Has anyone dealt with select cost-effectiveness?

Dr.ObesityLA said:

I want to bring up the cardiovascular angle on cardiovascular risk.

Positive "side effect" of cardiovascular risk: my blood pressure dropped so much that I'm now off amlodipine entirely! My cardiologist is thrilled.

If you're on BP meds and losing weight on a GLP-1, monitor your BP at home regularly. Hypotension symptoms (dizziness, lightheadedness when standing) mean your BP meds may need reduction. Don't wait for your next scheduled appointment — call your doctor.

MounjBrad said:

Agreed, and coverage criteria are plan-specific rather than insurer-specific.

This answered a question I did not know how to ask. Adding it to my notes with a link back to this thread.

Dr.ObesityLA said:

I want to bring up the cardiovascular angle on cardiovascular risk.

This is where I part company with the consensus forming above. The affordability discussion here usually stops at individual tactics. At list price this class is out of reach for most of the people who would benefit, and no amount of appeal strategy changes that — it is a pricing problem wearing a paperwork costume.

hank_denver said:

My reason for being on this is cardiovascular rather than cosmetic, which puts me in a small minority in most of these threads.

Anti-inflammatory mechanisms of GLP-1 agonists and cardiovascular risk: beyond weight loss, GLP-1R activation directly suppresses NF-κB signaling, reduces NLRP3 inflammasome activation, and decreases monocyte/macrophage adhesion to endothelium[1].

Clinical correlates: hsCRP reduction of 30-60% (consistently seen across trials), reduced carotid intima-media thickness, and decreased coronary plaque inflammation on PET imaging.

These anti-inflammatory effects likely contribute to the cardiovascular benefit seen in SELECT — and may explain benefits beyond what weight loss alone would predict.

Moderator note: leaving this open. It is being argued well and the disagreement is the useful part. Report rather than reply if it drifts again.