diff --git a/src/app/insights/medications/__tests__/page.test.tsx b/src/app/insights/medications/__tests__/page.test.tsx
new file mode 100644
index 000000000..7503f44fd
--- /dev/null
+++ b/src/app/insights/medications/__tests__/page.test.tsx
@@ -0,0 +1,81 @@
+import { describe, expect, it, vi } from "vitest";
+import { renderToStaticMarkup } from "react-dom/server";
+import type { ReactNode } from "react";
+
+/**
+ * Insights > Medications: the efficacy summary sits below every medication
+ * card and asks one efficacy read per medication. On entry it holds its slot
+ * with a sentinel and mounts only when scrolled near, so opening the page
+ * sends the cards' reads and not the summary's.
+ */
+
+vi.mock("@tanstack/react-query", () => ({
+  useQuery: ({ queryKey }: { queryKey: readonly unknown[] }) =>
+    queryKey[1] === "comprehensive"
+      ? {
+          data: {
+            medications: [
+              {
+                id: "m1",
+                name: "Ramipril",
+                dose: "5 mg",
+                category: "BLOOD_PRESSURE",
+                compliance7: 100,
+                compliance30: 95,
+                streak: 7,
+                taken7: 7,
+                skipped7: 0,
+                missed7: 0,
+              },
+            ],
+          },
+          isLoading: false,
+          isError: false,
+        }
+      : { data: undefined, isLoading: false, isError: false },
+}));
+vi.mock("@/hooks/use-auth", () => ({
+  useAuth: () => ({ isAuthenticated: true }),
+}));
+vi.mock("@/hooks/use-ai-capability", () => ({
+  useAiCapability: () => ({ available: false }),
+  useAiProviderState: () => ({ responseTimeoutMs: null }),
+}));
+vi.mock("@/components/insights/medication-efficacy-summary", () => ({
+  MedicationEfficacySummary: () => <div data-slot="efficacy-summary-mounted" />,
+}));
+vi.mock("@/components/insights/sub-page-shell", () => ({
+  SubPageShell: ({ children }: { children: ReactNode }) => <>{children}</>,
+}));
+vi.mock("@/components/insights/glp1-substance-curve-summary", () => ({
+  Glp1SubstanceCurveSummary: () => null,
+}));
+vi.mock("@/components/insights/metric-target-summary", () => ({
+  MetricTargetSummary: () => null,
+}));
+vi.mock("@/components/insights/insight-status-card", () => ({
+  InsightStatusCard: () => null,
+}));
+vi.mock("@/components/insights/coach-launch-button", () => ({
+  CoachLaunchButton: () => null,
+}));
+vi.mock("@/components/charts/compliance-heatmap", () => ({
+  ComplianceHeatmap: () => null,
+}));
+
+import { I18nProvider } from "@/lib/i18n/context";
+import InsightsMedikamentePage from "../page";
+
+describe("/insights/medications on entry", () => {
+  it("renders the cards and holds the efficacy summary until scrolled near", () => {
+    const html = renderToStaticMarkup(
+      <I18nProvider initialLocale="en">
+        <InsightsMedikamentePage />
+      </I18nProvider>,
+    );
+
+    expect(html).toContain("Ramipril");
+    expect(html).toContain('data-deferred-section="medication-efficacy"');
+    expect(html).not.toContain("efficacy-summary-mounted");
+  });
+});
diff --git a/src/app/insights/medications/page.tsx b/src/app/insights/medications/page.tsx
index bd17dc53f..efe9abb03 100644
--- a/src/app/insights/medications/page.tsx
+++ b/src/app/insights/medications/page.tsx
@@ -24,6 +24,7 @@ import { CoachLaunchButton } from "@/components/insights/coach-launch-button";
 import { InsightStatusCard } from "@/components/insights/insight-status-card";
 import { MetricTargetSummary } from "@/components/insights/metric-target-summary";
 import { MedicationEfficacySummary } from "@/components/insights/medication-efficacy-summary";
+import { DeferUntilNear } from "@/components/insights/defer-until-near";
 import { Glp1SubstanceCurveSummary } from "@/components/insights/glp1-substance-curve-summary";
 import { SubPageShell } from "@/components/insights/sub-page-shell";
 import { TileHeader } from "@/components/insights/tile-header";
@@ -321,12 +322,12 @@ export default function InsightsMedikamentePage() {
         })}
       </div>
 
-      {/* v1.28 — compact efficacy summary: reuses the same server-computed
-          efficacy DTO the detail-page "Wirkung" tab reads (never a second
-          computation), association-only, linking through to the full view. */}
-      <MedicationEfficacySummary
-        medications={medications.map((m) => ({ id: m.id, name: m.name }))}
-      />
+      {/* v1.28 — one efficacy read per medication, below every card: mounted when near. */}
+      <DeferUntilNear id="medication-efficacy">
+        <MedicationEfficacySummary
+          medications={medications.map((m) => ({ id: m.id, name: m.name }))}
+        />
+      </DeferUntilNear>
 
       {/* v1.28.20 — estimated active-substance curve for GLP-1 medications
           (additive; renders nothing when the user has no GLP-1 medication). */}