Hacker News Reader

Comment by prepend | Hacker News Reader

It’s very expensive at $10k/year/patient, but I wonder if the long term costs are still cheaper than treating heart attack or stroke. Obesity greatly increases the risk of cardiovascular events so I think this may end up saving Medicare money by shifting to pharmaceuticals from emergency care.

Of course, would be nice if they would negotiate a lower price as it’s really expensive.

But Medicare covers other chronic preventative meds, PReP coming to mind and that’s like $10k/year. But still way cheaper than HIV treatment that it prevents.

View on HN

It’s around £250 a month in the UK privately, when it falls under the NHS fully it will likely be even cheaper.

There is absolutely no reason for it to cost $10K per year in the US.

I’m more worried about the long term effects of it, we had plenty of “miracle drugs” in the past that resulted in significant damage long term to either those who took them or to their children.

GLP-1 receptor agonists have been pretty widely used for diabetes since 2005.

If there's a major unseen gotcha lurking, it hasn't showed up in the first two decades. (Plus however long prior to that the clinical trials were going on for.)

FWIW, £250/month (GBP) is the equivalent of $3750/year (USD).

With the right compounding pharmacy you can get it for less than ~$200/mo USD since Ozempic and Wegovy are the same drug, Semaglutide, just at a different dose.

Is it "off label" use of Ozempic? Yes. Are the FDA and medical patents in the US broken? Yes.

The cost of 10k per year is very likely to drop over time, especially if there's a huge roll out for millions of people. I think statistics calculations will show a net positive effect in terms of long term health care savings, unless Wegovy has serious side-effects that counter the benefits.

Medicare is also now allowed to negotiate prices. I fully expect this one to be on the list ASAP.

Medicare (the government part) wouldn't pay directly for Wegovy since it's an out-patient drug. That would be Medicare Part D, which is managed by private insurers who can negotiate.

Nah. Drugs covered by Part D are precisely what they got the right to step in for.

https://www.cms.gov/files/document/fact-sheet-medicare-selec...

> For the first time, the law provides Medicare the ability to directly negotiate the prices of certain high expenditure, single source drugs without generic or biosimilar competition. Below is the list of 10 drugs covered under Medicare Part D selected for negotiation for initial price applicability year 2026, based on total gross covered prescription drug costs under Medicare Part D and other criteria as required by the law.

https://www.medicare.gov/about-us/prescription-drug-law

> For the first time, Medicare will be able to negotiate directly with manufacturers for the price of certain high-spending brand-name Medicare Part B and Part D drugs that don’t have competition.

That the private operators of part D were always free to negotiate prices is most of the point.

With substantially less market power than "the Federal government on behalf of all of Medicare", and with the knowledge that the Feds will bail them out when costs are high.

https://www.kff.org/affordable-care-act/press-release/3-char...

> The Congressional Budget Office has estimated that negotiated prices will reduce Medicare spending on drugs subject to negotiation, translating into nearly $100 billion in federal savings between 2026 and 2031.

Part D expansion has come in way under estimated costs which is a massive shocker for a federal program.

That was my exact point.

Depends on what the long term side effects are.

Fen-phen reduced obesity for some, but the heart damage it caused made it more expensive than no intervention. [1]

[1] https://en.m.wikipedia.org/wiki/Fenfluramine/phentermine

It’s been in use for 20 years or so, so I expect we’ve discovered most long term effects.

Wikipedia said semaglutide was approved by the FDA in 2017. With later approvals in the EU, Japan and Australia. Was it approved earlier elsewhere?

Use for weight loss is relatively new as well. Approvals for that use are more recent, but off label use preceeds approval.

First of the GLP-1 receptor agonists was https://en.wikipedia.org/wiki/Exenatide in 2005 (with clinical trials prior to that). Safety profile is reasonably well understood with two decades under our belts.

Wasn’t it approved for people with diabetes?

I’m assuming the tests were done on people with diabetes then.

Were there tests done on non diabetic people as well?

Ah, but that is the beauty of it you see. You can then also sell a medication to counter the heart damage..

Beyond the sarcasm, it is concerning that most comments read here are raving about how much of a positive effect this cure could have. From a quick scroll, I haven't seen any addressing the fact that a new pill is not helping solve the cause of the problem.

We, as a society, have absolutely no reason to be obese. Yet, we choose to ignore the root of the problem, and cheer on the palliative chemical solutions. These solutions inevitably come we serious health side effects that we accept without blinking, as the most natural thing. And the industry also cheers as they can now also sell a second cure to address the side effects of the fist cure.

It shouldn't be forgotten that the pharmaceutical industry is, fist of all, a business.

https://arstechnica.com/tech-policy/2018/04/curing-disease-n...

How is a drug that reduces appetite and eating not solving the root cause of obesity?

Because the root cause isn't a sudden increase in appetite. What caused people's appetite to increase?

>Because the root cause isn't a sudden increase in appetite.

It seems plausible that the introduction of evolutionarily novel ultraprocessed foods, designed by scientists in labs to be as tasty as possible, could increase a lot of people's appetites.

I agree that they might create a positive feedback loop, see for example the ever-present sugar cravings that take a few days-weeks of no dessert or sugar to subside.

The processed foods however is what we’d want to get rid of. Otherwise all we do is slow down the loop, and add in more side effects.

> It seems plausible that the introduction of evolutionarily novel ultraprocessed foods, designed by scientists in labs to be as tasty as possible, could increase a lot of people's appetites.

Bravo. So we also know what we should go after instead of simply compensating the issue with new pills. Because we also know how well the pill approach worked in the US when handling pain..

This would address future generations, after a lengthy analysis and fights about what actually should be regulated and how. It wouldn't do anything for people right now.

So yeah, we could improve the future, but there's also lots of people who need help today and bringing up "but we failed in that one specific case" while being silent about everything else in medicine is silly.

The solution to a problem isn't limited to undoing the cause.

Pros and cons not withstanding, any intervention which reduces obesity is a solution. Think of it like having a flat and thinking that taking the nail out of the tire is the only way to fix it. Replacing the tire also works.

Any permanent solution must address the cause otherwise it isn't a solution, it's at best a band-aid.

The problem with analogies like this is that they make no sense. A medication that suppresses appetite isn't replacing the tire.

Second, replacing the tire is worthless if the road ahead has another million nails on it.

> We, as a society, have absolutely no reason to be obese. Yet, we choose to ignore the root of the problem

This applies to lots of conditions, right? I mean, society has absolutely no reason to have HIV. Just wear condoms and/or be obstinate. Easy peasy, right?

Fortunately, we have medication to treat and prevent HIV. Quite expensive, but they save lives.

We should rejoice that medications have been developed to cure otherwise incurable diseases. But this does not apply to the current case.

When 50% of your population is obese, and a further 33% is overweight, you have a major health crisis at play. And maybe, instead of trying to find better ways of soaking up the leaking water, we should focus on fixing the leak, not matter how great the cleaning products are that are being sold to us.

We've heavily regulated cigarettes, we've heavily regulated (some) life-threatening chemicals, it's time to focus on the rubbish being sold to us as food, and it's time to educate our populations without being too soft on the sensibilities of some, or too lenient towards the commercial interests of others.

> be obstinate

I don't think obstinance only works. Being a curmudgeon doesn't prevent one from having unprotected sex. :)

And I say this as someone who just says no to everything ;)

The main cause of the problem is probably the widespread availability of cheap processed food in the US and, increasingly, other rich countries. I would support regulating these foods, but that would be very politically difficult and it would probably take many years for regulations to gain enough traction to make a difference.

We know from behavioral genetics that, for people in the same environment, individual differences in obesity are about 70% heritable. And there's loads of evidence that the standard "diet and exercise" approach does not lead to long-term weight loss in the vast majority of people who attempt it. (It does lead to shorter-term weight loss, but then people regain the weight, for biological reasons.)

So, short of massive regulation of modern "food products", the only options are either bariatric surgery (which does produce long-term weight loss) or some new intervention. The GLP drugs are the most promising candidates in that category.

I agree that there's too much triumphalism about these drugs at the moment. We don't really know yet whether they will produce long-term weight loss without serious side effects.

Blue cross has $450 / mo negotiated rate. Medicare can do better than that and government has started doing negotiations for drugs.

It's 88 EUR/month in my EU-Baltics country. I'd say it can be made much cheaper here and therefore in the US as well.

I think you're missing the fact that USA, as a very rich country, tends to subsidize drugs for everyone. Your cost is artificially lower as ours is artificially higher.

The only way to make it cheaper in the US is to make your pay more.

Would you mind to explain? My gut feeling tells me you are right but I can not follow 100%.

> The only way to make it cheaper in the US is to make your pay more.

I think this is very unimaginative to claim that the developer/manufacturer costs are fixed in stone and THE ONLY WAY is for customers to zero-sum it amongst themselves.

Most of the cost was in development/trials, the marginal cost of manufacture is probably in the single digits per month. With such an enormous market demand the development costs can be recouped faster and there is a possibility to lower the prices in the states as well.

Also 10x difference points to more systematic differences in the healthcare systems not just altruism of the US citizens.

Corporations are well known for selling things at a loss.

Artificially lower, as in getting lower profit, not as in subsidised. If you're trying to say corps sell ozempic at a loss, that's a big (citation needed).

For comparison, (as far as I know) the drug with the most revenue per year is Humira which costs roughly the same per year and has several million customers globally.

There are several anti-obesity drugs in the pipeline that work through similar mechanisms that should be entering the market which should lower the price through competition.

Heart disease, diabetes, and fatty liver disease are some of the most common killers and the reduction in excess body fat will causally and significantly lower the risks for all of them.

Reply on news.ycombinator.com