Oral Wegovy: How to Take It, Who It's For, and What It Costs with Joseph Zucchi, PA

We finally have the first-ever FDA-approved oral GLP-1 for treating obesity, and it's a much bigger deal than the headlines suggest…

In this episode, I'm joined by Joseph Zucchi, PA, a clinical supervisor at a weight management clinic who lives and breathes the data behind obesity care. We break down oral Wegovy in practical terms: the real weight loss data, how it compares with weekly injections, why it’s different from Rybelsus, and who it’s best suited for. We also cover cost, insurance disruptions, and what to realistically expect if you’re considering a switch.

If you’re trying to make sense of your options in a fast-changing landscape, whether due to coverage changes, injection concerns, or simple confusion — this conversation helps break it all down using real data.

References

Connect with Joseph Zucchi, PA

Transition Medic Medical Weight Loss

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Audio Stamps

01:42 – Meet Joseph Zucchi, PA, clinical supervisor at a comprehensive weight management clinic with an on-site food store.

04:35 – What is oral Wegovy and how does it compare to injectable semaglutide in terms of efficacy and weight loss?

07:21 – The reformulation that makes oral Wegovy different from Rybelsus and why absorption matters.

10:22 – How to take oral Wegovy correctly: timing, dosing instructions, and common mistakes to avoid.

12:02 – Who should consider oral Wegovy and who might be better off sticking with injections?

13:45 – Side effects, dosing transitions, and what to expect when switching from injectable to oral.

22:03 – The importance of specialized care: why working with a weight management expert improves outcomes.

24:00 – Pricing, insurance coverage challenges, and accessibility of oral Wegovy in 2026.

All of the information on this podcast is for general informational purposes only. Please talk to your physician and medical team about what is right for you. No medical advice is being on this podcast.

If you live in Indiana or Illinois and want to work with doctor Matthea Rentea, you can find out more on www.RenteaClinic.com

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Transcript

0:28

welcome back to another episode of the podcast. Today I'm joined by Joseph Zuki. He's a physician, assistant and personal trainer, and he's a clinical supervisor of a weight management clinic who lives and breathes the data behind obesity care. And we're gonna dive in today talking about oral wegovy. What the numbers actually show, how it compares to injectables what clinicians and patients should realistically expect. This is something that is newer, we have not had this formulation before. That's one of the things we're gonna talk about.'cause I too was under the assumption that it was just rybelsus, higher dose. But that's not correct. And I wanna just read here an email that I got real quick, how I even, came to that. We need to talk about this more. So someone wrote in, hello. I've been on Zep bound for about 16 months and I've lost 55 pounds. I have about 10 more to go. I was recently informed by my insurance that they'll no longer cover it. It's like, I think we hear this all day long. Yes, we do. Um, uh, I really can't afford the four 50 cash pay option right now for anyone that's listening. This is in the US unfortunately. I know we have a very international. Audience that listens. I'm trying not to panic, but I don't know what I should do. What advice would you have? I know that there are so many people in the exact same boat right now, but a few experts are talking about it. I can't afford two 50 a month. Thanks in advance. So Joe, can we start off with you just introducing yourself more?'cause I know we wanna know where you are and everything like that, and then we're gonna dig right in. Thank you for having me. It's an honor to be on here. Definitely a big fan of your podcast. Love any places where we can be a platform to share the news of obesity medicine in an evidence-based way. So thank you. Yeah. Just about myself, I've worked in obesity medicine my entire career. Like you said, prior to that I worked in personal training and even, prior to being a pa, even worked in clinical, weight loss centers as well,. Passionate about this field. Definitely love helping patients. It's rewarding, in my practice. I am the clinical supervisor at Transition Medical Weight Loss here in Salem, New Hampshire. We have a very comprehensive program. We have dieticians, social workers. We have a food store here. We have a lab on site. We have everything body composition analysis and weekly check-ins with patients. And we used to be a cash-based program, but now we take insurance too. So we've really evolved over the years and just tried to be as well-rounded as possible. Excited to be here. I'm so excited to have you here. Listen, I've never heard the food store part. Can you tell me more about that? How do you guys do that? Yeah, so when we first started it was a bit more like some of the other kind of places that had shakes and bars and some shelf stable meals and healthy snacks. But we really actually kind of wanted to really grow that and give it a place where patients could come and have structure and meals and portion control and healthy options that were, pre-planned for them. So it wasn't so overwhelming as they started to learn about nutrition and kind of start the journey. We actually. Grew our store from probably a hundred products to now 600 different foods. We have freezers and fridges. I partnered with a few local restaurants that make us fresh meals. They deliver weekly, so we actually have, breakfast, lunch, dinners, snacks and drinks amongst all different options from fresh to frozen to shelf stable. We have fiber supplements, protein shakes. We probably have 30 different flavors of protein shakes in the store. We really have just tried to grow it to be certainly as much varieties as we can. If patients want food to have them get started, we have it. If people don't want the food, that's okay. Maybe they'll pick up a few snacks if they need it. But just a place where people can feel comfortable getting started. That is so interesting. Thank you for sharing that. Mm-hmm. That sounds like a dream, because I know I talk about a lot on the podcast that weight care is something where it affects every single area of your life. And one of the big ones is nutrition. Yeah. And it's so hard to dig in or to find the right products. Like you sometimes, oh my gosh, you have to blow hundreds on just figuring out what protein powder, of course, tastes okay. And things like that. Yeah. So what a blessing for people that are around you to just be able to come to one place to get everything done. That must be amazing for your patients. Yeah, they really appreciate the, just the simplicity of being able to have a place. We have a team member that shops with them and really guides'em through the process and, we can manipulate their food week by week, adjust their macros, adjust their calories. We try to have all different options out there, so if somebody's more, active, we can cater to their higher calorie needs. Or if somebody, needs a bit more. Lower carb or whatever it may be. So we really do have a very structured program and it has been one of the things that makes us unique, compared to some of other weight loss centers. But, yeah, it's an honor to run a program that is so comprehensive like this. Yeah. Okay. I'm sorry that I went down that rabbit hole, but I know everyone's gonna be interested in hearing this'cause it's definitely inspirational. Alright, so let's dig in. First, can you tell me a little bit about oral wegovy. FDA indication here. What exactly is it, age group, how it fits in with current medications. Yeah, for sure. Yeah, this is exciting. Right? So this is our first ever FDA approved oral GLP one for the treatment of obesity. Like you said, this is not the first oral GLP one because Rybelsus was around since 2019 for diabetes. But now, this is gonna have new indication and hopefully more use for patients, especially now, like we'll talk about more efficacy, higher dosage, so forth. In terms of indication. Very similar to the Wegovy that we know as an injection form. The difference being here that this is a once a day tablet, but it is FDA approved at this time for adults only. So 18 and older. The pediatric indication of 12 and older that is on the Wegovy injection label is not yet on the tablets. And it does carry over, of course, the typical label for treatment of obesity or overweight with a comorbidity. And it also carries over the nice cardiovascular indication, which we know is excellent. We have that, 20% reduction in cardiovascular risk from heart attacks and strokes in patients with a previous history of cardiovascular disease. And so that was on the label for wegovy injections and also on the label for the pills. The one indication that does not carry over is the mash indication. Which is still only on the injection label, so I assume this will eventually catch up as well. It's probably just clearance and FDA stuff. What percentages of weight loss can people expect? Because historically when we had lower dosing, again, we'll get to the dosing part. The percentage wasn't that great, but can you tell us what people have lost on oral and then compare it to the subq that we have currently? Definitely. Yeah. So that's the exciting thing. And I think initially we were hearing news of this, coming out, we were thinking it's probably not gonna be as good as the injection. But the good news is it really is, the efficacy here is pretty much on par with the injection. In trials, there are two different estimates. You have a perfect scenario where people follow the medication, take it to the end, take it daily, and then there's an estimate that follows people whether or not they finished a trial or they didn't necessarily follow it as well. Sometimes we see different numbers, but if in the trial or the trial product s demand where people followed it truly, they had about 16.6% weight loss at the end of that trial, which is right off par with the injections. Right? Yeah. The injections were 16.9%, so very close there. And then in the other Es demand it was around 13.5% versus 14.9%. So again, very, very close. So we're looking at around, 14 to 16% on average weight loss, which is certainly, very efficacious for many patients. Yeah. Just a moment to wax poetic here. It's so incredible how quickly we're making progress, when you think about the percentages, like I remember even just, I don't know, 5, 6, 7 years ago, it's like we just had phentermine. We were trying to get to 5, 6, 7, 8, 10%, right? And now it's 16 plus percent. It's, it's amazing. I, I don't know, it's so amazing how rapidly this is all evolving. I share your excitement. It's so, so exciting. Can you tell me what the difference is compared to Oral Rybelsus and I'm just gonna see if people are listening and don't know. So that's oral semaglutide. Again, wegovy is also semaglutide, but can you tell me some of the dosage differences and also the formulation and why it's different? Yeah. This is where it gets into some new nuances. That's fascinating and people may be quick to overlook it. So Rybelsus, like we said, been around since 2019. Certainly, approved for type two diabetes. Not perhaps as popular as ozempic, but, an option for people that preferred not have an injection. If that medication in previous trials didn't show a ton of weight loss, and there's two things that have changed in the oral wegovy here. First, we have the higher dose, which we'll talk about, which is a big deal, but second is this reformulation and so rybelsus. Originally it was called R one, and that formulation had pretty poor bioavailability, 0.4 to 1%, and you're taking a pill that 99% of it isn't gonna actually get absorbed, right? Yeah. And so that version, certainly had efficacy and A1C reduction and so forth. It was available in three, seven and 14 milligram dosages. There is a new version of Rybelsus called R two that I believe in America isn't really available well, distributed yet, but in other countries it's starting to become the new standard, but the R two formulation has been, the actual tablet has been tweaked a little bit to have better absorption. Now slightly, now we're looking at one to 2% bioavailability. Basically double. So when this new bioavailability, in this new tablet form. We now have new dosages, so Rybelsus R two is 1.549. And so now we have see those numbers and we think it's weaker, but in reality it's actually, it's better absorbed. So It's better. Yeah. And so the oral wegovy is based on this Rybelsus R two tablet, so that's why the dosages are actually quite similar. 1.549, and now 25. And the 25 is the big deal because at that dose we're getting probably similar. Efficacy as the injection. It's just that we're taking this daily versus a weekly shot. Can you talk about how the formulation's different, what it does with the stomach acid? Yeah. What makes Oral Wig Ovy unique and why you wanna definitely make sure you're getting an FDA approved version of it is because this medication as a very complex manufacturing process. And so the tablet has something called snack, SNAC, and that ingredient actually. When it's absorbed in the stomach or when it's taken in by the, orally, it buffers the acidity of the stomach acid to allow transcutaneous absorption through the gastric lining here. And so it basically is allowing the medication to get absorbed through the wall of the stomach. And get into the bloodstream that way because otherwise it would just get degraded and broken down and, denatured as a peptide and so very unique molecule here. And as we'll talk about, requires specific dosing instructions to be taken first thing in the morning on an empty stomach for this absorption to happen properly. Yeah, I feel honestly probably it, I probably even said something wrong a few episodes ago in my podcast because I didn't know that the formulation was different. I understood if we can talk about. The smaller amount of liquid and all of that, but I didn't understand how it was interacting. Yeah. Can you explain how people need to take it? Time of day, volume, all of that, and why it matters? Yeah, of course. So yeah, this is gonna make a big difference for patients in terms of, probably efficacy. If we don't follow the instructions here, it may not get absorbed and we already are talking about one to 2% absorption in ideal circumstances, right? Every little detail counts. And so the label recommends, that patients take this once a day, first thing in the morning on an empty stomach. We wanna make sure that, they've been fasting for a while here, so hopefully eight hours at least, the stomach is empty. We wanna take this pill with no more than four ounces of water, which is very important. We don't wanna over dilute our stomach here'cause this needs to, make contact with the gastric lining. Patients once they consume that should wait at least half an hour before consuming any other pills, any other medications, any other liquids, any other food. And so if somebody's used to just having you know their pills in the morning with their morning coffee, this needs to be taken a little differently here. So put this by your bedside table. Take this when you wake up, get ready for the day, and then you can start your breakfast and your day and any other medications half an hour or so later. And so that's the specific criteria. In fact, in the bottle, in the label, it even says to make sure you store these pills in the original bottle that it comes with. Don't even put it in a separate container. These tablets are very sensitive. We just wanna make sure they're not getting exposed to moisture. Specific to follow the guidelines for sure. I think these little details that you're giving are so incredibly important because what I'm hearing with this medication, although it's amazing that we have an oral formulation, da da da, there are so many things that have to be looked out for that if you don't have someone educating you properly on it, it might quote unquote fail, but it's not for lack of the medication, it's because of education. Storing it wrong, taking it wrong, not being able to manage side effects, all that kind of stuff. I'm hoping that people are taking. Ver a lot of notes as they're listening, they're gonna go to this, Who do you think is a really good candidate for this? Yeah, great question. Yeah, I think a few different things. One is certainly people who are needle phobic and afraid of injections. This is finally an option. Now we can present to patients that has the efficacy and the great data. We know of GLP ones in pill form and hopefully this makes it more of a comforting way for them to consume the medication. I will say, if somebody is doing the injections and things are going well, don't be afraid to stay on the injections. Once a week injection for some people may be perfectly fine, and easier for them, especially if they, have trouble getting this first thing in the morning as a tablet. But I would say definitely people who prefer pills over injections. Great. Secondly, some patients have found the injections perhaps daunting or maybe a bit more, intensive therapy for them. Whether it truly is or not, they find that pills are more of an entry level and maybe a lower barrier to entry. And so hopefully the pills will feel more comfortable for them, whether for initiating their weight loss journey or also as a maintenance dose. Like we just said with your email, some patients have lost weight on several medications and now, due to costs, unfortunately they're looking for something more cost effective. And if this medication can help them to maintain their weight loss at a lower price, then that's a big deal. It's always frustrating for us as providers that we have to factor in pricing and deal with all the different insurances and the day-to-day changes that happen. We just want our patients to get the best therapy that's the best fit for them. But we do live in this world where our coverage is poor and pricing is high, and so hopefully as costs continue to come down, we can continue to make these more accessible. As a life changing treatment for patients. So I'm happy to see this is, technically the lowest cost GLP one available. So that's a step, which is still sad to say.'cause in the US right, the pricing starts at, I think 1 49 goes up to 2 99. So anyway, that's probably gonna change though. This is, January 26 when you're listening, everybody. Yep. What has occurred to me, I'm assuming that the dosing is more. Steady state for people when they're on the daily tablet because one of the things that my patients really struggle with the weekly injections is that oftentimes 1, 2, 3 days prior, they really start to get hungry again. Food noise kicks up. There is that sort of, if we take Zet bound like day three, it's at it peak, and so I'm wondering, did any of the studies comment on that or. Have data comparing that. It's a great question. Yeah. I'm constantly curious, just anecdotally, when we have patients on these medications, how they'll report the consistency of the appetite suppression throughout the week. I'm optimistic like you, that taking something daily is gonna lead to more consistent spurts throughout the week versus a higher dose that kind of is a little bit going down throughout the week, so it makes sense logically, but we'll see. The half-life is still the same as the injection. Semaglutide still seven days or so, half-life. But I did see the TM Max kind of the time to reach maximum absorption after taking the pill is about an hour. Hopefully patients are seeing, a difference quickly and then throughout the week it stays more steady as long as they're staying consistent with taking the tablet every day. Yeah. And yeah I'm curious about that. I'm also curious to see the side effect profile had similar nausea to the injections, but as many patients sometimes report. More nausea a day or two after the injection, and then less throughout the week. Yeah. How will the pills be? Will it be, a little less but more consistent? Hard to say exactly, because back in the day when we were using a lot of saxenda, which is a liraglutide, if anyone's listening, victosa, in the diabetes also in daily form. Yeah, exactly. When we were using that, I had some patients that every morning were feeling horrible. And so it didn't get better over time. This is gonna be so interesting to see how this plays out because I'm hoping that it's an improvement, right? Sure. What did the side effect profile the oral compared to previous subq? What's the comparison there? Very similar. So the Oasis four trial was the main trial looking at this 25 milligram dose here in, in patients with obesity, overweight. And it was a smaller trial compared to, like the initial, step trials for Wegovy injections. But the percentages of side effects were relatively similar. Nausea was 46% on the pills and 44% on the injections. Constipation, diarrhea, quite similar actually. A little less constipation in the pill form, but this could be within the. Statistical analysis of error here, and then vomiting was slightly higher on the pill at 30% versus 24%, pill to the injection. Again, pretty close. Definitely not seeing less side effects, but hopefully not worse either. And do you know what's interesting? The subq data I have never had that high a percentage of patients vomiting. Right. I agree. And so it's right. It's interesting. And I know there are, okay, we don't, we only have a limited time today, but the point is I think you're gonna reach on this too, but it's so different when you're working with people that specialize in this. Because sometimes a lot of what I see in the data, I just don't see that in my practice because we're doing things differently. When people hear that, you're thinking, oh my gosh, that's a lot of work. Percent vomiting. But it really doesn't have to be the case necessarily. So I just wanna point that out. If anyone's listening and they're a little dubious. So important. Yeah, I think that's very vital. We hear 30% we're like, oh my goodness. But yeah, like you said, in my practice, it's very rare that patients are truly vomiting. It's more of a nausea that is subsiding over time. I think, like you said, having a provider that's gonna monitor you closely. Maybe slow the titration if side effects are present, making sure the nutrition's in a good place to mitigate the nausea, making sure the portions are in a good place, reducing those, grier foods that can cause more nausea. All these things can definitely help patients to tolerate it better, and that's what's gonna lead to better outcomes down the road, of course, in terms of helping people maintain their therapy. So don't be afraid to slow the titration if you are having issues, but at the same time. Hopefully as things are going smoothly, we can continue the pathway upward as needed. You mentioned the, doses that are out currently with Oral Wegovy, Can you tell us about what would the, predicted equivalency chart be if someone was. Already on subq. If they're coming from injection wegovy over to oral, how would that transition go for them? The label doesn't get into the details of all the different dosages, but if we go by the label, it does say if somebody is on the 2.4 milligram injection, they can transfer right over to the 25 milligram tablet. They would start their first tablet one week after their last 2.4 injections. That makes sense. If somebody is on the 25 milligram tablet and wanted to switch to the injection. They would do the actual injection the next day,'cause that would be their next dosing for their pill, so to speak. And so there is a kind of an easy pathway there. The label does say if someone does not tolerate 25 milligram tablet, but the recommendation actually is to consider the 1.7 milligram injections, which is interesting. And so we do have that kind of stepping stone pathway outside of that. It is, there is no conversion chart, so to speak. It's probably gonna be up to our just experience to know where to flip someone to. Yeah. And, hypothetically the absorption of the nine might be similar to the one milligram injection. The four might be close to a 0.5 and the, the 1.5 might be similar to a 0.25 injection. Just based on the idea that the injection has 89% bioavailability and it's once a week, whereas the pill is daily with a one to 2% absorption. That's why the numbers sounds so different. But in reality, the amount that gets into bloodstream is probably gonna be quite similar. Yeah. I'm curious to start to write it more and see what you're talking about. Of my sense, because I know a lot of the time when we went from subq Wegovy over to Zep Bound mm-hmm. There were dosing equivalents and I found based on the certain patient profiles, summit made more or less sense to go higher or lower and that's just over time, the sense that you get as a clinician, and I Exactly. When people are only sticking to the charts, I'm thinking, but that's not really always appropriate because there's, many factors at play. I'm curious when this rolls out, was there any mention, I'm assuming it's a no, but I'm asking in case I missed it. Was there any mention of coming from Tirzepatide Soze bound over to Oral Wegovy? Sure. Yeah, no mention certainly in the label. I think. There were trials, I'm thinking of the O four LARON trial showing patients switched from Zon to O four, Laron from Wegovy or Zon. There was a trial looking into that. But yeah, nothing specific for the Wegovy tablet, I would say. Like you said, it's gonna come down to our, discretion and like you said, knowing the patient, if they are more prone to nausea, always be better to err on the side of caution and stop more conservatively. Go slow and titrate slow and start low. And that can be the safest bet and we can always move up from there versus starting too high and risking side effects. But the other hand, if somebody is somebody who's really had no nausea all along, we can probably feel a little more comfortable starting them a bit higher. But I would say, it is just gonna be very personalized. Yeah. And it's hard when people are writing, and first of all, there's no medical advice on this podcast, but it's really hard what you're saying with. Cost, what else their life looks like. It's hard for us to say what would be right or not for people. I think that's gonna be something that sometimes you have to take a leap of faith. You say, okay, I'm gonna trial this out. If it doesn't work out, I'll go back. If that's an option. I think people think they're like locked in as something it's like. That's not necessarily true. So, so true. So we just like a little bit more, not so black and white. Especially with weight care. I find that that's, there's lots of gray in there, you know? Yeah. There's more options than ever. That's the exciting thing is it's no longer a one size fits all. Hopefully as we get more options, we have more individualized, personalized medicine and what works for one person may different than somebody else, and that's great. We can help them with that nuance. Completely. Who do you think would this would work best for? Or not so much? Yeah, I would say for a lot of people, I'm excited to see how much, popularity there is with the pill. I think, in my practice a lot of patients have gotten comfortable with the injections. They're doing fabulous on them, and for them, this is, not necessarily a need for'em to switch. But for other people, we may not be aware that they were holding back on this medication all along because they were afraid of injections or. Felt as though the needle was not gonna be something they would tolerate. So I think we are, I've seen even my, in my own practice, people coming in now who are now interested that perhaps weren't interested for the past decade. I think it's exciting. We'll learn more. But I have a feeling, hopefully this improves accessibility access based on not just pricing, but the ability for pills to be manufactured more easily. Hopefully no chance of shortages and, making this easy to distribute without needing a cold chain and keeping these things in, shipping them cold. Pharmacies don't have to have refrigerators to store them. All this hopefully improves just logistics in a sense, in my world, a lot of my people travel a lot. Like they might have a job where literally three weeks, three outta four weeks, they're in different locations. And it's been challenging from the standpoint of med refill, carrying it around. Now, a lot of these injections can be at room temperature, but sometimes. I had a patient go to Ecuador for a week that was not so fun. They don't have air conditioning everywhere, right? It was very remote village that they went to. And so these are just scenarios that you never think of and if you know that someone's in those type of situations a lot, this can be a lot more accessible. There was a data point that you had reached on that if, am I repeating this correctly, that if people had, if they were working with a wait care specialist, that they were eight times more likely to be on the MET a year later. Is that right? Yes. Yeah. That was from a trial, a study that published it and talked about that statistic, so yeah. That's powerful. It's a, it shows the value and patients getting a provider who's going to understand these medications, who's gonna monitor them more closely. And help'em through the titration and any side effects. And, of course the lifestyle habits alongside it to lead to better outcomes and better chance of maintaining therapy. A lot of the headlines that sometimes, oh, patients stop these medications after a year or patients gain back the weight. Sometimes these headlines they're not taking into account the full picture. They didn't stop it'cause they wanted to, they stopped it'cause they either lost coverage or those trials were dated back when there were shortages or their insurance changed and we shouldn't be blaming the medication when in reality the patient wanted to stay on it. Perhaps they just weren't getting the right care or couldn't afford it. I'll never forget when the Saxenda study came out and I thought, well, I have not been able to get it for people for a year. So what, what are you quoting here with the study Exactly. It's so funny, the headline versus the reality always right? And then the newest headline, which was a good trial I think, was the BMJ showing. When patients stop these medications, there's gonna be a tendency of weight regain within a year or two. But we see that, and we shouldn't be shocked, we should say this is a chronic disease, right? Obesity is a chronic disease that deserves chronic care. And we should not consider this any different than other chronic diseases. If someone's on a blood pressure medication. We wouldn't stop the medication after six months and say, all right, you're all set, right? This is something patients need to maintain therapy, and that's not a fault of the medication or a fault of the patient. This is the biology of obesity and the appetite hormones and such will make this a challenge. And sometimes, of course, no one's locked on them for life. Patients always have the option to stop if they feel like they, have that prerogative. But we wanna support them in understanding that staying on this therapy is likely the best scenario to help them to maintain their weight loss. And that's not a crutch, that's not a quick fix. That's treating a disease with a treatment. That's not a cure, but it's a treatment. Yeah. I think it's that the insurances need to catch up with that. This is not an aesthetic thing, that this is complex, multifactorial. I'm hearing more and more insurance companies that are policing, They're sent scales and you have to step on it daily and if the numbers don't come in, if the step counts aren't there, yeah. There's no other disease that we police in this way where if you're not doing this, we won't give you that. It's honestly, it's, it's, I think it's abusive. They're not doing that with blood pressure or anything else. And they're doing that for weight. Right. Yeah, I know. It's just frustrating when they're so strict. I mean, as I do, these prior authorizations are getting harder and harder. I, I had one that was like a litany of options and we wanted, they wanted records of the patient's food logs and. Receipts from the personal trainer that they saw. I mean, it's just crazy if you had that for any of the disease state, it would be inhumane to withhold therapy for that. So totally. I'm glad to hear. I'm not the only one struggling with that though. I know for myself I'm on a medication and I know my doctor is excellent. Of course the denial came through the other day and you always. Expect that, but they put in there, oh, that records were not given. I was like, I do not believe this for one moment. Yes, records are always given. Yep. They love to just deny and you have to go and appeal and sometimes there's a pathway to get it. Sometimes, unfortunately it's a planned exclusion'cause the employer didn't opt into covering it. It is a very kind of wide variety of coverage. This year, hopefully we see coverage get better, like you said. Prices are coming down, but that's the cash price, not the list price. So behind the scenes with rebates and PDMs, we don't really even know what the cost would be for an insurance to offer coverage for this, but let's hope that they get better pricing because it deserves to be covered as a medical, as a medication. Yeah. Do you think there's anything that we didn't cover here? I know we talked about a lot in a really little period of time. Do you think there's anything that. We missed. We think we touched a lot. They're all great things. I would just say, just to revisit the pricing at this point in time, like you said, in January, 2026, we're seeing the lowest starting price of 1 49 a month for the lowest two dosages. Theoretically, the second dose will go up to 1 99 at sometime in around, April 15th. And then the higher dosages, which are nine and 25 are gonna be priced at 2 99 a month. And so even at the top dose that is cheaper than the injection by$50, which is again, a step in the right direction. Outside of that, the only other kind of little tidbit I would say is patients that are taking a medication like Levothyroxine, which is a first thing in the morning medication, already waiting half an hour before eating. This may add a little kind of difficulty here, so you would wanna do the Wegovy tablet first, wait half an hour, then you could take your levothyroxine and then wait half an hour and then begin your food and such from there. If that timing doesn't work, well note that if you happen to wake up at 4:00 AM for a bathroom break, you could take your wegovy then. And then when you start your day, hopefully the levothyroxine is at least half an hour later and you're good. Or if you talk with your provider, they may consider the idea of a bedtime dose of levothyroxine if it's a long enough fasting period after dinner. So different options. But again, there's the nuance that providers that work in this space are gonna be thinking about that are important. Yeah. Yeah. Thank you for providing those details. That's amazing. Okay, so I wanna respect your time, but just thank you so much for coming on. Everyone will just have been madly taking notes, and we'll make sure if anyone's listening on my website, renta clinic.com/blog, we'll have all of this written out as well. Joe, can you tell us where are you located? How can people find you, how can they follow you, clinic, all of it. Sure. Yeah. I work at Transition Medic Medical Weight Loss in Salem, New Hampshire. Transition to salem.com is our website. I'm licensed in New Hampshire and Massachusetts, both seeing patients in person and virtually. So anyone who's here who wants evidence-based, care, I'm happy to help. But certainly there are many providers out there that are available that are in this space. So certainly if you're. Primary care provider or whoever you're seeing is unfortunately, brushing these medications under the rug too quickly. Then I encourage you to find somebody who's gonna give you the right time and encouragement and guidance on this because your health is worth it. Outside of that, you can follow me on LinkedIn, Joseph Zuki. I do post different infographs and information to try to keep up with the latest and greatest information in the space of obesity medicine. Thank you so much. Thank you.