SELECT cost-effectiveness — looking for input

NurseAsh_DET said:

Denials are usually procedural rather than clinical, and the order that works reflects that.

This is exactly what I could not find anywhere else. Taking it to my next appointment.

Adding the clinical framing, because it changes how the question reads.

Continuous metabolic monitoring dashboard for cardiovascular risk — I track everything in a spreadsheet and here's the month-over-month trend for my key markers:

Weight: consistent downtrend, -2.1 lbs/week average
Fasting glucose (finger stick): stable at 86 mg/dL
Blood pressure (home): 116/72 average
Resting heart rate: 66 bpm (down from 82)
Waist circumference: down 16 inches total

The resting heart rate improvement correlates with cardiovascular fitness gains. Everything is moving in the right direction.

lisa_labSD said:

Cardiac biomarkers and cardiovascular risk: my cardiologist ordered advanced cardiac labs given my family history.

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.

Worth separating that from cost and coverage, which this thread keeps folding into the same question. They behave differently and the advice does not transfer.

claudia_zurich said:

SELECT is the trial that changed the framing of this class, because it was an outcome trial rather than a weight trial: about a 20% relative reduction…

Vitamin deficiency cascade with cardiovascular risk: after 6+ months of reduced food intake, I developed a subtle but important pattern: low B12 → elevated homocysteine → increased cardiovascular risk marker.

The connection: B12 is a cofactor for homocysteine metabolism. Without adequate B12, homocysteine accumulates. This is ironic — taking a CV-protective medication while developing a CV risk factor from reduced nutrition.

Solution: comprehensive vitamin supplementation and regular lab monitoring. Don't let the medication's benefits be undermined by nutritional deficiencies.

Moderator note: good thread. Keeping it here rather than moving it, because the question is general enough to be useful.