"Outrageously" priced weight-loss drugs could bankrupt US health care
arstechnica.com
arstechnica.com
Serious question: Why not just bootleg the stuff?
It's a very small protein, easy to make, and "research chemical" companies that sell structurally similar bodybuilding drugs and nootropics are a dime a dozen. Search online for "BPC-157" (a protein drug of only slightly inferior complexity) and you'll find a million places that sell it at $25 for a month's supply. Those vendors are legitimate far more often than not.
If Novo Nordisk won't sell to humans at a humane price -- instead preferring to gouge insurance companies and the gatekeeping medical bureaucracy -- I'd argue that there's a moral imperative to bootleg the drug and distribute it to those who would benefit from it at a fair price.
And, unlike many of the bodybuilding drugs (which are a big business,) these new weight-loss drugs aren't scheduled, so you won't get in much trouble even in the unlikely event you are caught.
Nobody in government wants to accept IPR is broken but they'll find a way to bend it's ruling into a hoop, for the specific needs of the moment.
That describes a decent chunk of the tech industry!
So high semaglutide pricing won't end up "bankrupting" the US medical system. It'll push an ever larger number of patients -- and more than a few well-meaning doctors, who already recommend things like BPC-157 -- into the gray market. That this would further delegitimize the medical establishment and FDA would be a well-deserved outcome.
I think you are confused about what a compounding pharmacy is -- at least if you refer to how it works in the US.
It's still expensive, but far cheaper than brand name with similar efficacy. Competition from these programs will likely drive costs much lower over the next few years.
Blockbuster drugs still under patent usually don't have alternative avenues of supply that are significantly cheaper than the main avenue. I wonder what law or regulation allows this alternative avenue to persist.
These are first mover prices.
What's the monthly health cost of being obese?
The reason compounding pharmacies are very useful in the US is not because the process of compounding is useful; it's that they have carveouts in regulations that make it hard for the FDA to control them. When there is a drug that is useful and safe, but not approved by the FDA for the purpose you want to use it, you can often get it from a compounding pharmacy.
Semaglutide is a GLP-1 agonist. There are many other GLP-1 agonists, of varying efficacy and side effects, and many of them which a compounding pharmacy can purchase in bulk at very reasonable prices. However, only Semaglutide has been FDA approved for the indication of weight loss, and being the sole approved product means they can milk their patent-granted monopoly for a ridiculous amount of money. Simply because without FDA approval, you cannot get the other similar drugs for the purpose of weight loss. Unless you go to a compounding pharmacy, which, for dumb historical reasons, happen to have loopholes in FDA regulation, so long as they are artisanally producing compounded drugs tailored to a specific individual.
Why not do away with patents and IP altogether if the standard is that as soon as someone makes something needed it can be stolen?
The irony that, were it not priced outrageously, it could save the health care industry billions as these people with obesity will otherwise require epesneive treatments if the remain obese.
Why not carve out a new exception for breakthrough drugs that have the potential to add X% to the GDP or save X lives/annum?
This ain’t it though.
"Could" is doing a lot of work there. We don't really know what to expect for these patients 20 or 40 years out.
Long-term outcomes and population-scale polypharmacy risks are not really clear, and won't be for decades.
These drugs enable a valuable intervention for individuals at high risk of health hazards and it's fantastic that they're available, but the perspective changes when you look at outcomes for tens (hundreds?) of millions of people over long spans of time -- there are a lot of inescapable unknowns. One can't actually be sure that the benefits of fast, widespread use will outpace the costs, or at what scale.
Many genuinely effective drugs have gone through exactly this kind of hype cycle only to lead to regret, embarassment, and/or skepticism later on.
Good science, and the good public policy that's informed by it, moves slowly.
A truly harmless weight-loss drug is the white whale of the pharmaceutical (assuming it can be profitable enough to offset the losses that would go along with the decrease in needed treatment for problems ancillary to obesity). These drugs, so far, seem pretty good but some of the side effects should take the shine off for people who thing this is ”The Cure” for obesity.
0) https://en.wikipedia.org/wiki/Birth_defects_of_diethylstilbe...
Semaglutide was approved in 2017 and been very widely used (>9 million people). That's been wide & long enough to determine that risks are either exceedingly rare or significantly slow acting.
OTOH the risks and costs of obesity are massive and well known. We're weighing massive known benefits against risks that are either rare (likely less than 1 in a million) or take decades to manifest.
Like in software, pretty sure the main expense is R&D.
The real difference between the two sectors is that for medicine, you have a captive audience. People are willing to give up their life savings for certain medical interventions. That same cannot be said for software.
There are, of course, also instances of gouging. But it’s not like these things should inherently cost $20/mo, or whatever, if you want to be able to pay biomedical researchers enough not to go do something else highly compensated like finance/consulting/whatever. Sadly, I had a lot of classmates in engineering school who went that route instead. We urgently need more nuclear reactors, but one of the smartest guys I know, a nuclear engineer, is doing healthcare private equity.
A lot of saas is more like $200+/mo for businesses, and chatgpt might be $20/mo for consumers, but there are companies paying $1m/mo or more for that api.
Personally I'd rather have a system where these kinds of innovations are made and where they eventually become widely available than a system where govt or others forcefully take or force-price an innovation, thus harming future innovations.
laughs in anarchist don’t threaten me with a good time!
We also need to differentiate “theft” (actually taking a tangible thing) from “ripping off” (stealing an idea and making that thing yourself).
Theft is bad (depending in who you steal from and why), ripping off is only bad if you believe current economic models/practices are good. But
I’m only talking about conceptually since this doesn’t account for the consumer’s safety. In practice one downside to unregulated markets is they get exploited by bad actors for profit by making inferior products that harm consumers, unlike regulated markets that get exploited by bad actors for profit through regulatory capture.
A. The issue becomes creating a manufacturing and cold chain distribution system involving the fewest people with compartmentalized knowledge. I'm not sure how you'd launder it or keep enough of it a secret to not get eventually busted because someone would open their mouth. It'd probably be busted with RICO if any sort of profits were involved. Must pay taxes, for sure.
B. DIY chems home pharma kit is another approach.
C. Traffic from other countries like France at near cost prices.
D. Send patients to low-cost countries to buy up medications for their own personal use, and post or FedEx it back to themselves in bulk.
E. Hold politicians accountable and make the FDA and FTC set hard limits on price gouging so that Medicare, health insurance co's, and American patients aren't overcharged. You'd think health insurance co's would be right out in front complaining about the high cost of medications and lobbying for change.
Aren't this what "corporations are people" prevent? Plenty of people doing shady, or outright evil stuff, get their way because they're behind a corporation.
Evil or shady acts must first be illegal to be potentially prosecutable crimes or be injurious to have standing as tort claims. And limited liability isn't unbounded.
Historically, the black market for medication has been vanishingly small. People don't as a rule trust drugs they get off of alibaba or wherever; even the viagra gray market is a small fraction of the prescription revenue.
And this doesn't treat something critical, it's a weight loss drug. To be blunt most people would probably choose to remain fat vs. buying an illegal generic.
Wow, I think the exact opposite. Weight loss is a huge industry and people are desperate.
Technically, compulsory licensing is allowed under TRIPS (https://www.wto.org/english/tratop_e/trips_e/public_health_f...). But the US and others opted out of this (https://www.wto.org/english/docs_e/legal_e/31bis_trips_annex...).
The other reasons are:
1/ Even the manufacturer doesn't know everything about how the drug was made. They characterize the final compound but the compound was made by some sort of living cells so each one has different properties. For the same molecule, one cell line may produce a drug with entirely different toxicology profile compared to another. You need a full manufacturing chain with different departments analyzing it at different stages to guarantee the desired effect.
2/ Patents make sure that the vanishingly few groups with the capability to do the above characterization would not want to risk their business doing it.
3/ For every one molecule that made it to market, dozens or hundreds of others were discarded. They all cost about the same amount to develop up to the point they were thrown away. Due to the amount of regulations in place, the cost to research is obscene and the final manufacturing cost is peanut compared to the price of the pipeline what the drug went through.
If the grey market is cheaper than you would pay for the real drug after insurance’s contribution, who cares?
Novo Nordisk's patent -- US8129343B2 -- lays out the process, which is nothing more than Fmoc solid state synthesis. "The protected peptidyl resin was synthesized according to the Fmoc strategy on an Applied Biosystems 433 peptide synthesizer in 0.25 mmol or 1.0 mmol scale. . ." So they don't make it in cells, but by totally conventional peptide manufacturing techniques.
As for #2, you must be unfamiliar with the existing gray market for pharmaceuticals. Among others, both the bodybuilding community and the nootropics community experiment extensively with pharmaceuticals -- and they do drug synthesis and distribution in a way that's actually extremely cost-effective! (Necessarily, because their customers are humans who pay out of pocket directly.)
#3 is trite and overstated. It's a standard drug industry talking point, but it really has no bearing on this discussion.
because the US is largely responsible for the rich world's tyrannical patent and copyright laws?
No need to pirate, just kick in gear the Great White express.
Novo Nordisk is a Danish company. Read that again: it is European.
Why would you suggest more government to a government created problem? Usually because people don't realize the government as the root cause in the first place. Get the government out, let people actually pay for their own health care, so they actually 'care' what they're paying. Use insurance for the exceptions cases. And social programs for the people who really can't afford it.
Capitalism actually works if you let it.
Right. This is why drugs like BPC-157, mentioned above, go for $25/month. There's a lot of competition on the gray market, and often the only way for vendors to differentiate themselves from the pack is on pricing, so drugs rarely if ever sell for more than double their manufacturing cost.
In the world of legitimate patented pharmaceuticals, the manufacturing cost is not even a consideration. It is often -- as it is here -- less than a single percentage point of the sale price.
This argument is always that if the government would just step out of the way the private market would provide for everyone and there would be full employment. As though somehow things like minimum wages and OSHA are what keep capitalism from reaching its full potential. As though things were better in the 19th century.
I've read Friedman and Hayek. The world they wanted is a terrifying world indeed.
When companies stop competing with each other, and start trying to suck as much money out of the government that they can - that's when things fall apart.
This is so hilariously wrong I'm not even going to address it.
You either pay for things up front with taxes, or you pay for them later by way of inflation. There's no free lunch.
The government has chosen inflation. Really at this point they'd save money by shutting down the IRS, dismantling the entire tax system and just pay for things by printing what they need. Inflation is the ultimate flat tax.
Exactly.
Let's take this further. Nobody should be making money off other people's suffering.
So.
Let's also zero out doctor's and nurse's salaries.
Hospital administrator's salaries.
This would also apply to all charities that try to alleviate any suffering. No administrator should make any money off other people's suffering.
The only profitable enterprise should be showing ads!
These same people are the ones who formulated a chemical that works, proved that it works, proved that it is safe. That same chemical improves the health of the population saving billions in costs and quality adjusted life years. So just describing it as just a manufacturing cost is disingenuous.
And you know this, but you think you're being clever. It's not clever.
https://old.reddit.com/r/unitedkingdom/comments/1cn8dy8/what...
Look at how many times NHS is referenced and how it is viewed by those utilizing the system. In my opinion, socialized medicine tends to fail as the overall demand for healthcare will usually exceed the available supply in most societies.
I'm sure there are counterexamples to be provided; however, I think the benefits of a capitalist healthcare system are underappreciated.
That’s what “demand” represents in this equation. Not people who want faster cars or different colored Stanley cups, but access to life saving drugs and treatment. I’m not saying para-socialized systems are better (it’s capitalism with a wig) but the “benefits” of capitalism are nowhere near equally shared and in fact highly concentrated at the top. The benefits are in fact over-appreciated by those who have them and they will do anything to keep the dirt people away from their stash.
I don’t have a solution, but my point is praising mass death for the squalid masses is tacky and I personally wouldn’t do it on public forums.
*edited for spelling error
And where do you see me praising mass death?
Further edit: I would go far enough to say you lack any understanding of our current healthcare system besides meaningless feelings on how it should be in a utopian society. Resources are not limitless. There is a continual shortage of healthcare providers which there are no good solutions for currently. If you don't want to address this reality, there is really nothing to address at all.
What benefits? The benefit of mortgaging your home to pay for cancer treatment? The benefit of having your access to healthcare directly tied to your employment (especially considering that many wage workers are kept from working more than 35 hours a week lest they become eligible for employee sponsored health plans)? The benefit of having folks like Martin Shkreli corner the market on generic drugs and raise the prices, not because manufacturing costs have risen but because they are seeking windfall profits?
Seriously, what benefits? We have this silly notion that capitalism provides us with choice, and that this choice is a desirable good in itself. Choice is overrated. Health care is a commodity. You walk into any doctor with a broken arm, diabetes, COVID, pneumonia, depression, or any one of hundreds of other maladies, and the treatment for those will be the same regardless of the physician or the hospital or the clinic.
Those same people you say can't afford healthcare are the ones that are heavily subsidized by others through ACA, free community health plans, or Medicaid.
Healthcare is not a commodity despite your claim. It requires labor.
It seems most people are generally satisfied with their health insurance in the USA as opposed to the UK (see links below). In fact, the satisfaction from employer provided healthcare was much higher pre-ACA than it is currently. The middle class got shafted with increased premiums and deductibles to help subsidize those with low income. This has led to lower healthcare utilization rates in the middle class. The rich don't care since it's a marginal cost relative to their income/wealth. And, the biggest spenders (elderly) don't care since they are mostly on Medicare.
Most of the countries that report high satisfaction with their socialized medicine are both rich and have a low population count.
---
https://www.kff.org/private-insurance/poll-finding/kff-surve... Most insured adults (81%) give their health insurance an overall rating of “excellent” or “good,” though ratings vary based on health status.
https://www.nuffieldtrust.org.uk/news-item/public-satisfacti... Overall public satisfaction with how the NHS runs now stands at 24%
Wrath brings Heart Disease.
Sloth causes osteoporosis.
Polygamy risks the manifestation of a malformed body&mind when your random scattered offspring begin dating each other years after your death (centuries before Birth Control "cured" pregnancy).
Sullen faces, hunched posture, double chins, pot bellies - evidence of a derailed populace convinced to open the floodgates of desire. Your curse is a Cattle Car Healthcare System.
Eat less, do more. Pain is Weakness Leaving the Body.
Lest the Fast Track sequesters even more useful talent.
The clergy knew this, but you would rather overrule judgement with surgeries and pills (clean-up crew salary&options).
Morality is about someone else's tomorrow, because you will not be abandoned (despite your folly). Citizen Upkeep described in the form of iambic pentameter and parable.
The last time using 28 USC 1498 was proposed in the pharma sector, it involved ciprofloxin. The pharma industry panicked. Suddenly, ciprofloxin became much cheaper.
It states that “at their current prices, [anti-obesity medicines] would cost the federal government more than it would save from reducing other health care spending—which would lead to an overall increase in the deficit over the next 10 years”
If you gave a vaccine 100% effective against cancer to 18 year olds it would probably look like a money loser on a 10 year timeframe but that's clearly not the window to measure.
… and that reason is because obese people have lower lifetime medical cost. Anything that reduces obesity will tend to increase long-term healthcare spending, because it’s cheaper to die of congestive heart failure at 50 than to live to 80 and incur a couple hip replacements and a bunch of expensive end-of-life care.
(technically it varies by country, depending on their particular allocation of end-of-life spending vs earlier care, but generally the expected cost of a 1-unit BMI reduction is more likely to be neutral or positive than an overall total reduction. And the US is even worse since we weight spending enormously heavily towards senior care due to Medicare - someone dying at 40 is a very cheap outcome for our system.)
> A one-unit decrease in BMI showed gains in life expectancy ranging from 0.65 to 0.68 year and changes in total health care costs varying from -€1563 to +€4832.
https://pubmed.ncbi.nlm.nih.gov/37222003/
Skinny people have been absolute bastards about the whole thing from the start, they don’t want to lose the ability to look down on and belittle a class of sub-humans, they want to smirk and tell people to eat less and work out more, and losing that underclass will hurt their own perceived social standing. So now that there’s a drug that helps people eat less, it needs to be argued against strenuously lest that eventuality come to pass.
That’s why you’re seeing the moralizing and “they should lose weight without medical assistance!!!” come out instantly yet again. It was never about actually wanting them to lose weight per se, it was about the ability to moralize to an underclass who that group argues deserves their status - the whole “my assholery is an incentive to lose some weight!” school of thought that is so prominent.
Semaglutide and the class of drug is overall extremely well-studied, well-tolerated, and effective at treating several different families of chronic medical problems around the reward system of the brain. And that’s frankly terrifying to a large group of people who are low-key bigots and are facing the loss of their favorite punching bag. Like what if there was a drug that you just took it and 90% of people lost significant amounts of weight? That’s terrifying to a group of people who without a subclass to look down on will now move down a rung on the social ladder themselves.
The black mirror with the exercise bikes nailed it. People want to toss soda cans at fatties forced to work menial subclass jobs and tell them to lose some fucking weight, that’s what it’s always been about in this discourse from the start. They just can’t quite get away with physical assault in our reality, but they’ll certainly endorse emotional abuse and unequal treatment, “for their own good” etc.
It’s just a shame that this sentiment has also hindered the ability to look into endocrine disruption or gut microbiome etc. There are lots of interesting things that skinnies were too emotionally vulnerable to allow research into, that have just been vaulted over by semaglutide.
The solution to the drug price crisis is for the US to stop subsidizing the rest of the developed world.
The US should set a rule saying that it will not pay more than the price the drug company charges to any developed country.
I don't think its resonable for most people to continue taking GLP-1 antagonists all their lives. Its been widely shown that most people rapdily gain back ~2/3 of their weight after stopping semaglutide. This means that the people who lost weight did not build sustainable weight management habits during their time on these drugs.
IMHO a better solution would be to design individualized weight loss programs which would help people build sustainable healthy eating habits, and change their relationship to food while using GLP-1 as a tool to help the process and motivate people. I understand that is much easier said than done, especially at such a large scale.
Maybe the answer lies in a combination of various actions, some ideas include,
- Medicare and Medicaid negotiating to reduce the cost
- Possibly offering lower/higher dosages based on needs to better manage cost
- Offering incentives/discounts when GLP-1 is used in-combination with health coaching.
- Offering GLP-1 drugs with lifetime maximums similar to Orthodontic procedures such as braces or clear aligners, with some exceptions based on medical needs.
- Reduce food deserts, especially in rural and low income areas.
- Penalize companies which sell seriously addictive / unhealthy foods. We did that with Cigarettes! Unhealthy diets filled with addictive sugary processed foods cause similar harm to families, society, and future generations.
Why not? People take statins or beta blockers for the rest of their lives. Sure it's not that feasible at current US prices but they won't be that expensive forever.
But why? Plenty of chronic conditions require chronic medication (e.g. insulin).
A woman I know has been on this stuff for a couple years now and while she has plateaued for about 6 months, her current weight is now in a healthier spot.
It’s crazy what losing some weight can do to people’s mental health too. Like her home is more organized, she’s more active with walking (doesn’t hurt anymore), she just overall describes not fearing food anymore.
And now for the bad news, her insurance no longer covers it. It’s kind of insane but apparently this stuff has a black market, like she buys it from one of her coworkers like it’s some sort of street drug.
In summary I think we need more time to see but from what I’ve heard this does seem to be a long-term solution similar to insulin shots if you had to compare to something existing.
> And now for the bad news, her insurance no longer covers it.
This is one of the reasons why I think these GLP-1 drugs are going to be classified by insurance as a temporary tool to help people improve their health. Rather than a long term medical necessity like insulin.
> I think we need more time to see
I agree with this statement, we definitely need more time. We don't fully understand the long term effects of GLP-1 in large populations.
I'm in the camp of, if its possible to use GLP-1 as a ramp to building sustainable habits and then wean off the drug, then as many people as possible should be weaned off.
Probably this will be the next patent-ever greening strategy pursued after the weight loss thing.
It’s an absolutely wild drug in medical terms. “The white whale” is an understatement here. It literally is a white whale for multiple whole fields of medical science.