7 ms·

"Outrageously" priced weight-loss drugs could bankrupt US health care

45 points by psychanarch 2y ago

moneytide1 2y ago
If you feel guilty encountering the pleasures of vice, then I am less likely to be expected to produce sons&daughters destined to become diabetes clinicians instead of astronauts. 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.
A_D_E_P_T 2y ago
> A study by researchers at Yale estimated that drugs like Wegovy can be profitably manufactured for less than $5 per month. 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.
- loloquwowndueo 2y ago
  Patents?
  - ggm 2y ago
    I believe the most likely outcome is a price curve downwards as Novo nordisk is quietly forced info JV with US manufacturers under implicit threat of some one-off ruling akin to an IPR eminent domain action. 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.
  - redwoolf 2y ago
    When it comes to pharmaceuticals, the patents are ridiculous. Take for example Contrave[0]. It is a combination of Naltrexone and Bupropion, both of which are no longer under a patent. Put them both in the same pill and it's under a new patent. [0] https://en.wikipedia.org/wiki/Naltrexone/bupropion https://en.wikipedia.org/wiki/Naltrexone/bupropion
    - 3abiton 2y ago
      So buying them separately and mixing them in your mouth is legal? It's like combining 2 pieces of open-source software and selling them under one product.
      - clipsy 2y ago
        > It's like combining 2 pieces of open-source software and selling them under one product. That describes a decent chunk of the tech industry!
      - redwoolf 2y ago
        Totally legal. You can have your doctor prescribe 50mg Naltrexone and 300mg Bupropion and you can take them at the same time every day. It's the same drugs in the same ratios. Contrave is not novel in any way. There's substantial prior art. And yet a patent was granted to cover this combination and prevent anyone else from taking two generic drugs and combining them into one pill.
redwoolf 2y ago
The USA should nationalize the health care industry and all the pharmaceutical companies. Illness should not be a source of profit.
- andsoitis 2y ago
  > The USA should nationalize the health care industry and all the pharmaceutical companies. Novo Nordisk is a Danish company. Read that again: it is European.
  - AequitasOmnibus 2y ago
    Nationalized healthcare doesn’t stop at a pharmaceutical manufacturer’s borders. You think NHS or any other country with socialized medicine pays what the US does? With socialized healthcare the pharmaceutical companies pay what the nation dictates or it doesn’t do business with that nation. I highly doubt Novo Nordisk would write off the US if it went to Medicare for all.
  - redwoolf 2y ago
    Not really sure what that has to do with anything. It would be easy for the USA to keep Novo Nordisk from doing business within its borders and have a nationalized pharmaceutical company produce the drugs at cost.
- JKCalhoun 2y ago
  I recall when we hiked to to Canada to get the same drugs at a fraction of the price. No need to pirate, just kick in gear the Great White express.
  - lesuorac 2y ago
    Dallas Buyers Club needs to go north
- bottlepalm 2y ago
  Like education, government involvement only causes prices to go up. Why wouldn't they? The government has unlimited money. The education and healthcare industry beats the government like a money pinata. 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.
ungreased0675 2y ago
Isn’t obesity responsible for massive healthcare costs? What about quality of life?
- schmidt_fifty 2y ago
  [dead]
tempsy 2y ago
This is silly because it doesn't take into consideration all the health issues that are alleviated when people stop overeating and get down to a normal weight
- jlund-molfese 2y ago
  Which ones weren’t accounted for in the CBO report, which tried to take into consideration other health issues (from a financial perspective at least)? 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”
  - khuey 2y ago
    I know 10 years is the standard CBO timeframe but are we sure it's the correct one for a drug like this? 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.
  - paulmd 2y ago
    > 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” … 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/ 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.
mataug 2y ago
My hot take on these GLP-1 drugs is that they won't work long term for most people. If the plan is to give the drug to as many obese people as possible and take a victory lap, thats going to fail. 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.
- khuey 2y ago
  > I don't think its resonable for people to continue taking GLP-1 antagonists all their lives. 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.
- epylar 2y ago
  > I don't think its resonable for people to continue taking GLP-1 antagonists all their lives. But why? Plenty of chronic conditions require chronic medication (e.g. insulin).
- willio58 2y ago
  While I 100% agree that GLP-1 antagonists won’t lead most to making actual changes to their behaviors with food outside of forcing them to not over-eat when actively taking the drug, I am not so sure about your hot take here. 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.
RcouF1uZ4gsC 2y ago
> If Novo Nordisk set its US prices for Wegovy to match the Danish price, spending to treat half of US adults with obesity would drop from $411 billion to $94.5 billion, a roughly $316.5 billion savings. 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.
aaron695 2y ago
[dead]
Animats 2y ago
The Government could manufacture the drug itself under 28 USC 1498.[1] "Reasonable and entire compensation" to the patent holder is required, but previous cases indicate that does not authorize a huge markup. 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. [1] https://www.law.cornell.edu/uscode/text/28/1498 https://www.law.cornell.edu/uscode/text/28/1498
more_corn 2y ago
The savings in reduced diabetes, heart disease and cancer would make up for it.
black_13 2y ago
[dead]
deleted 2y ago
[deleted]
deleted 2y ago
[deleted]
bitcharmer 2y ago
The healthcare system in the USA is designed to make the people bankrupt first due to medical debt

45 points by psychanarch 2y ago

If you feel guilty encountering the pleasures of vice, then I am less likely to be expected to produce sons&daughters destined to become diabetes clinicians instead of astronauts. 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.

A_D_E_P_T 2y ago

> A study by researchers at Yale estimated that drugs like Wegovy can be profitably manufactured for less than $5 per month. 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.

loloquwowndueo 2y ago
Patents?
- ggm 2y ago
  I believe the most likely outcome is a price curve downwards as Novo nordisk is quietly forced info JV with US manufacturers under implicit threat of some one-off ruling akin to an IPR eminent domain action. 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.
- redwoolf 2y ago
  When it comes to pharmaceuticals, the patents are ridiculous. Take for example Contrave[0]. It is a combination of Naltrexone and Bupropion, both of which are no longer under a patent. Put them both in the same pill and it's under a new patent. [0] https://en.wikipedia.org/wiki/Naltrexone/bupropion https://en.wikipedia.org/wiki/Naltrexone/bupropion
  - 3abiton 2y ago
    So buying them separately and mixing them in your mouth is legal? It's like combining 2 pieces of open-source software and selling them under one product.
    - clipsy 2y ago
      > It's like combining 2 pieces of open-source software and selling them under one product. That describes a decent chunk of the tech industry!
    - redwoolf 2y ago
      Totally legal. You can have your doctor prescribe 50mg Naltrexone and 300mg Bupropion and you can take them at the same time every day. It's the same drugs in the same ratios. Contrave is not novel in any way. There's substantial prior art. And yet a patent was granted to cover this combination and prevent anyone else from taking two generic drugs and combining them into one pill.

redwoolf 2y ago

The USA should nationalize the health care industry and all the pharmaceutical companies. Illness should not be a source of profit.

andsoitis 2y ago
> The USA should nationalize the health care industry and all the pharmaceutical companies. Novo Nordisk is a Danish company. Read that again: it is European.
- AequitasOmnibus 2y ago
  Nationalized healthcare doesn’t stop at a pharmaceutical manufacturer’s borders. You think NHS or any other country with socialized medicine pays what the US does? With socialized healthcare the pharmaceutical companies pay what the nation dictates or it doesn’t do business with that nation. I highly doubt Novo Nordisk would write off the US if it went to Medicare for all.
- redwoolf 2y ago
  Not really sure what that has to do with anything. It would be easy for the USA to keep Novo Nordisk from doing business within its borders and have a nationalized pharmaceutical company produce the drugs at cost.
JKCalhoun 2y ago
I recall when we hiked to to Canada to get the same drugs at a fraction of the price. No need to pirate, just kick in gear the Great White express.
- lesuorac 2y ago
  Dallas Buyers Club needs to go north
bottlepalm 2y ago
Like education, government involvement only causes prices to go up. Why wouldn't they? The government has unlimited money. The education and healthcare industry beats the government like a money pinata. 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.

ungreased0675 2y ago

Isn’t obesity responsible for massive healthcare costs? What about quality of life?

schmidt_fifty 2y ago
[dead]

tempsy 2y ago

This is silly because it doesn't take into consideration all the health issues that are alleviated when people stop overeating and get down to a normal weight

jlund-molfese 2y ago
Which ones weren’t accounted for in the CBO report, which tried to take into consideration other health issues (from a financial perspective at least)? 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”
- khuey 2y ago
  I know 10 years is the standard CBO timeframe but are we sure it's the correct one for a drug like this? 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.
- paulmd 2y ago
  > 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” … 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/ 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.

mataug 2y ago

My hot take on these GLP-1 drugs is that they won't work long term for most people. If the plan is to give the drug to as many obese people as possible and take a victory lap, thats going to fail. 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.

khuey 2y ago
> I don't think its resonable for people to continue taking GLP-1 antagonists all their lives. 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.
epylar 2y ago
> I don't think its resonable for people to continue taking GLP-1 antagonists all their lives. But why? Plenty of chronic conditions require chronic medication (e.g. insulin).
willio58 2y ago
While I 100% agree that GLP-1 antagonists won’t lead most to making actual changes to their behaviors with food outside of forcing them to not over-eat when actively taking the drug, I am not so sure about your hot take here. 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.

RcouF1uZ4gsC 2y ago

> If Novo Nordisk set its US prices for Wegovy to match the Danish price, spending to treat half of US adults with obesity would drop from $411 billion to $94.5 billion, a roughly $316.5 billion savings. 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.

aaron695 2y ago

[dead]

Animats 2y ago

The Government could manufacture the drug itself under 28 USC 1498.[1] "Reasonable and entire compensation" to the patent holder is required, but previous cases indicate that does not authorize a huge markup. 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. [1] https://www.law.cornell.edu/uscode/text/28/1498 https://www.law.cornell.edu/uscode/text/28/1498

more_corn 2y ago

The savings in reduced diabetes, heart disease and cancer would make up for it.

black_13 2y ago

[dead]

deleted 2y ago

[deleted]

deleted 2y ago

[deleted]

bitcharmer 2y ago

The healthcare system in the USA is designed to make the people bankrupt first due to medical debt