We're Still Talking Obesity Today

I guess we’re just going to keep talking about obesity meds.

There was a ton more coverage since the last time I rapped at ya, but there’s an increasing big signal-to-noise issue as everyone tries to come up with an angle or an opinion. That means you can probably ignore, for instance, the Washington Post columnist trying to wrangle with the issue.

But not everyone is swirling. I complained yesterday that any celebration of coming insurance coverage was premature, and Josh Cohen over at Forbes has a piece making that point more eloquently than I did.

I’m also attracted to anything focused on the lobbying around Medicare coverage, so this KFF Health News piece from Tuesday about efforts to bring Black patients and physicians into the debate over Medicare coverage is worth the read.

What else? STAT’s take on the intersection between telemedicine and obesity-med scripts is a phenomenon that I imagine we’ll hear more about as well.

My parting thought on this for today comes from a new JAMA editorial. The author, Harvard’s Meredith Rosenthal, looked at the landscape around Alzheimer’s and obesity meds and concluded that the current system just can’t make these available broadly and equitably, suggesting that radical change is in the offing:

“A new era in which the US health care reimbursement system explicitly considers cost, effectiveness, and distributional effects of paying for prescription drugs may have arrived.”

Imagine having millions of dollars of Arnold Ventures money and choosing to spend a chunk of it writing this 100-page report.

The effort from Patients for Affordable Drugs is ostensibly to show how pharma-connected three advocacy groups are: The Haystack Project, No Patient Left Behind, and the Community Oncology Alliance. But that’s not particularly interesting, unexpected or secret. Of course Peter Kolchinsky at No Patient Left Behind is pro-biopharma. HE’S A WELL-KNOWN BIOTECH VENTURE CAPITALIST.

I feel like it’s a tell that P4AD is spending its time looking for industry connections in IRS filings and LinkedIn profiles rather than engaging on the actual issues. I mean, Kolchinsky has some pretty out-of-the-box views on pharma patents. I would LOVE to see P4AD’s David Mitchell discuss “contractual genericization” with Peter. That would move the drug-price debate forward.

Instead, P4AD is spending its time documenting where NPLB advisory board members were working in 1993 and other meaningless minutiae. (Full disclosure: in 1993, I was working as a counselor at Camp Coniston.)

I have said many nice things about Arnold Ventures here. I said “No one has ever gotten a better return on investment in health policy than John Arnold. It’s amazing." I called one of their other grantees “the single biggest drivers of health policy in the United States.” Even though I might have ideological qualms, I respect the hustle.

But then I look at what P4AD is doing with their Arnold dollars, and I just shake my head.

• The IRA has drug companies in a terrible catch-22. On the one hand, executives who want to invest their company’s resources prudently have to consider the IRA’s incentive structure, which encourages companies to deprioritize small molecule meds and speedy approvals for small patient populations. On the other hand, here is how the media are framing those decisions: companies “may be willing to delay treatments for cancer patients if it means making more money.” (Per STAT’s interview with Genentech CEO Alexander Hardy.)

• About a month ago, Sen. Elizabeth Warren released a report about how no one could actually find, in their local pharmacies, the $25 generic insulin that had been promised. Now Bloomberg Law is out with a story that comes to the same conclusion. But both the Senate report and the Bloomberg reporting fail to answer a simple question: why? Like, is it the fault of the drug companies? The pharmacy chains? Someone else? Feels like an important detail that remains cloudy.

• This is a dumb op-ed. There are all kinds of criticisms that can be leveled against the way Mark Cuban is building his generic-drug empire, but “he should be nicer to PBMs” is not one of them.

• An OTC version of the naloxone nasal spray for opioid overdoses from the nonprofit Harm Reduction Therapeutics will be available for $36 for a box of two, according to Endpoints, which is about the cost of production. The company is also seeking to give away 200,000 doses.

• Bluebird bio has started 16 patients down the path of getting one of their two approved gene therapies, and the company said that insurance companies have not gotten in the way in any cases so far. Prior auths for the therapies are taking about two weeks.