MikeFit_NJ said:

SURMOUNT-1 landed around 20.9% mean weight loss at 15mg over 72 weeks, against roughly 15% for semaglutide 2.4mg in STEP 1.

I read this differently from MikeFit_NJ, on substance rather than tone. 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.

One concrete data point for the thread. Practical numbers: half-life about 5 days, steady state 3 to 4 weeks, ladder 2.5 / 5 / 7.5 / 10 / 12.5 / 15mg, and the maintenance doses with published data behind them are 5, 10 and 15mg.

amsterdam_pete said:

The affordability discussion here usually stops at individual tactics.

Coming at amsterdam_pete’s question from a different direction. The GIP arm is doing real work rather than padding the label. GIP receptor agonism appears to improve adipose insulin sensitivity and lipid handling, and — counter-intuitively — GIP signalling in the CNS reduces nausea rather than adding to it, which is why tolerability at high total agonism is better than the GLP-1-only comparison would predict. SURPASS-2 is the cleanest head-to-head: tirzepatide beat semaglutide 1mg at every dose tier.

Following on from DoseLogDan — and this may be the naive question:

Whether anyone has held 10mg long term rather than climbing, and what happened over the following year?

OP back with an update, since a thread like this is useless without one.

Update: approved on the third attempt after a peer-to-peer. Nothing about my case changed; only who was doing the talking.