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The Ozempocalypse Is Nigh

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Re: The Ozempocalypse Is Nigh

#51

Post by jandrewrogers »

scarab92 wrote: post #27
dragonwriter wrote: post #21

Earlier quoted context omitted.

> How can people pay $1000/month for the rest of their life 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…

It seems like the entire US medical system runs on prices that no one actually pays. I don't really understand what all that extra complexity achieves?

The US government requires that they receive the lowest public price for any medical care they pay for. Unfortunately, the US government is a very expensive customer to work with for many reasons. By sandbagging costs with very high public prices, it gives healthcare providers the latitude to, after various hidden discounts, charge the government more than private sector customers that actually cost them less to serve.

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.

Re: The Ozempocalypse Is Nigh

#52

Post by chneu »

jandrewrogers wrote: post #7
deadbabe wrote: post #2

Can someone please explain the economics of GLP-1s? How can people pay $1000/month for the rest of their life, just to keep weight off? Rent and mortgages are already insane as is, and then there’s insurance, kids, etc.

Americans are wealthy and don’t even realize it. The median household has >$1000 left over each month after all ordinary expenses against income, per the US government’s own data and statistics. Not everyone can afford it but a large percentage can. They may value this more than many other things they can waste that excess income on. The drugs are only going to get cheaper with time.

It's easy for Americans to think they're poor when half the country buys into a false version of reality where crime is rampant, the economy is constantly failing and welfare queens are eating your dogs.

Re: The Ozempocalypse Is Nigh

#53

Post by chneu »

nazcan wrote: post #32
kashnote wrote: post #31

Earlier quoted context omitted.

The sellers can write it off as a loss. It’s a way to avoid paying taxes

What does this mean? You don't get to write off the difference between your "target price" and actual sale price. 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).

I think, but am not sure, the point they're trying to make is that hospitals and insurance companies can "charge" really high prices and then they can forgve those high prices in exchange for a tax break?

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.

Re: The Ozempocalypse Is Nigh

#54

Post by timewizard »

trilbyglens wrote: post #43
timewizard wrote: post #23

Earlier quoted context omitted.

What do you believe is different between their process and the patent holders?

They don't need to recoup their investments in discovery and regulatory approval.

What do we believe the discovery pathway was? Billions of dollars spent by heady businessmen with a keen eye for the molecules of interest? Hardly:

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.

Re: The Ozempocalypse Is Nigh

#55

Post by michtzik »

r58lf wrote: post #44
scarab92 wrote: post #27

Earlier quoted context omitted.

It seems like the entire US medical system runs on prices that no one actually pays. I don't really understand what all that extra complexity achieves?

PBRs have contracts with medical insurance. They get paid based on how much money they "save" the insurance company. "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 lowe…

If you use an abbreviation like PBR, it helps to either explain what it means or use the correct one. Do you mean PBM = pharmacy benefit manager?

Re: The Ozempocalypse Is Nigh

#56

Post by michtzik »

unsnap_biceps wrote: post #13
wewewedxfgdf wrote: post #6

I'm far from convinced that some random "compounding pharmacy" produces effectively the same thing as Ozempic.

Compounding pharmacies existed before Ozempic and their entire business model is producing custom drugs at reasonable prices. For Ozempic, they order the GLP-1 peptides from a large Pharma company and then mix it to order with bacteriostatic water and any other additives. Mine includes a B-12 compound that is attempting to help with the weight loss. They are highly regulated and require trained and licensed employees…

> They are highly regulated and require trained and licensed employees. The compounding pharmacies I don't trust are the ones that only started to do Ozempic and nothing else.

We already know that the compounding pharmacies violate patent law. Why should I believe they follow any other regulation?

Re: The Ozempocalypse Is Nigh

#57

Post by the_third_wave »

dave333 wrote: post #47

Medicare should spend 1% of its budget each year to buy pharma stocks. Slowly it will become neutral to drug prices since what it pays for expensive drugs will be returned in the stock value.

No, slowly it will pay out on one side and get back a bit on the other until it becomes a major stock holder and the whole house of cards collapses.

Re: The Ozempocalypse Is Nigh

#58

Post by dave333 »

the_third_wave wrote: post #57
dave333 wrote: post #47

Medicare should spend 1% of its budget each year to buy pharma stocks. Slowly it will become neutral to drug prices since what it pays for expensive drugs will be returned in the stock value.

No, slowly it will pay out on one side and get back a bit on the other until it becomes a major stock holder and the whole house of cards collapses.

Why would it collapse? Can limit govt holdings to say 25% of each company to maintain profit motive. I think this would attract other investment - front running the govt money - and greatly increase the ability to research new drugs. Can also direct some research money into drugs with significant benefit but little profit. Over time increased investment would allow lower prices. Over time compounding would help fund medicare.

Re: The Ozempocalypse Is Nigh

#59

Post by the_third_wave »

unsnap_biceps wrote: post #16
deadbabe wrote: post #2

Can someone please explain the economics of GLP-1s? How can people pay $1000/month for the rest of their life, just to keep weight off? Rent and mortgages are already insane as is, and then there’s insurance, kids, etc.

I can afford 1k/month and will if that's what's required. My life is well over 1k/month better with a healthier weight. I preform better at work, I'm happier, and I should live longer. That's worth the money.

Or you eat less and/or healthier food to achieve the same result without the side effects. Spend part of that $1000 (but not too much) on better food which you (or someone in your family) prepares at home, keep the rest for other purposes.

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.

Re: The Ozempocalypse Is Nigh

#60

Post by monkburger »

scarab92 wrote: post #41
monkburger wrote: post #38

Earlier quoted context omitted.

Profits over patients. 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 d…

How should this system work, in an ideal world?

Just force price transparency. Force drug makers to advertise the selling prices of their drugs, and enforce price discrimination laws. Force insurance and PBM companies to advertise the drug prices if purchased through insurance or PBM. Everybody should be paying the same price. And if not, everyone should be allowed to find out if they can pay a lower price.

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/

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