonna trigger me to make mushroom soup at some point soon. Um, a nice mushroom soup.
SPEAKER_00:Yeah.
SPEAKER_01:So I'm looking forward to making some of that soon. Maybe not immediately, but that is on the list. So that was the show we watched. And then there's a piece of technology that I don't understand. Grocery shopping today. Um, occasionally we go to Sam's Club.
SPEAKER_00:Oh, yeah.
SPEAKER_01:And we do the scan and go. And so all the items in your cart are accounted for. You pay for it on the app. In the old Sam's Club, they used to have these people who would stand by the exit and they would have their scanner. Nice people. They say, Hey, how you doing? I got scan three items. They beep, beep, beep. Okay, see you later. But then they installed pretty ubiquitously in all of the Sam's clubs. It's like the stat at the beach, too. They've got these like archways, and I think they have a bunch of cameras, and you walk through the archway, and it seems like something gets sent to their device, and you hear a beep, and then they look at you and say, See you later. And I don't understand how it works. Items are stacked on top of each other in your cart, and it doesn't make sense to me how they're able to just say, Yeah, you're good.
SPEAKER_00:I know. I can't wrap my head around it.
SPEAKER_01:Things are underneath behind things. I can't take a picture of all of it, so that makes me wonder. I don't know how that technology works. Well, there was that. Um, any other thoughts on that? I have one more thing I want to mention. So we went to this place called Cypress Coffee, which was great. Um, yeah, it was really good.
SPEAKER_00:That was really good.
SPEAKER_01:Very new. Um, gonna try to put a it was it was just really great. We walked in there. There was one person working behind. She said she runs the place. I asked, like, if is this your like place, and she said she runs it. So I don't know what I guess maybe, yeah. Um, and she like makes all of the she called it cream. Um it was delicious. We had like a cold Vietnamese latte, I guess.
SPEAKER_00:Yeah, Vietnamese coffee is good. I feel like I think I've only ever had it like once. Yeah, I think there's condensed milk in it. I think that's the like whole thing with that, huh?
SPEAKER_01:And then a CG signature, which it wasn't too sweet, but it was like creamy and savory, and it was delicious. And I thought it was good, brand new, you know, you gotta support your places, so that was nice. But there's like a bunch of coffee places in the area now. There's like good karma, there's habitat house, that's what it's called. But yeah, all really cool stuff. Um, but that new place was awesome. So I just wanted to say that out loud, because you know, what if someone goes and tries it now?
SPEAKER_00:Yeah, I would go back.
SPEAKER_01:I would definitely go back. And we told her we were, so we can't not show up again. Okay, what do you think? Any other burning thoughts or desires?
SPEAKER_00:Nope.
SPEAKER_01:All right, Nikki, why don't we dive in and give the people what they came here for? Unless they came here for the banter, anyway. So, what are we gonna talk about today, Nick?
SPEAKER_00:Today we're talking about price changes on GLP ones and what's going on.
SPEAKER_01:Yeah, these um, these are slippery meds to get um get a hold of, so it would seem. Um, it seems like they're really well covered for diabetes in a lot of circumstances. Um, not particularly if you're it's a little tricky if you're a Medicare patient, but you know, when there's a lot of trouble getting access to them because they are so effective at what they do, treating diabetes, treating sleep apnea, treating obesity, and a lot of other things that they've become to be understood that they help with, access is kind of tough. And insurance companies are kind of tightening their grip when it comes to coverage of these meds because as it currently stands, they're expensive and they're expensive to make, they're expensive to purchase. So we'd had a previous episode where we talked about like compounding pharmacies and how they're not like super, they're not good. You should you should probably avoid them if you can. Um, you know, everyone is an adult and can make their own choices about their body. But this led to the rise of Novo Nordisk and Eli Lilly, the two companies that make Wagovi and Zeppound, the two GLP1 receptor agonists plus. Um they led to direct to consumer pricing. So, well, so in November 2025, Novo Nordisk, the company that makes Wagovy and Ozempic, changed prices from$4.99 a month to$349 a month for existing cash pay customers. And they also offered a temporary introductory rate of$199 a month for new cash customers in the first two months. So uh these cash pay offers are available for Wagovia Nozempic on their websites, as well as other platforms, which this is kind of interesting, like Costco, Good RX, Weight Watchers, and several other telehealth providers that you see advertised on TV. And these groups all work directly with Novo Nordisk. So this is all in the back of Eli Lilly dropping their prices. They dropped the price of ZEPBound to$350 per month and made a promise. Now I don't have to do any of this, I guess, but they made a promise that in the course of the next two years, they would drop the price to$245 per month. This is also recognizing that ZEPBound is more effective at weight loss than and other treatments than Wagovi and his fewer side effects. So these price cuts come at a period where insurance coverage is becoming increasingly restrictive. They are tightening the grip. Uh, it is challenging to get these things covered. Um, you need staffs of people to be able to process the paperwork that goes along with these medicines by way of something called a prior authorization. And the costs of even paying for them is becoming increasingly high, um, including the out-of-pocket costs. Coverage also varies by plan, like whether they do or don't cover them for people with diabetes, or especially those who just are trying to treat obesity. And so all of this offers a does this finally move the needle on GLP1 receptor agonists being more accessible and cost-friendly. Um these medicines have become so incredibly important. And when you look at someone who has just metabolic disease, like diabetes, hypertension, hyperlipidemia or high cholesterol, or metabolic disease of the liver, we're finding like everything kind of can narrow down. Like, yes, your lifestyle changes are extremely important. They're the first things you should do, but for people where that doesn't work, these medicines have been life-changing and completely practice changing. So I think it's a move in the right direction, but I don't know if it's it solves every problem. Because what$350 a month? I mean, that's still a lot of money, I feel like it's a lot of money,$350 a month for Wagovy itself, which you know, I think they hang their hat on it. And I I do not think that Zet Bound has that at this point. So I think that's why they contend with it and they can like offer the same price. But$350 a month is a lot of money for an out-of-pocket cost for a medicine, um, especially for the average person. Now, I don't perhaps you couldn't I agreed if you couldn't hear his woof in the background. Part of me wonders, are you able to use a flexible spending account or a health savings account to use pre-tax dollars to help pay for this? Um, I don't know. I you know, it's something you can explore on their websites, but we just thought that this was interesting news to share because I think things like this are going to be happening. Um, while the health conversations around this administration have been um disappointing to say the least, I think recently there were discussions with this administration that there would be more Medicare coverage for GLP1 receptor agonists because it's a huge population of people where there is just a stark drop-off of coverage for these medicines that are chronic. Chronic in the way that like if you were taking their blood pressure for high blood pressure, you would take that for as long as you needed to. You would take this as long as you need to. So is there a price you think that it would become like actually reasonable for cash pay for people?
SPEAKER_00:I mean, I think that's all like relative.
SPEAKER_01:Yeah. That's a good point.
SPEAKER_00:I think me personally, I feel like it feels like a hundred bucks a month.
SPEAKER_01:Yeah. A hundred feels way better. There's um I think part of the cost is the pens, like actually producing the auto-injector pen itself costs a lot of money. And there they are coming out with more oral ones, and they are re-examining oral options at higher doses for varied purposes and effectiveness. So specifically, Eli Lilly has one coming out that is oral, um, that is in the late stages of clinical trials and may hit prime time in early 2026 at some point. So when that final data comes out, we'll talk about that more so that people are aware of it. But if you didn't know there were these price cuts, yeah, a hundred it might be wishful thinking. I feel like they might, I mean, they've even said like they would get down to 245. That's a big commitment every month, though. Especially when you got a lot of other things going on.
SPEAKER_00:Yeah.
SPEAKER_01:On the other hand, it does it can truncate all of the other options. Like if you're on a medicine for your diabetes, if you're on two to three separate medicines for your blood pressure, you have your CPAP machine, and like you can just theoretically, if you take this and it's as effective as it needs to be for you, can you get off all those other ones? I've seen it plenty of times. So then you have to weigh, right? I guess like you have to weigh is this once weekly medicine that costs X amount of dollars worth it for me.
SPEAKER_00:Or you're taking like four other meds every single day. Sleeping with a CPAP every night. Right. That's what I like. I don't know. It's like so annoying when people are like you're already on like maybe a handful of meds for whatever like chronic condition that's like probably directly related to your weight. And then they're like, Oh well, I don't want to take anything forever. If I stop, if they stop taking that, they're gonna gain weight. Like, yeah, if you stop taking your blood pressure medicine, your blood pressure's gonna be high.
SPEAKER_01:I know.
SPEAKER_00:If you like are uh you have diabetes and you take insulin for that, if you don't take that, worse things are gonna happen. I know. I know, and then like doing something once a week, and I think people are really turned off that it's an injection.
SPEAKER_01:Me too.
SPEAKER_00:And aside from it, like if you're like scared of needles or whatever, like regarding the actual needle, I think people think because it's an injection, it's like I don't know, like more like aggressive. I guess.
SPEAKER_01:I think so.
SPEAKER_00:And like you're still like putting the medication into your body, regardless of how it gets there. Like I know that there are different things that you know happen after and how it's like sure absorbed and blah blah blah, but like you know what I mean?
SPEAKER_01:When push comes to shove, like you're still taking medicine.
SPEAKER_00:Like, what would make an oral better than a than an injection?
SPEAKER_01:I think it's just because it's more commonplace. It's just what people are used to.
SPEAKER_00:Yeah.
SPEAKER_01:And I think that's it. I I've seen a healthy number of people with the fear of needles or just like conceptualizing that exact thing that you just described there. And it's a little bit of a sticking point, and some people are totally freaked out by it. Um, some people who would like really benefit from taking this, and I'm like, please reconsider and like give it an open mind and at least try it. And if you don't like it, stop.
SPEAKER_00:But like Yeah, you can always stop.
SPEAKER_01:Yes, that's a good point.
SPEAKER_00:And it's like not one of the meds where like you really can't stop cold turkey and you have to like kind of like titrate it down, you know. Like, if you don't like it, you just don't take it that week, and you just don't.
SPEAKER_01:Yeah. That's a I think that's an important thing that like people also should recognize is that like it is your body, and you should always let your whoever's taking care of you know that you're thinking about making these decisions, but like at the end of the day, it's you and you get the chance to do this. So, like I oftentimes I just like people to know their options when it comes to things and like when it comes to treatment options for any various thing. But I know there I think it's because back to your point about why people get so bent out of shape, it's because they people don't think of obesity as a chronic disease, and it is. That's one piece of this. And I think it's because it's not invisible. Like so many of the things that we talk about here and that I talk about every day are invisible risks. And someone who has a certain body size that's like increased or larger than an average person, it's a lot more visible, and they may or may not have metabolic disease that is invisible, but I guess maybe that's why, and this is like all on the back of like so much of our culture about size and what's valued and how it's viewed, which is just problematic in general. But maybe because it's not invisible, diabetes invisible, hypertension invisible. These are like abstract concepts all in an effort really to like get someone to pay more attention to their health and like make healthy choices more often than unhealthy choices. And I don't know. I think these these medicines in particular offer a lot for us to think about as like where we value what are we actually treating when we're looking at stuff. I don't know. And like I think studying for the obesity medicine boards like was really enlightening about like what are we actually doing here when we're taking care of all these things? When like if someone loses weight, all of these other things very often fall in line.
SPEAKER_00:Yeah, what do you mean? It's doing a lot.
SPEAKER_01:No, I know, but like before this, like we didn't there were no there was bariatric surgery.
SPEAKER_00:Yeah.
SPEAKER_01:And like someone could have a BMI of 45 and snoring at night, stopping breathing, and like they're getting their blood pressure meds, which they need to keep them safe. But the real underlying thing is the class three obesity. I don't know. I just think this stuff is so important. That's why I'm like getting an extra specialty in it. Well, hopefully this was fruitful. Um, did you have any other thoughts?
SPEAKER_00:Nope.
SPEAKER_01:Um, so anyway, thank you for coming back to another episode of your checkup. Hopefully, you were able to learn something for yourself, a loved one, or a neighbor. You can find us on our website where we have our whole collection of episodes. Um, you can find some that are relevant to you. You can check out our women's health collection about menopause, osteoporosis, breast cancer screening, PCOS, and more. You can find our pediatric collection and several others about hypertension, diabetes. You can share with a loved one or a neighbor. But most importantly, stay healthy, my friends. Until next time, I'm Matt Doleski.
SPEAKER_00:I'm Nicolas.
SPEAKER_01:Thank you, and goodbye.
SPEAKER_00:Bye.
SPEAKER_01:This information may provide a brief overview of diagnosis, treatment, and medications. It's not exhaustive and is a tool to help you understand potential options about your health. It doesn't cover all details about conditions, treatments, or medications for a specific person. This is not medical advice or an attempt to substitute medical advice. You should contact a healthcare provider for personalized guidance based on your unique circumstances. We explicitly disclaim any liability relating to the information given or its use. This content doesn't endorse any treatments or medications for a specific patient. Always talk to your healthcare provider for a complete information tailored to you. In short, I'm not your doctor. I am not your nurse. And make sure you go get your own checkup with your own personal doctor.
