ONCE AGAIN, you have a choice. You can read about the economics of obesity through analyst-driven think pieces that dive into frozen vegetable sales and the impact of Ozempic on the size of Slim Jims.
Or you can read this blog post from the head of the Congressional Budget Office, Phillip Swagel, on obesity meds. Weirdly, it hasn’t received much traction beyond this Inside Health Policy piece, despite its headline-worthy, less-than-rosy take on the economics of obesity medicines.
There are really two ways to look at the post.
The glass-half-empty types will probably see a missive that suggests a great deal of skepticism about the economic impact of weight loss and an implied warning about the wisdom of allowing Medicare coverage.
The post makes the point that the literature tying weight loss to savings is not be well-developed, and what we do have is not particularly encouraging, especially when weighed against the price of the medicines.
The glass-half-full observers will put more weight on Swagel’s statements about the lack of evidence. It really does seem like the CBO is struggling with the need to come up with conclusions without a solid foundation to build from. And they’re being direct in their request for more info.
If you’re in the second group, it’s worth noting that the Novo outcomes study hasn’t yet published, so it’s not included. And that research is just the tip of the iceberg. Sure, we don’t have a lot of great data on outcomes (that can then be transmogrified into economic data), but we will. And that tidal wave of data is going to absolutely swamp the meager sand castles of conclusions we’ve been able to draw to date.
All this to say: if you want to panic about the CBO’s dim view of obesity meds, the blog post gives you good reason. But for those willing to be patient, it sure seems like Swagel’s perspective has an expiration date.
(Some quick butt-covering: I don’t want to imply that these drugs are only a good value if they reduce overall net system spending, which is a line that Swagel dances around. Most interventions don’t pay for themselves. The question is whether the health/societal gains are worth that cost. None of this is going to be simple.)
ICER has been pretty adamant that we have to treat gene therapies (“single and short-term therapies,” in their parlance) differently from all other interventions, especially gene therapies for really expensive diseases.
The massively over-simplified rationale goes something like this: there are some disease areas where the standard of care is not remotely cost-effective, and gene therapies ought not get full “credit” for being a better deal than what ICER sees as the overpriced alternatives. So ICER is playing around with a couple of ways of allocating those savings so that the gene therapy company doesn’t get credit for all that value.
It’s kind of a fascinating topic to think about, but ICER’s perspective is not ready for prime time, according to a must-read issue brief from Cencora that lays out objections to the ICER approach, concluding that ICER’s framework is “inconsistent” and “lacks scientific rigor.” PhRMA has a blog post out summarizing the Cencora POV.
Elsewhere:
Another Humira biosimilar is about to hit the market with a less-than-disruptive pricing model.
The American Action Forum did the math on where the savings generated from Medicare price controls are going. It is not news that a lot of those dollars are not going back to the Medicare program, but the AAF lays out the numbers in a compelling way.
Fierce summarized this SEC filing from EQRx that documents the end of the company’s run. It’s hard not to process that narrative and not come to the conclusion that — at the end of the day — EQRx was unable to deliver on its mission not because of the FDA or any failure of its disruptive-pricing dream, but because the molecules it was working with were so “meh” that they couldn’t even sell the rights at fire-sale prices in the final days.
Hawaii is going after PBMs. I feel like I probably need to investigate this one on-site.
The high-interest-rate environment is hurting pretty much everyone. Except, naturally, the health insurers. They’re doing swell.
If you don’t think too hard about it, this STAT op-ed is an interesting piece about payers getting deeper into clinical research.
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And Cencora pushes a takedown of ICER’s approach to gene therapy Read More Cost Curve
