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Jayakumar, Miami VA Healthcare System, United States Reviewed by Abdeljalil Elgot, Hassan Premier University, Morocco

Despite these advances, there remains a critical need for robust post-marketing surveillance to capture real-world toxicity data beyond the controlled settings of clinical trials

What insurance typically covers FDA-approved peptides for approved indications: Semaglutide (Ozempic) for type 2 diabetes: Often covered Semaglutide (Wegovy) for obesity: Sometimes covered with restrictions Tirzepatide (Mounjaro) for type 2 diabetes: Often covered Tirzepatide (Zepbound) for obesity: Limited coverage What coverage looks like: Prior authorization typically required Documentation of failed dietary interventions BMI thresholds for weight loss indications Co-pays still substantial ($100-500 monthly) What insurance doesn't cover The vast majority of peptide therapy falls outside insurance coverage: Compounded peptides (BPC-157, TB-500, most growth hormone peptides) Anti-aging applications even for FDA-approved drugs Performance enhancement uses Off-label applications These costs are entirely out-of-pocket for most patients

and a separate cohort from Liverpool