On The Pen GLP-1 News

This week on On The Pen, The Weekly Dose Podcast, retatrutide heads into a major federal court fight as the Department of Justice gives FDA fresh legal ammunition just days before oral argument.
At the same time, FDA is escalating its scrutiny of mass GLP-1 compounding, with a warning letter to Empower Pharmacy that could have major implications for semaglutide, tirzepatide, telehealth prescribing, and patient access.
We also break down Viking Therapeutics’ new VK2735 maintenance data, including early weight-loss numbers that are starting to draw retatrutide comparisons and the possibility of every-other-week or even monthly maintenance dosing.
Plus, Roche’s enicepatide, formerly CT-388, just posted a 2.65 percentage-point A1C reduction and 15.5% weight loss in people with type 2 diabetes and obesity, raising new questions about how competitive the next generation of GLP-1/GIP drugs may become.
This episode is about more than one drug. It is about where obesity medicine is heading, who gets access, how regulators are drawing the lines, and why the next few years may look very different from the market we know today.

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Lilly just gave us a glimpse of what could come after today’s GLP-1s, and it may not be about simply pushing patients to stronger drugs and higher doses.

This week on On The Pen: The Weekly Dose, we break down Lilly’s surprising early data combining just 5 mg of tirzepatide with 3 mg of eloralintide, producing roughly 17% weight loss in only 16 weeks. Could combinations like this eventually approach retatrutide-level efficacy with better tolerability? And when retatrutide reaches the real world, how many patients will actually need or tolerate the higher doses responsible for its biggest clinical-trial numbers?

We’re also digging into the bigger stories shaping the future of obesity medicine, including new research suggesting semaglutide may influence aging beyond calorie restriction in mice, the emerging race to preserve lean mass during GLP-1 weight loss, apitegromab’s eye-popping price, Lilly’s legal battle over retatrutide’s classification, the underground market already selling unapproved Reta, and the latest development in Lilly’s lawsuit against Mochi.

The science is getting better incredibly quickly. The bigger question may be whether we can deliver enough efficacy, tolerability and muscle preservation at a price patients can actually access.

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Is obesity still a disease worthy of treatment when the patient is six years old?

This week, Novo Nordisk released Phase 3 STEP Young data in children ages 6 to 11 with obesity. After 68 weeks, 40.4% of children treated with semaglutide moved below the obesity threshold, compared with 0% on placebo. More than 85% of the children entered the trial with class II or class III severe obesity, and both groups received lifestyle intervention.

That raises a harder question than whether people are comfortable with kids taking GLP-1s: compared with what? A nearly 90% chance that obesity present at age 3 persists into the teen years? An approximately 80% chance that a teen with obesity carries it into adulthood? Another decade of stigma, bullying, and metabolic disease while we keep telling families to try harder?

I’m unapologetically supportive of studying and treating severe childhood obesity. That does not mean ignoring long-term questions around growth, puberty, nutrition, lean mass, or what happens when treatment stops. It means recognizing that withholding treatment is also a decision with consequences.

We also break down the new Structure Therapeutics data, including aleniglipron, an oral small-molecule GLP-1 that produced up to 16.2% mean weight loss at 72 weeks, and ACCG-2671, an experimental oral amylin/calcitonin agonist that produced 3.3% mean weight loss after a single dose, with some important tolerability caveats.

Plus, we look at a preliminary semaglutide signal involving asthma and COPD, and one of the strangest Ozempic access stories of the week.

Recorded from the Bask Health Studios.

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This week on On The Pen, the GLP-1 story is moving in two very different directions.
The Fifth Circuit handed FDA major wins in the fight over semaglutide and tirzepatide shortages, FDA updated its consumer guidance around compounded GLP-1 medications and multi-dose vials, and employers continue questioning whether they can afford obesity-drug coverage.
At the same time, the medical case for these medications keeps getting stronger.
We break down Mounjaro’s new cardiovascular indication and what preventing heart attacks and strokes could mean for the true long-term cost of GLP-1 treatment. We also look at 600,000 Medicare beneficiaries already enrolling in the $50 GLP-1 Bridge program, California’s effort to tackle affordability, the rapidly expanding oral GLP-1 market, and new real-world data on patients staying at lower doses of semaglutide and tirzepatide.
The science is expanding. Access is contracting.
And that may be the biggest challenge facing the next phase of the GLP-1 revolution.
In this episode:
• What the Fifth Circuit compounding decisions actually mean
• FDA’s updated language around compounded GLP-1 vials
• The 28-day multi-dose vial controversy
• Mounjaro’s new cardiovascular indication
• Why GLP-1s may reduce long-term healthcare costs
• Employers dropping obesity-drug coverage
• 600,000 people joining the Medicare GLP-1 Bridge
• California’s push for lower GLP-1 prices
• The oral GLP-1 race
• New data on lower-dose semaglutide and tirzepatide
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This content is for informational and educational purposes only and is not medical advice. Always discuss medication and treatment decisions with a qualified healthcare professional.

GLP-1 access is getting tighter just as obesity treatment is becoming more effective, more affordable, and more important to public health.
In this episode of the On The Pen Podcast, Dave Knapp breaks down two of the biggest GLP-1 stories of the week: why most states are opting out of the Trump administration’s new Medicaid obesity-drug coverage model, and why employers are preparing to cut GLP-1 coverage in 2027.
We also dig into the growing conversation around GLP-1 microdosing after Real Housewives of Orange County star Emily Simpson described using a lower-frequency maintenance strategy after losing around 50 pounds. Could lower-dose or intermittent GLP-1 therapy eventually become a legitimate maintenance tool? Could it help lower long-term healthcare costs? And could earlier, lower-intensity treatment eventually become a form of prophylaxis against obesity-related disease?
This episode covers Medicaid GLP-1 coverage, the BALANCE model, Zepbound coverage, Wegovy coverage, employer insurance changes, compounded GLP-1 access, GLP-1 microdosing, obesity maintenance, semaglutide, tirzepatide, metabolic disease prevention, obesity medicine, healthcare costs, and the future of GLP-1 treatment.
If you take Ozempic, Wegovy, Mounjaro, Zepbound, compounded semaglutide, compounded tirzepatide, or simply follow the rapidly changing world of obesity medicine, this is a conversation you need to hear.
Subscribe to On The Pen for breaking GLP-1 news, obesity medicine updates, access and insurance coverage news, new weight-loss drugs, clinical research, and patient advocacy.
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