A PBM Study Clouds the Reality of Weight-Loss Meds (Plus an Infallible List of the Top 10 Stories of the Week)

Welcome to Cost Curve Weekend, the once-a-week summary version of my daily email newsletter. Congrats to United Healthcare, which said yesterday that it is now booking nearly $2 billion in pure profit every month. So if you’re wondering where your health care dollars are going, well, there’s part of your answer.?

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Oh, this is clever.?

I woke up Tuesday to this Reuters headline: “Exclusive: Most patients using weight-loss drugs like Wegovy stop within a year, data show,” which was nothing if not eye-catching.?

The lede made reference to “an analysis of U.S. pharmacy claims shared with Reuters,” which got me scrolling to figure out the sourcing. Who did the analysis? Where was it published? What kind of data was the analysis built on??

I had to read for a while, but there -- in the ninth paragraph -- was the source: Reuters got their exclusive from Prime Therapeutics (which pushed out its own release later that day).?

What a PR coup for Prime, which had its data giving the sheen of respectability through smart media relations. (The Reuters “exclusive” was linked to without comment by Axios, Politico, and STAT’s DC Diagnosis and Pharmalittle newsletters.)

I’m being snarky here, because the conclusions -- only 32% of patients remained on drug for a year, and those patients on the medicine had higher health care costs after they started the drug -- seemed to be overstated, a point that STAT’s Damian Garde made in his Readout newsletter.?

There was no data on why patients stopped the drug. The piece speculated that it was due to financial constraints and side effects, though one could just as easily spin a story that patients stopped the med once they hit a goal weight.?

As for the financial piece, obesity is a chronic disease, where the economic burden often falls in the future. Claiming that patients had higher spending over the short term isn’t particularly surprising, but the possibility that those patients will be less likely to develop diabetes or suffer heart disease in a few years is real. (We’ll get more data on that in the weeks and months to come.)

The lesson: consider your sources, and act accordingly.?

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The Infallible, Rank-Ordered Top 10 Value/Access Stories of the Past Week:

1. It’s been a long time since I saw something as interesting as news that Brenzavvy, a new SGLT2 -- the blockbuster class that includes Jardiance and Farxiga -- is coming to market with a cash-only price and a deal with Mark Cuban. I’ll get deep on this next week in Monday’s Cost Curve email. (As always: you can subscribe here.)
2. The GoodRx/CVS Caremark tie up suggests that there is a fundamental shift in how pharmacy benefits are being delivered, though I have so many questions (some of which Adam Fein has already outlined). The public relations execution here is noteworthy, too, and I’ll go at that in Tuesday’s Curve.
3. There was a Senate report on how no one seems to have Lilly’s $25 insulin in stock (or, if they do, it’s not priced at $25). And while I take the results of the survey at face value, it’s not clear to me what’s going on. The report certainly didn’t explain it.?
4. The IRA saga continues, with the Chamber of Commerce asking for an injunction that suggests we’ll see action from the courts earlier than may have been expected.?
5. Serious thinkers understand that the NIH is not in the business of drug development, but new, NPC-funded research in JAMA Health Forum makes plain exactly how little the NIH does around clinical development.
6. Novo Nordisk has a list price for Wegovy in Germany. It works out to US$338 for a four-week supply. That’s a lot less than the med sells for in the United States, so expect some carping in the months to come about the disparity between U.S. and ex-U.S. prices.?
7. HHS Secretary Xavier Becerra warned COVID vaccine-makers not to price their products aggressively when they hit the commercial market. “Price gouging behavior takes advantage of the trust the American people have placed in you through the COVID-19 response,” he said in a letter to manufacturers.?
8. There’s new data out that shows that the 340B disproportionate share hospitals -- and the pharmacies that serve them -- are rarely located in medically underserved areas. And it’s a problem that’s getting worse. A smaller percentage of those providers are in underserved areas than two years ago.?
9. Dan Leonard , the former head of AAM and NPC, was out with an op-ed in Real Clear that compellingly makes the case that the problem with the insulin market is the PBMs. Dan has hung his own shingle, so if you’re not connected with him, now would be a good time.
10. ngl: the positive FDA decision on OTC birth control would have been a lot more meaningful if there was a sense of price. But that detail remains unavailable, so this story barely squeaks into the top 10.??