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Safety signals identified through extended follow-up include: Gastrointestinal effects : Nausea, vomiting, and diarrhea remain the most common adverse events, typically diminishing over time but causing discontinuation in approximately 57% of patients Gallbladder disease : Increased incidence of cholelithiasis and cholecystitis, possibly associated with weight loss, though the exact mechanism remains under investigation Diabetic retinopathy : Risk of complications, particularly with rapid glycemic improvement in patients with pre-existing retinopathy Acute kidney injury : Risk associated with severe gastrointestinal adverse events leading to dehydration Pancreatitis : Rare cases reported, though causality remains uncertain

Federal annuitants are not impacted by Medicare's restriction of weight-loss drug coverage and can enjoy this benefit through EGWPs, which include a $35 monthly cap on insulin and the $2,000 out-of-pocket prescription drug maximum that all Part D plans will have in plan year 2025.