FlexNP
@rnflex.bsky.social
Jack of all trades nurse practitioner, trail runner photographer, coonhound rescuer, lover of glucagon agonism in the liver, kidney and pancreas, fascinated by obesity medicine, retatrutide fan boy
Had a peer to peer call for an MRI and the insurance person on the other end literally said "this diagnosis code will be instantly approved, are you worried about that with this patient"
Me: *stunned into silence* YES actually let me addend my note to say that right now
Them: Ok approved!
Me: *stunned into silence* YES actually let me addend my note to say that right now
Them: Ok approved!
January 16, 2026 at 6:45 PM
Had a peer to peer call for an MRI and the insurance person on the other end literally said "this diagnosis code will be instantly approved, are you worried about that with this patient"
Me: *stunned into silence* YES actually let me addend my note to say that right now
Them: Ok approved!
Me: *stunned into silence* YES actually let me addend my note to say that right now
Them: Ok approved!
Goes without saying that if you're writing a newsletter/blog/whatever you've gotta include memes and a sense of humor.
(But also seriously after this year semaglutide is cooked, all the newer multi-agonists are so much better)
(But also seriously after this year semaglutide is cooked, all the newer multi-agonists are so much better)
January 16, 2026 at 3:35 PM
Goes without saying that if you're writing a newsletter/blog/whatever you've gotta include memes and a sense of humor.
(But also seriously after this year semaglutide is cooked, all the newer multi-agonists are so much better)
(But also seriously after this year semaglutide is cooked, all the newer multi-agonists are so much better)
I swear I'm not a shill for Eli Lilly.
It's just they're *that* far ahead of everyone else in the race for new GLP1/weight loss/diabetes medicines. Fully 40% of the drugs discussed in this article come *just* from one company.
That's unheard of in pharma spaces.
It's just they're *that* far ahead of everyone else in the race for new GLP1/weight loss/diabetes medicines. Fully 40% of the drugs discussed in this article come *just* from one company.
That's unheard of in pharma spaces.
My next article! An exhaustive list of every trial that I could find involving GLP-1 drugs that is reporting out in 2026. Eli Lilly 2026 pipeline alone could have been an entire article, they're a juggernaut at this point. Everyone else including Novo Nordisk is just trying to catch up at this point
Preview of incretin attractions
A massive roundup of all the incretin trials reporting out in 2026
the-incretins.beehiiv.com
January 15, 2026 at 11:23 PM
I swear I'm not a shill for Eli Lilly.
It's just they're *that* far ahead of everyone else in the race for new GLP1/weight loss/diabetes medicines. Fully 40% of the drugs discussed in this article come *just* from one company.
That's unheard of in pharma spaces.
It's just they're *that* far ahead of everyone else in the race for new GLP1/weight loss/diabetes medicines. Fully 40% of the drugs discussed in this article come *just* from one company.
That's unheard of in pharma spaces.
My next article! An exhaustive list of every trial that I could find involving GLP-1 drugs that is reporting out in 2026. Eli Lilly 2026 pipeline alone could have been an entire article, they're a juggernaut at this point. Everyone else including Novo Nordisk is just trying to catch up at this point
Preview of incretin attractions
A massive roundup of all the incretin trials reporting out in 2026
the-incretins.beehiiv.com
January 15, 2026 at 3:41 PM
My next article! An exhaustive list of every trial that I could find involving GLP-1 drugs that is reporting out in 2026. Eli Lilly 2026 pipeline alone could have been an entire article, they're a juggernaut at this point. Everyone else including Novo Nordisk is just trying to catch up at this point
I think what is both amazing and sad to me as a PCP is that I can see a patient for the first time, suggest a single medication change for a chronic condition and suddenly that medication changes everything for the better and then the patient asks why no one tried that before? I can never answer.
January 14, 2026 at 10:46 PM
I think what is both amazing and sad to me as a PCP is that I can see a patient for the first time, suggest a single medication change for a chronic condition and suddenly that medication changes everything for the better and then the patient asks why no one tried that before? I can never answer.
Their marketing is problematic but shaming a company by their ingredients like this is not at all helpful. Many of the ingredients highlighted are found in whole foods that many of us have in the home!
You can read the list of ingredients.
Recognize any of these in your kitchen?
Recognize any of these in your kitchen?
January 14, 2026 at 6:23 PM
Their marketing is problematic but shaming a company by their ingredients like this is not at all helpful. Many of the ingredients highlighted are found in whole foods that many of us have in the home!
My one human effort to put all my hypertensive patients on Telmisartan continues unabated. 3 more patients started on it or switched to it today!
Soon the local pharmacies will have to stock more of it solely because of me 🤣
Soon the local pharmacies will have to stock more of it solely because of me 🤣
January 13, 2026 at 12:30 AM
My one human effort to put all my hypertensive patients on Telmisartan continues unabated. 3 more patients started on it or switched to it today!
Soon the local pharmacies will have to stock more of it solely because of me 🤣
Soon the local pharmacies will have to stock more of it solely because of me 🤣
Can we just....not have dementia patients on insulin 3-4 times a day?
Like can we do that pretty please?
It's 2026, we have better drugs and at that point A1c goals are out the window anyways.
That is an absolute disaster waiting to happen.
Like can we do that pretty please?
It's 2026, we have better drugs and at that point A1c goals are out the window anyways.
That is an absolute disaster waiting to happen.
January 12, 2026 at 8:28 PM
Can we just....not have dementia patients on insulin 3-4 times a day?
Like can we do that pretty please?
It's 2026, we have better drugs and at that point A1c goals are out the window anyways.
That is an absolute disaster waiting to happen.
Like can we do that pretty please?
It's 2026, we have better drugs and at that point A1c goals are out the window anyways.
That is an absolute disaster waiting to happen.
Tell me how AI will convince a patient to take a statin. Tell me how AI will discuss vaccination, marginal lab results, and about 100 other things that require critical thinking and can't be boiled down to an algorithm.
“results showed the AI’s treatment plan matched the physicians’ 99.2 percent of the time **according to the company**
“AI is actually better than doctors at doing this,” said Dr. Adam Oskowitz, Doctronic co-founder and an associate professor of surgery at the University of California San Francisco
“AI is actually better than doctors at doing this,” said Dr. Adam Oskowitz, Doctronic co-founder and an associate professor of surgery at the University of California San Francisco
January 12, 2026 at 1:40 PM
Tell me how AI will convince a patient to take a statin. Tell me how AI will discuss vaccination, marginal lab results, and about 100 other things that require critical thinking and can't be boiled down to an algorithm.
Reposted by FlexNP
Honest to god, I think some people might actually sit down and reread the Declaration of Independence given the anniversary, and I hope that some of them are like "wait one goddamn second."
I think they really believe shows of force and executing people is going to make Americans more docile and compliant, and I also think they’ve got that backwards. Regular people are getting angrier, braver, and more resolute.
January 12, 2026 at 3:24 AM
Honest to god, I think some people might actually sit down and reread the Declaration of Independence given the anniversary, and I hope that some of them are like "wait one goddamn second."
It is done! French onion soup. Homemade beef stock. Caramelized onions. Gruyere and sharp provolone cheese on toasted fresh French bread 🤌🤌
January 11, 2026 at 10:47 PM
It is done! French onion soup. Homemade beef stock. Caramelized onions. Gruyere and sharp provolone cheese on toasted fresh French bread 🤌🤌
We have an entire team of people just for prior authorizations and know how to appeal things and still we deal with multiple denials a week that make no sense. Here a good recent example. Patient needed med. There were 8 options insurance covered 2 of them. Short thread..
Here is the CBS Sunday Morning piece for which I was interviewed about findings from my book Coverage Denied. Health insurance barriers ration health care by inconvenience, imposing hurdles to get prescribed care with administratively burdensome appeals many can’t navigate. youtu.be/SRPOoPDN-7w?...
State of denial: How insurance companies impact health care today
YouTube video by CBS Sunday Morning
youtu.be
January 11, 2026 at 9:17 PM
We have an entire team of people just for prior authorizations and know how to appeal things and still we deal with multiple denials a week that make no sense. Here a good recent example. Patient needed med. There were 8 options insurance covered 2 of them. Short thread..
Yessssss, now it can simmer with the stock and dinner is ready for later!
January 11, 2026 at 3:38 PM
Yessssss, now it can simmer with the stock and dinner is ready for later!
Beef stock simmered all night, now time to caramelize an absolutely absurd amount of onions. French onion soup day!!
January 11, 2026 at 1:38 PM
Beef stock simmered all night, now time to caramelize an absolutely absurd amount of onions. French onion soup day!!
I bought beef bones, 5 pounds of onions and red wine today to make stock overnight for French onion soup tomorrow. One of my favorite wintertime soups
French onion soup is the best comfort food. #DoctorsWhoCook 🍽️ #goodlunch
January 10, 2026 at 10:34 PM
I bought beef bones, 5 pounds of onions and red wine today to make stock overnight for French onion soup tomorrow. One of my favorite wintertime soups
There's only one drug that's in phase 3 trials right now that could challenge retatrutide for weight loss efficacy and it's VK2735. Finally have phase 2 data fully published!
P2 #weightloss data over 13 weeks for VK2735 the once weekly GIPR-GLP1R medicine in adults with #obesity or overweight and ≥ 1 weight-related comorbidity onlinelibrary.wiley.com/doi/10.1002/...
January 10, 2026 at 1:22 PM
There's only one drug that's in phase 3 trials right now that could challenge retatrutide for weight loss efficacy and it's VK2735. Finally have phase 2 data fully published!
Reposted by FlexNP
All the lies they're telling about Renee Good are in service of an even bigger lie: that individual human lives have no intrinsic worth and are therefore theirs to dispose of. publiccomment.blog/p/the-poison...
The Poison Always Drips Through
On Renee Good and George Floyd
publiccomment.blog
January 9, 2026 at 9:34 PM
All the lies they're telling about Renee Good are in service of an even bigger lie: that individual human lives have no intrinsic worth and are therefore theirs to dispose of. publiccomment.blog/p/the-poison...
Student loan payments are now back on and millions have lost health insurance or are paying more for insurance....so uhhh not sure the economy is ramping up in the way they want it to
WHITE HOUSE ECONOMIC ADVISER HASSETT SAYS ECONOMY IS RAMPING UP
January 9, 2026 at 2:46 PM
Student loan payments are now back on and millions have lost health insurance or are paying more for insurance....so uhhh not sure the economy is ramping up in the way they want it to
Mary Sue drug confirmed.
Tirzepatide + Taltz (an IL-17a MAB) significantly improved psoriatic arthritis symptoms and caused significant weight loss at the same time in data published this afternoon.
@rheumcat.bsky.social @mikejohansenmd.medsky.social
investor.lilly.com/news-release...
Tirzepatide + Taltz (an IL-17a MAB) significantly improved psoriatic arthritis symptoms and caused significant weight loss at the same time in data published this afternoon.
@rheumcat.bsky.social @mikejohansenmd.medsky.social
investor.lilly.com/news-release...
January 8, 2026 at 9:26 PM
Mary Sue drug confirmed.
Tirzepatide + Taltz (an IL-17a MAB) significantly improved psoriatic arthritis symptoms and caused significant weight loss at the same time in data published this afternoon.
@rheumcat.bsky.social @mikejohansenmd.medsky.social
investor.lilly.com/news-release...
Tirzepatide + Taltz (an IL-17a MAB) significantly improved psoriatic arthritis symptoms and caused significant weight loss at the same time in data published this afternoon.
@rheumcat.bsky.social @mikejohansenmd.medsky.social
investor.lilly.com/news-release...
Because I have to share updates and we need some happiness on here, here's my pineapple plant. Slowly blooming and I've been hand pollinating as the blossoms open and close!
January 8, 2026 at 2:31 PM
Because I have to share updates and we need some happiness on here, here's my pineapple plant. Slowly blooming and I've been hand pollinating as the blossoms open and close!
We don't stop statins just because your LDL is now 70. Same for blood pressure. It's controlled by medication.
Same rules apply here with obesity treatments.
Same rules apply here with obesity treatments.
Stopping effective medications to treat hundreds of serious chronic diseases results in resurgence of the disease. #Obesity is no different, yet why are PPL surprised? Stopping obesity drugs means people regain weight and lose heart health benefits www.statnews.com/2026/01/07/w...
Stopping obesity drugs means people regain weight and lose heart health benefits
Why the weight, and heart risks, return after stopping GLP-1 drugs.
www.statnews.com
January 8, 2026 at 1:57 PM
We don't stop statins just because your LDL is now 70. Same for blood pressure. It's controlled by medication.
Same rules apply here with obesity treatments.
Same rules apply here with obesity treatments.
Reposted by FlexNP
Spiro is an amazing drug with amongst the widest ranging effects. I'd be very skeptical that it isn't beneficial is different ways than just elevating potassium (which is presumably one of its beneficial effects).
January 8, 2026 at 11:58 AM
Spiro is an amazing drug with amongst the widest ranging effects. I'd be very skeptical that it isn't beneficial is different ways than just elevating potassium (which is presumably one of its beneficial effects).
Guess who gets to do a 2 hour Grand Rounds presentation today on current Diabetes treatment guidelines for the first hour, then hour 2 is GLP-1 meds?!
Yeah this guy!! I'm so excited to do this! Much GLP1 and glucagon myth busting along with breaking down stigmas around obesity!
Yeah this guy!! I'm so excited to do this! Much GLP1 and glucagon myth busting along with breaking down stigmas around obesity!
January 7, 2026 at 3:57 PM
Guess who gets to do a 2 hour Grand Rounds presentation today on current Diabetes treatment guidelines for the first hour, then hour 2 is GLP-1 meds?!
Yeah this guy!! I'm so excited to do this! Much GLP1 and glucagon myth busting along with breaking down stigmas around obesity!
Yeah this guy!! I'm so excited to do this! Much GLP1 and glucagon myth busting along with breaking down stigmas around obesity!
Embarrassing to see this in a Nature publication. They split out tirzepatide and semaglutide by their brand names. They're the same drug with different indications. They don't do that for keytruda.
Reality is GLP1 medications will be #1 and #2 for sales in 2026 which IS remarkable.
Reality is GLP1 medications will be #1 and #2 for sales in 2026 which IS remarkable.
January 7, 2026 at 12:32 PM
Embarrassing to see this in a Nature publication. They split out tirzepatide and semaglutide by their brand names. They're the same drug with different indications. They don't do that for keytruda.
Reality is GLP1 medications will be #1 and #2 for sales in 2026 which IS remarkable.
Reality is GLP1 medications will be #1 and #2 for sales in 2026 which IS remarkable.
Prior authorization for Prednisone?
At some point this madness has to stop. What the hell else am I going to prescribe for a systemic allergic reaction?
At some point this madness has to stop. What the hell else am I going to prescribe for a systemic allergic reaction?
a basketball player wearing a cavs jersey is smiling while standing in front of a crowd .
ALT: a basketball player wearing a cavs jersey is smiling while standing in front of a crowd .
media.tenor.com
January 6, 2026 at 5:40 PM
Prior authorization for Prednisone?
At some point this madness has to stop. What the hell else am I going to prescribe for a systemic allergic reaction?
At some point this madness has to stop. What the hell else am I going to prescribe for a systemic allergic reaction?