Strong Data Showing Heart Benefits to Obesity Meds Raises the Big Question: Whither Medicare

Programming Note: Cost Curve will be off Thursday, Friday, and next Monday so that I can watch my social media manager/future Terrier do her thing against some of Canada’s best skaters.

It’s tempting for me to spill lots of pixels on the data from the SELECT trial — the Wegovy study that found that the medicine cuts the risk of cardiovascular events — given that it’s such a big deal. 

But I don’t have much to add to the great commentary already out there from a scientific and medical standpoint. As with all great research, it opens up a whole new set of questions to explore. The evolution of our understanding of these medicines, clinically, is going to be hugely fascinating to watch. 

Instead, let me weigh in with one detail that I didn’t see discussed much: what happens to Medicare patients? After all, the median age in the trial was 62, right on the doorstep of Medicare eligibility. Medicare is barred from covering weight-loss meds, but all sorts of workaround have been proposed, from straightforward legislative fixes to more convoluted administrative solves.

Novo execs — during their IR call to discuss the results — were asked about what they expect to see from that Medicare evolution, and the answer was somewhat pessimistic. 

“Can we at least speculate with you about how aggressively you’re trying to pursue a CVD indication or persuade CMS to provide coverage on the CVD side?” asked Citi’s Peter Verdult.

The response, from Novo’s Martin Lange: “The technicality that you’re thinking about is to go [secure coverage] via not-obesity approvals. I don’t think that we see that in the cards right now.”

I like AstraZeneca’s approach to talking about the IRA for two reasons. One, they’re clear and specific about their messaging. As this Endpoints piece makes clear, they’re concentrating on fixing the orphan drug elements by influencing implementation, not seeking the law’s wholesale destruction. Two, AZ seems to be unafraid about making IRA objections a core part of their corporate approach. It’s always good to see the pharma industry spoiling for a good street fight. 

Here’s a little light IRA mythbusting from AEI’s Ben Ippolito and Harvard’s Amitabh Chandra in which they argue that the IRA might boost adherence, but it’ll boost utilization management, too. 

Modern Healthcare profiled the emergence of the small, feisty PBMs dedicated to destroying the entire framework of the industry. But the piece didn’t exactly offer a rosy assessment of their chances, throwing out phrases such as “uphill battle” and “considerable obstacles.”