FYI: Meet the UChicago researcher whose math just predicted the federal GLP-1 retreat. (4 days early.)

Four days ago the federal government quietly delayed Medicare's biggest expansion of GLP-1 coverage, and almost no health publication connected the delay to the academic whose research had been predicting exactly this outcome for over a year. Today's issue is about him.

His name is Dr. David Daeho Kim. He is a health economist at the University of Chicago. He has built the academic case that GLP-1s are not cost-effective at lifetime use prices in the United States. The federal government essentially confirmed his framework by walking away from the table on April 21. Almost nobody told the patients.

We are going to.

This is Off Label, Not Medical Advice.

Let's go.

The Morning Read: Meet the UChicago researcher whose math just predicted the federal GLP-1 retreat. Four days early.

Dr. David Daeho Kim is an Assistant Professor of Medicine and Public Health Sciences at the University of Chicago. PhD in Health Economics from the University of Washington (2016). Master's in biostatistics and bachelor's in biomedical engineering from Michigan. He started as a pre-med student. He realized somewhere along the way that his actual aptitude was in statistics, not biology, and during the year before his master's program he stumbled on the web page for Harvard's Center for Health Decision Science. He cold-emailed every faculty member listed.

That cold-email is the seed of everything that follows. The pre-med who became a health economist who became, by 2026, one of the most influential voices in the policy debate over the most-prescribed-by-headline drug class in modern medicine.

His Google Scholar page lists over 3,000 citations. He sits on the World Health Organization's Guidelines Development Group for GLP-1RAs for obesity management. He sits on the Institute for Clinical and Economic Review's Midwest Comparative Effectiveness Public Advisory Council. He is an Associate Method Editor for the Annals of Internal Medicine. He authored a book called "How to Fix a Broken Health Care System."

You probably haven't heard of him. Your insurance company's pharmacy benefit managers absolutely have.

Kim has three connected GLP-1 research papers from 2024 to 2025. Together, they form a coherent academic argument. Apart, they each lead to the same conclusion: the lifetime-use framing of GLP-1s is economically untenable at current US prices.

Published in JAMA Health Forum on March 7, 2025. Lead author Jennifer H. Hwang, DO, with Kim as senior author. Title: "Lifetime Health Effects and Cost-Effectiveness of Tirzepatide and Semaglutide in US Adults."

What it found: at current US net prices, tirzepatide costs $197,023 per quality-adjusted life year. Semaglutide costs $467,676 per QALY. The standard cost-effectiveness threshold is $100,000 per QALY. Both drugs had a 0% probability of being cost-effective at any threshold between $100K and $200K per QALY. To reach the $100K threshold, tirzepatide would need a 30.5% price cut. Semaglutide would need an 81.9% price cut.

The paper became one of JAMA Health Forum's Top 10 most popular articles of 2025. The New York Times cited it on March 14, 2025. The data the paper produced is now the gravitational center of the GLP-1 cost-effectiveness debate.

Published in JAMA Health Forum on April 4, 2025. Same lead author. Same senior author. Co-authors include Dariush Mozaffarian (Tufts) and A. Mark Fendrick (Michigan), two of the most senior US health policy researchers.

What it found: if Medicare expanded coverage of GLP-1s for obesity, 3 million Medicare beneficiaries would start using the drugs over 10 years. Drug costs would total roughly $66 billion. Offsetting health savings (averted heart attacks, strokes, kidney disease, diabetes complications) would total roughly $18 billion. Net cost to the federal government: about $48 billion over 10 years.

This is the paper that quietly modeled what would happen if CMS tried to expand GLP-1 access. It modeled the math the agency would actually face. It said "this is what it costs."

Published in Health Affairs Scholar in May 2024. Title: "Balancing Innovation and Affordability in Anti-Obesity Medications: The Role of Alternative Weight Maintenance Program."

What it proposed: instead of putting patients on GLP-1s for life, use the drugs for an initial weight loss phase, then transition patients to cheaper interventions for long-term maintenance. Lower-cost generic medications. Behavioral health programs. Structured nutrition support.

What the modeling found: this alternative model produces a slight clinical benefit reduction compared to continuous lifetime GLP-1 use, but a substantial reduction in lifetime healthcare spending. Most of the benefit, much less of the cost.

This is the paper that articulated, in academic language, the entire framework that the CMS BALANCE Model design was built on. The lifestyle support component, the time-limited drug coverage, the maintenance pathway. The federal government's own program design borrowed Kim's framework, whether they cited him or not.

If you read only one quote from a Kim interview, this is the one. From a UChicago Medicine 2024 interview about the alternative model paper:

This is the entire contrarian framing of yesterday's issue, articulated by the academic whose research underwrites it. Kim said the quiet part out loud. He said it in 2024. The federal government caught up to him on April 21, 2026.

On April 21, 2026, the Centers for Medicare and Medicaid Services announced it was delaying the Medicare Part D portion of the BALANCE Model for 2027 "pending further evaluation and data collection." The Bridge program was extended through December 31, 2027 as a fallback. The Medicaid portion is still launching May 1, 2026 (six days from now).

The mechanic that triggered the delay: BALANCE required at least 80% of Medicare Part D plan sponsors to opt in for the program to launch. The application deadline was April 20. The delay memo went out April 21, the next day. Industry analysts who track CMS have noted that the speed of the response is itself a signal: when a threshold is missed by a hair, agencies usually take a week of internal deliberation. A next-day memo means the miss was material.

Translation: federal payers, watching the numbers, declined to take on lifetime GLP-1 coverage at the negotiated prices in large enough numbers for the program to launch. They saw the same math Kim modeled in April 2025 ($66 billion in costs, $18 billion in savings, $48 billion net) and walked away from the table.

This is what it looks like when academic economic modeling correctly predicts a real-world market outcome 12 months in advance. Kim's work is no longer hypothetical. It is empirically supported by the federal government's own behavior.

Three caveats to keep this honest.

His exact words on the drugs themselves: "There's no doubt that the drugs are demonstrating tremendous health benefits. The problem is the price is too high." He is not arguing the drugs do not work. He is arguing the prices do not work, at lifetime use, for federal budgets and large-population coverage. The clinical evidence is solid. The economics are the problem. Those are different problems.

The University of Southern California Schaeffer Center published a competing analysis in July 2025 using a different model called FAM with GRACE methodology, which weights health gains in sicker patients more heavily than standard QALY analysis does. Their conclusion: tirzepatide may actually be undervalued at current prices for older Medicare populations, with a value-based price of $10,817 per year. That's higher than current net prices. The methodology debate is real. Kim uses standard QALY, the most widely accepted framework in health economics. Schaeffer uses GRACE, which is methodologically defensible. Both reach different numbers. The Centers for Disease Control and Research Triangle Institute presented a separate model at the American Diabetes Association in June 2025 and got an ICER of $288,704 per QALY for GLP-1s in diabetes prevention, which corroborates Kim's directional finding. Most independent analyses sit on Kim's side. Schaeffer is the methodologically sophisticated outlier.

The press has often referred to "Kim's research." More accurate: it is the Hwang-Kim research group. Jennifer H. Hwang, DO is a board-certified internal medicine and obesity medicine physician at UChicago, and she is the first author on the JAMA Health Forum papers. Kim is the senior author and the principal investigator. Both names should be on this work. Hwang is a practicing primary care physician, which gives the work clinical credibility that pure academic critiques lack. The combination is unusual and important.

Text your doctor this: "I've been reading work by Dr. David Kim and Jennifer Hwang at the University of Chicago that proposes an alternative model where GLP-1s are used short-term for initial weight loss, then patients transition to cheaper maintenance medications and lifestyle interventions. Their March 2025 JAMA Health Forum paper estimates current GLP-1 prices fail standard cost-effectiveness thresholds. Can we talk about whether their framework applies to my situation, and whether a structured initial-then-maintenance approach would work better for me than indefinite use?"

Copy, paste, send.

Kim's career path is the case study. A pre-med student who pivoted to health economics via cold email, who then built the simulation framework (the Diabetes, Obesity, Cardiovascular Disease Microsimulation, or DOC-M) that the entire field now uses, who then sits on the WHO Guidelines Development Group, who then publishes the paper that becomes a JAMA Health Forum Top 10 article, whose research is then operationalized in federal Medicare policy, whose policy framework is then validated when the federal government walks away from expanding lifetime GLP-1 coverage. That arc is two decades of patient academic work that suddenly looks predictive.

The information asymmetry is enormous. A celebrity with 10 million Instagram followers can post about Ozempic and shape patient behavior at scale. Kim's research, with the WHO and federal government quietly listening, reaches almost no patients directly. The gap between rigorous research and patient awareness is one of the largest in healthcare. Off Label exists in part because that gap exists.

The radical position is the marketing position. Kim is the boring middle. He is using standard QALY methodology, the most widely accepted framework in health economics. His conclusions feel radical only because the marketing of GLP-1s has gone so far in the lifetime-use direction that mainstream economic analysis now reads as contrarian. The radical position is "everyone should be on this drug forever and the math will work out." The mainstream economic position is "at current prices, we cannot pay for lifetime use at population scale." Kim is the latter.

Watch this: the next Hwang-Kim paper. Per UChicago Medicine reporting, Jennifer Hwang is currently working on a follow-up project to refine clinical guidelines for prescribing GLP-1 drugs more selectively. When that paper drops, it will provide the operational framework for who-gets-what-for-how-long that the BALANCE Model design implies but does not yet specify. The Medicaid side of BALANCE launches May 1, 2026 (less than a week from now). State Medicaid agencies have until July 31 to apply. The Hwang-Kim follow-up paper, when it lands, becomes the academic foundation that states will cite when they design their own access criteria. We're tracking it.

Tomorrow we walk through the actual cost-effectiveness math you just read about. How a QALY works. What an ICER actually is. How to read a paper like Kim's the way the policy world reads it. The goal: you finish the issue able to interpret these studies as well as the people who write them.

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— Off Label

This is Off Label, Not Medical Advice. Content is for informational purposes only. Always consult a qualified healthcare provider before making medical decisions about starting, stopping, or modifying any prescription medication. Off Label is not anti-medication and not anti-research. The drugs discussed in this issue are FDA-approved, clinically effective for their approved indications, and have demonstrated meaningful health benefits in published trials. The thesis of this issue is about who is shaping the academic conversation about GLP-1s and how that conversation is influencing federal policy, not a recommendation for or against any specific medication or treatment plan.