LillyDirect Adds Neurology to Its Pharm to Table Platform

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THE ARC/ Bringing Pharm to Table to Memory Care

As I declared yesterday: It’s Pharm-to-Table Week here at Cost Curve. 

Today’s pharm-to-table news is Lilly’s announcement that it has added “memory and thinking” to the suite of services under LillyDirect. Lilly, of course, makes Kisunla, an Alzheimer’s med. 

STAT has a story, and it’s a skeptical take. Not bad. Just skeptical.** 

To me, the entry into neuro underscores what Lilly is really up to I had imagined that, especially with the cash-pay approach, Lilly was building the plumbing for an alternative drug supply chain that could offer more flexibility. But that’s not it. (Or, at least, that’s not the whole story.)

Lilly’s interest seems to be in changing the consumer experience of care. LillyDirect is leaning into places where that experience is especially lousy. Obesity is an obvious place to start. There are long waits for primary care, lots of stigma, complicated care pathways.

At the BMO Obesity Summit this week, I offered a hypothetical patient journey: Say a middle-aged guy with a BMI of 32 wants to address the issue. He doesn’t have a PCP. Getting in with a new doc is a nine-month process where I live. Then it’s probably six months of “diet and exercise.” If that doesn’t work, then, perhaps, medical intervention … after a prior auth that requires a better-documented “diet and exercise.” 

It’s not absurd to think it would take two years -- and endless paperwork and hoops -- to get on medical treatment.

That’s a process that’s ripe for reinvention. 

Ditto memory care. What’s clinically significant when it comes to Alzheimer’s? What kind of diagnostic journey should a patient be on? At what point is specialist care needed? How easy is it to get access to that kind of expertise? What kind of questions should even be asked? 

Again: As a patient, as a health care consumer, there is a high likelihood that all of this will lead to a a crappy experience overall. 

So if LillyDirect can start to work with thoughtful, well-validated platforms -- connected to both telehealth and in-office providers -- to create a better experience, that’s almost certainly a good thing for U.S. healthcare. It’s not a panacea. It’s not the only pathway. It’s worth scrutinizing. 

But it’s also an experiment in patient-first health care that we badly need to run. 

** Lilly is pretty explicit that part of what they’re offering is not just telehealth referrals but also tools to connect people with in-office care. STAT spent a grand total of 15 words on that part of the launch: “Patients will also have access to a tool to find local, in-person Alzheimer’s doctors.”

QUICK TURNS/ Obesity Treatment Is a Good Deal … Plus the Obligatory 340B Link 

I spent a lot of time at the aforementioned BMO event this week talking about a fundamental disconnect in the obesity-spending debate: Investing in coverage of these medicines today will almost certainly lead to a payoff in the future. The issue is that the health care system and the government aren’t set up to value future payoffs, so — given the size of the investment — it’s just easier to restrict access and punt. 

The USC folks, however, continue to detail exactly what that investment could deliver if we could just change our time horizon, suggesting that obesity treatment could bring a 13% return on investment for society. That’s a great deal!

(While we’re on the topic, one of the standard objections to the idea that these medicines are a good deal is the argument that poor adherence just wrecks long-term cost-effectiveness. A patient who goes on a GLP-1, then goes off it six months later and gains the weight back, has basically just sunk all of those drug costs. But it turns out there is reason to think that it is a solvable problem. FlyteHealth just put out a white paper that says that they’ve kept 83% of the GLP-1 patients on treatment for a year. The clinicians are figuring this out.)

ELSEWHERE: 

• I’m still tiptoeing around the tariff issue because a) I don’t know Jack about international trade, and b) the impact on prices is, at this point, still theoretical. (Check back in a week. Maybe that will have changed.) But for those trying to keep up, this Brookings white paper on how the moves could hit brand and generic drugs differently is pretty good. Also interesting: this Reuters piece about how manufacturers are trying to get as much product as possible into the United States as quickly as possible.

• Pro tip for communicators: Add the acronym “DOGE” to almost any headline and watch your clicks soar. Today’s example: Jack Kalavritinos’s Real Clear piece on 340B: “Hey DOGE – Check out 340B and Where the Money Is Going.”

Cost Curve is produced by Reid Strategic, a consultancy that helps companies and organizations in life sciences communicate more clearly and more loudly about issues of value, access, and pricing. We offer a range of services, from strategic planning to tactical execution, designed to shatter the complexity that hampers constructive conversations. 

To learn more about how Reid Strategic can help you, email Brian Reid at [email protected].