Scheduling Note: Cost Curve is off tomorrow. Back on Friday
The two most important stories today are a pair out of Reuters on the obstacles that payers are erecting around GLP-1 medicines for obesity and diabetes. The obesity piece is here, and the diabetes story is here.
Though they’re two different articles, they are essentially based around the same question: how far will payers go to implement utilization management programs, and what will the impact on patients be?
The diabetes story follows a fairly standard script: prior authorizations delaying therapy by weeks or months and step therapy forcing patients to use less effective medicines until they can “prove” that they truly need the GLP-1. Based on an unscientific survey of Reddit users, more than half of patients struggle with this.
The obesity coverage was more interesting, and, perhaps, more dastardly, recounting some of the increasingly creative ways of keeping patients from accessing new obesity medicines. The piece focuses on the use of telehealth providers who provide weight-loss counseling to delay the start of medical treatment and mentions efforts to funnel patients to certain doctors.
The underlying frustration here is that these insurance-company countermeasures aren’t designed to improve patient care. Patients whose doctors think they need GLP-1 for diabetes or obesity really do need those medicines. The obstacles are 100% a cost-containment strategy, rationing care based on a patient’s (and physician’s) willingness to jump through hoops.
I am increasingly of the belief that the most meaningful assault on the pharmaceutical industry in 2023 is captured in the FTC’s objection to the Sanofi-Maze deal for Maze’s Pompe drug. It is, at a minimum, way more important than the march-in rights effort (which continues to generate commentary … see here for a WSJ op-ed that leans into the Bayh-Dole history and here for Science blogger Derek Lowe’s thoughtful-as-always take).
Unless someone beats me to it, I’m going to explore that thesis in more detail, probably in Cost Curve Weekend on LinkedIn, but, in the meantime, it’s worth reading STAT’s interview with Maze’s CEO, who details how he was blindsided by both the FTC and Sanofi.
The FTC, in its heavily redacted complaint, hints darkly at all of the ways that Sanofi was going to use the Maze deal to lessen competition, but it doesn’t sound like Maze saw the partnership as anything but an opportunity to make sure that a promising medicine received the resources it required to make it to patients.
Anyway: more to come here.
It’s the season for webinars, and this one — on how to ensure access and equity within the framework of the IRA — is worth the listen. The equity component of the IRA has probably not been discussed enough, and this provides a thoughtful overview of where the most critical gaps are.
KFF is highlighting its polling around IRA awareness, pushing out a post showing how few Americans are tracking on the major components of the law. I know that’s not new — we talked about it earlier in the month — but KFF’s amplification of the numbers is noteworthy.
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