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FEEDBACK LOOP/ Survey Is Still Open
If you haven’t yet let me know your favorite see-and-be-seen events, the survey is still open. I’ll shoot to share some findings on the most popular conferences among Cost Curve readers tomorrow or Thursday.
THE ARC/ Three Different Pharm-to-Table Approaches
One of the top five most interesting things happening in the drug supply chain is the move pharmaceutical companies to offer their medicines (somewhat, kind of) directly to consumers, a move that health entrepreneur Halle Tecco as memorably called “pharm to table.”
To be more precise with language: the companies are not actually going directly to consumers — we’re still dealing with prescription medicines, so doctors remain a part of this!, and there remain firewalls between the various parts of the machine — but rather creating (or plugging into) a more closed ecosystem.
Lilly is the most advanced. Its LillyDirect effort has been live for a year. It’s most famous for making Zepbound available for a cash price, but it has migraine and diabetes options available as well, offering patients access to telehealth … which is then plugged into an online pharmacy. As best I can tell, only Zepbound (in vials) has a cash option.
Of note, Lilly’s effort here is dynamic: They added additional Zepbound doses and a new pricing structure two weeks ago. Last week brought two new telehealth partners, Teladoc and LifeMD. Ro, as of December, is also on Team Lilly.
PfizerForAll is built on a similar model: Telehealth for migraine, COVID, flu, heart disease, and cancer, with online pharmacy services (Alto, it appears) for migraine and COVID. The Pfizer site is plugged into other Pfizer education and management tools.
And now there’s NovoCare Pharmacy, which is offering a cash-only version of Wegovy. There’s no telehealth attached, just an online pharmacy. Novo said that it aspires to bring the program to brick-and-morter pharmacies, too.
Novo’s deal is also structured so that only uninsured or commercially insured patients without coverage can take advantage of the $499 offer. That means Medicare patients are out of luck (Medicare remains barred from reimbursing for obesity meds, though there are loopholes).
Not sure why that’s a different structure from Lilly, but I’d welcome an explainer.
So it seems like there are three variables at play in these various endeavors. There’s telehealth (Lilly, Pfizer). There’s integration with an online pharmacy (Lilly, Novo, Pfizer). And there’s a cash-pay option (Lilly, Novo; obesity meds only).
At one level, this is all just basic stuff pasted together. Telehealth isn’t a new concept, especially telehealth for obesity, with pharmacy attached. There’s a rapidly growing model for that kind of thing (Hims & Hers, etc.), so we’re just seeing pharma get in on an existing game. Indeed, the explanation for this tactic is often framed as an effort by brand-name companies to compete against compounders.
But that may be underselling what’s going on here. Having easy-to-access cash prices creates the possibility for some more complex changes to the drug supply chain.
There is already a company selling the idea that employers should exclude obesity meds from their formal PBM drug benefit but subsidize employees who want to use cash-pay options. (Otherwise, employers are caught in a catch-22: If they manage the benefit too tightly, they can’t get the best prices, and costs go up. To get low prices, they need to drop restrictions, boosting volume … and costs.)
That kind of approach shows how pharm-to-table programs could interact in novel ways with benefit design, perhaps affording employers more control over how they build out their benefits.
I’m not quite smart enough to imagine all of the ways this kind of systemic rewiring will be used in the years to come (open to your thoughts!), but it’s a call option on an increasingly disintermediated future.
QUICK TURNS/ Accumulators and America, 340B and Minnesota
Nice work by Avalere in its continued effort to map the pushback on copay accumulators. Twenty-one states now bar the practice, meaning that about 16% of Americans with commercial insurance are protected. In some ways, though, celebrating these victories may be premature given that a) the use of accumulators is still growing, and b) the use of maximizers is growing even faster. (See Adam Fein’s post last month for the details here.)
Medicaid cuts aren’t squarely in this newsletter’s area of focus, but there’s going to be a lot of health-policy oxygen consumed by the debate. It’s pretty clear that the discussion to come is going to be framed around “waste, fraud, and abuse,” and Modern Healthcare has a nice overview of why that’s a pretty fraught frame with which to look at the program.
If you haven’t already, I strongly suggest that you clear your calendar for tomorrow afternoon and tune in to the University of Michigan Virtual V-BID Summit. It will be like getting 20 IQ points for free.
Credit to Minnesota: The state’s first 340B transparency report was a useful first step, but it had a glaring hole: It didn’t count medicines administered by providers, only those that were dispensed by retail pharmacies. Undeterred, legislators patched that hole, and Minnesota just published its draft guidance on how data on all 340B drugs — including administrated medicines — should be reported.
Speaking of Minnesota, the 2025 Minnesota State High School All Hockey Hair Team video is now live. Some impressive salad this year.
Cost Curve is produced by Reid Strategic, a consultancy that helps companies and organizations in life sciences communicate more clearly and more loudly about issues of value, access, and pricing. We offer a range of services, from strategic planning to tactical execution, designed to shatter the complexity that hampers constructive conversations.
To learn more about how Reid Strategic can help you, email Brian Reid at brian@reidstrategic.com.
