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Public reimbursement, HTA-style conservatism, and price revisions dominate adoption not self-pay hype

However, an expert says it doesn't have to be complicated

For older adults on long-term PPIs, periodic B12 monitoring is appropriate and a daily sublingual methylcobalamin is a reasonable preventive measure to discuss with the prescriber

Review the treatment plan: An evidence-based clinic will have a clear, step-by-step dose escalation schedule that matches medical guidelines

However, the accelerated approval pathway means that evidence is still interim: while part one of the ESSENCE trial demonstrated improvement in liver scarring and inflammation, it does not yet show whether semaglutide reduces the risk of serious outcomes such as cirrhosis, liver failure or liver cancer