The Ozempocalypse Is Nigh
astralcodexten.com
astralcodexten.com
People would just raise the price for pharma stocks then.
Maybe that is a good thing since it would make it harder to buy pharma stocks for others, but the government will still pay too mcuh.
You can order GLP-1 peptides from China for cheap. Once you have the peptide, all you have to do is put it in the right amount of bacteriostatic water. In theory this is no harder than any other mix-powder-with-water task. But this time if you do anything wrong, or are insufficiently clean, you can give yourself a horrible infection, or inactivate the drug, or accidentally take 100x too much of the drug and end up with negative weight and float up into the sky and be lost forever. ACX cannot in good conscience recommend this cheap, common, and awesome solution.
The price for tirzepatide is under $0.50/mg at this point.
That's wild. Even the article author seems to have a tongue in their cheek when issuing this "warning" that is definitely not a hint. Is it safer than it sounds?
You can do group buys with your friends to get a single batch made, then send in a few random samples to a lab for HLPC and sterility testing. This adds a few bucks per month to the total cost depending on the size of your buys. The ancillaries are all US medical grade from various sources and not material to the discussion.
There are no other sources for the raw compounds so it’s all coming from the same place and handful of Chinese finishers if it’s not not direct from Novo or LLY.
If you give yourself an infection with a subq shot you almost have to be trying. The rest is basic math.
There are certainly additional risks involved - but they are not the obvious ones you think of in the first 10 seconds.
If you’re very paranoid, you can get it third party tested again and it will still be way cheaper than buying from a compounding pharmacy.
In fact, I know a few people who get brand pills (Rybelsus) mailed from India, where it's much cheaper. This insane pricing is a US only thing.
For me, I've been at a stable weight for over a decade. I figure if I can drop down over a few months, I can stay at my target weight.
The article also mentions the grey market, where you can buy a year’s worth of power from China for a couple hundred bucks. You do need to be able mix it up properly though.
The drugs are only going to get cheaper with time.
For some reason this suggestion, i.e. the suggestion to solve a problem by eliminating the root causes, does not seem to be popular on this forum. I'd very much like to know why this is given that this place is supposedly frequented by rational people. If eating too much unhealthy food is making you fat you don't solve that by putting a chemical stopper in your veins, you solve it by eating less of the bad stuff.
Most fat people who want to lose weight have already tried eating less food. Just like many alcoholics have tried to cut down or stop drinking. Some of those people succeed, but many others don’t. The reasons why are far more complex than commitment and willpower.
Try this experiment: put a gun to your head and pull the trigger. You may find it hard. Your hand may shake; you will start sweating; rising panic will cloud your thinking.
But it's so easy! Just a couple pounds of pressure on the trigger. Anybody can do it.
That's me substituting a physiological problem for a psychological one.
Weight depends on a complex interaction between many systems of the body. Losing significant weight and keeping it off in healthy way without side effects can be difficult.
There was a good look at much of this in the Nova episode "The Truth About Fat" in 2020. Old Nova episodes are usually behind a paywall if you aren't a member of your local PBS station but occasionally old episodes become free for a while. It might be worth checking occasionally to try to catch it during one of those free periods.
2) They’re rich. Not even that rich. I mean hell we paid $1,500/month for two kids to go to preschool, for years, and that sucked but we could still save. And we had a household income of like $130k or so at the time. Doing fine, not saying we didn’t have alright income, but not that uncommon. Now imagine a two-FAANG income like many folks on here. $1,000/month, even times two, is entirely within reach for them. Also,
3) You can go off it for periods and just go back on if the weight starts to creep up. Anyone who’s successfully maintained weight for periods in the past may be able to manage long stretches without it and not gain much. And further,
4) It’s not going to cost that much for long, in the scheme of things. The price will likely settle in the tens of dollars per month when the patents expire.
Taking in nearly double over the average household income is, by definition, uncommon.
This is incredibly common in many parts of life, humans gonna human I guess.
The first year of that, about 20% of households were around our level of income or higher. We could have covered $1,500 in daycare without much trouble at a somewhat lower level of income, so say 25% could cover $1,000/m without driving themselves into a really, really bad place financially, provided they’ve not already committed that to other things (expensive car payments, they have very young kids in daycare, whatever)
Neither 20% nor 25% are uncommon.
If you’re thinking “well that’s just coastal cities dragging the stats up” then check stats on 3rd-tier but not-notoriously-poor cities and see what they look like. In the flyover state city fitting that description we lived in at the time, the local household income percentile distribution roughly matched the national one.
That’s a TAM of people who can afford $1,000/month for something they really want of, what, 50 million or more adults in the US? And that’s at full sticker price, which few are paying.
How much more than one-in-five before a category of person is not uncommon?
That you perceive it as a complaint is hilariously ironic. I'm just telling you that your notions of "common" are wrong. You are attempting to use your economic situation to justify the outcomes for others. That, my friend, is poor posting.
> about 20% of households
This is super easy. 1 out of 5 is "not common." You can be as parsimonious as you like it doesn't change the ground reality that there are fewer people like you than there are people like you.
> How much more than one-in-five before a category of person is not uncommon?
Weird hill to die on. There's nothing wrong with or your economic situation except your expectation that other people share it. Which they generally don't.
That said, even that is not really all that useful. Anyone who is motivated can get these drugs for around $500-600/mo via programs that exist for the vast majority of the population. That roughly halves the cost comparisons here. Very few folks who want these drugs have zero options other than to pay full retail.
Americans with six-figure incomes seriously don't understand the rest of the country lives.
Why should GLP-1s be any different?
$1000/month seems like a lot. Although if you end up eating significantly less, there's some savings there.
Bonus is you no longer crave expensive sugary or alcoholic drinks and food.
No one actually pays that price. The $1000 misrepresented in the article as the "usual insurance price" is actually the list price, from which insurers negotiate discounts (that is, the full price -- not just the out of pocket price charged to the insured -- for insured patients is significantly less than that $1000 price), while most people who get the drug outside of insurance get it through some program (if it is the actual, brand-name drug, run by the manufacturer) that also charges much less than the list price.
I don't really understand what all that extra complexity achieves?
And a reminder that companies always do better if they make more money, not point in purposeful losses (unless you are getting a side benefit like goodwill from charity).
That's not at all how it works so they don't have any idea what they're talking about. This is like when people say businesses can "write it off on their taxes". Only people who don't know what that really means say it.
That said, a lot of the time, inentionally or not, the answer is "it facilitates the transfer of money to the shareholders of the big private health insurance companies"
Of all the industries in the US Health Care is the MOST regulated. How on earth is that "unchecked"? The problem is the checks are (and always will be) written by the companies.
Healthcare has a lot of regulations, for sure, but it adds a lot of complexity doesn't result in a good system for users -- so, bad regulation. OTOH, I think FSI regulations like Glass-Steagall and Dodd-Frank, as well as regulatory agencies like the SEC and CFPB (gasp!), have been huge successes for retail users of banks and financial markets -- so, better regulation.
Everything else is some weird sneaky BS.
Again not an expert. Just a guy who had to listen to some awfull training courses.
"Save" is defined as list price minus contracted price that the insurance pays for the drug.
PBRs manipulate the list price to be higher so that they "save" the insurance company more money.
They also manipulate the co-pays so that patients will choose drugs that "save" the most, as opposed to the lowest price drug.
Different payers will come up with their own unique take on health care coverage prices, favoring some things (lower costs) over others. Some may favor prenatal care and maternity, some may favor meat-and-potatoes basic health needs over specific categories of care. Larger payers may get a percentage point or two average-over-everything lower, smaller ones may favor a particular subcategory to create what they feel is a "good enough but still competitive in some key marketable categories" package. Each one is bespoke and quite varied.
From the outside, it can look insane: you walk into a hospital and ask how much a procedure costs, and the person at the desk is honestly confused and honestly has no answer. The reason? The cost is entirely relative to the cost structure package hammered out by a specific insurance company - there isn't really a fixed "cost" per se.
It is a perverse incentive created by the government insisting on the lowest price but having a very high overhead cost to deal with relative to everyone else that has to be paid for. Far from ideal but that is where we are. Quite a few fake prices in regulated markets can be explained by the government requiring that they receive the lowest price while incurring an unusually high cost overhead to the vendor.
I have literally no skin in the game. Speaking as one of the winners in this charade, this whole thing is so stupid. It makes you wonder why they don't set drug MSRPs even higher.
With respect, that is absolutely incorrect. People absolutely pay over $1000 and do so monthly. For example, Kaiser of Northern California makes it very difficult for their doctors to prescribe these, and nearly impossible to get a prescription for Monjaro (which is particularly effective). Therefore, Kaiser patients/insured for whom these drugs are of immense benefit but who must have their prescriptions from out of network physicians receive ZERO insurance coverage. This means they get neither the negotiated insurance price discount nor any co-pay on the full cost. I am directly aware of this. And it is a travesty. Yet the benefits of these drugs is so significant and uniquely available through these drugs that in a sense, if it is possible to pay, then pay one must. Because in effect they are invaluable.
The only folks not covered by the latter mostly either have no insurance or Medicare.
That said, many folks take a few months to figure out these programs exist, and some consumers simply never do the research.
Pharmacies have to have crazy high prices though because PBMs reimburse at such shit rates, based on some percentage of the price given to them. Because if they buy the bottle at $30 and list the price at $60, the PBM contract will only reimburse at the adjusted wholesale price (another made up number), eg: 17% plus a $1.99 dispensing fee. This disgusting math results in getting a loss on the drug.
Even all this leaves out some of the most absurd abuses of PBMs. They set minimum drug copays, have the pharmacy collect a $15 copay for a $5 drug, and have the pharmacy pay the PMB the $10 difference. They make it a breach of contract for the pharmacy to inform the patient this is happening or to charge the $5 and bypass the insurance. The total lack of anything even approaching ethnics is absurd...
This is an extremely politicized question in the US, where a public health insurance option (a solution that's popular in much of the rest of the OECD) is fiercely opposed by a large swath of the population.
At the very least though, in an ideal world, payers, providers, pharmacies, and PBMs should not be allowed to be part of the same company.
And yes, get rid of PBMs. They are toxic middlemen who want their 'cut' for doing nothing at all.
See Gale (2023): https://pmc.ncbi.nlm.nih.gov/articles/PMC10441264/
The hard part is discovering them and proving they're safe and effective.
We already know that the compounding pharmacies violate patent law. Why should I believe they follow any other regulation?
https://www.pnas.org/doi/10.1073/pnas.2415550121
And this type of drug lends itself to some of the least expensive trials you can hope for. The dosage level, expected dosing period, and measurement of outcomes are all uniquely well suited to inexpensive study. The trials were also exceedingly fast and quickly broke off into testing for all kinds of conditions such as Parkinsons but for the core case of weight loss it was as easy as it gets.