Ozempic and Wegovy are selected for Medicare's price negotiations

https://apnews.com/article/drug-prices-medicare-biden-trump-aae2271614f5959b484e5f081313f2e1

by geox • 2 years ago

188 318 2 years ago

apnews.com

DrBenCarson• 2 years ago

Would rather have Mounjaro and Zepbound

Someone12346• 2 years ago

Or do both, and let them compete with each other for Medicare's business.

arcticbull3• 2 years ago

That's been so effective so far.

Retric• 2 years ago

Cheap drugs have massive downward price pressure on alternatives.

RobotToaster• 2 years ago

The cynic in me thinks they are only going for Semaglutide because the patent expires in several places in 2026, tirzepatide has another ten years.

hobobaggins4• 2 years ago

The patent on the manufacturing process, not the peptide itself.

some_random2• 2 years ago

Very glad to see this, it's worth noting that the compounded semiglutide pricing (think generic, although it's more complicated than that) has been plummeting ever since it was introduced onto the market. We've seen some pretty incredible results and I really hope they get cheap enough to be prescribed more widely.

Someone12346• 2 years ago

It is worth noting that Compounded Semaglutide sold in the US is still more expensive than branded Semaglutide sold in other markets, where national price negotiations occur. For example, it can be under $100/month in several European nations.

The US just has no mechanism to control prices. There isn't really competition for specific drugs.

chriscappuccio• 2 years ago

The research peptide sites are about the only reasonable places to buy this stuff

MichaelZuo4• 2 years ago

I’ve seen these comparisons a lot, but how is it determined that the actual quality of a name brand medicine is the same in the two different markets…?

i.e. The price difference could be reflecting a real qualitative difference such as being produced in different facilities, slightly less pure ingredients, less stringent QC, etc…

s1artibartfast11• 2 years ago

I think it is critical to differentiate price controls and purchasing controls.

Most other markets with state insurance have purchasing controls. That is to say, if the price is too high, the government doesn't buy it.

Very few places have price controls e.g. "products cant be sold for more than X".

The US government is the outlier in that it situationally states it will pay the price no matter the cost.

Reasonable government policy needs to start with putting a price on human life (QALY), and purchasing goods and services that come in under that price. This is how it works in other state insurance systems.

karaterobot• 2 years ago

Why is it worth noting in this context? It seems like an unrelated observation. The original commenter is clearly in the U.S., so you're telling them something that doesn't help them at all.

HDThoreaun2• 2 years ago

Compounded drugs are only legally available when the fda declares there is a shortage. Once novo nordisk shows that they can make enough of it buying compounded versions will be illegal.

loeg8• 2 years ago

Tirzepatide is out of FDA-declared shortage but somehow Semaglutide isn't: https://www.fda.gov/drugs/drug-safety-and-availability/fda-c... But expect it to be soon.

thrance3• 2 years ago

The issue is not with manufacturing costs, Ozempic is €83 in France for example, because there is a single buyer for every drugs (namely the Assurance Maladie, a state apparatus).

petesergeant• 2 years ago

Now Mounjaro is out, Ozempic can only really compete on price, which has to be adding downward pressure

qeternity• 2 years ago

Why is there a specific list? Why don't we just let Medicare negotiate.

mportela• 2 years ago

Unfortunately, that's all the Biden administration could get written into law. The Big Pharma lobby is too strong and definitely battled to keep this list as small as possible.

ourmandave• 2 years ago

At least the door is cracked open and it's a start.

Of course, Big Pharma will fight to slam it shut again.

refurb4• 2 years ago

That's because it's not really a solution.

It's not a negotiation between two parties with equal power, it's just the government saying "either pay this price or you'll be penalized".

The better solution is to allow parallel trade of pharmaceutical across borders.

It will force countries paying far less to pay more and conversely the US paying less.

dboreham2• 2 years ago

Because corruption.

croissants• 2 years ago

Pat and cynical oversimplifications are bad for discourse, because they suggest that a default angry response is correct and, coincidentally, frees you from having to think harder about anything.

Don't give in!

twoodfin2• 2 years ago

Because this isn’t really a “negotiation” as configured by the statute: Medicare doesn’t have a formulary, it doesn’t pay for drugs, the Part D plan providers (some quite large and with their own negotiating heft) do.

It’s a price-setting exercise. Yes, the drug-maker can walk away, but at the cost of massive punitive excise taxes on selling their drug to anyone in the US, not just Medicare Part D plans.

refurb4• 2 years ago

Exactly.

It's like saying taxes are a "negotiation for a contribution to the state government".

knuckleheadsmif3• 2 years ago

A little more complicated because in some settings drugs are covered by Medicare part B but generally not if administered yourself at home. Then yes it’s part D and the most out of pocket in Part D from 2025 going forward is $2K.

Also, they do negotiate for a very few drugs and the number is climbing. This was part of the IRA. However only drugs that are FDA approved for your issues are covered.

Before the IRA the government was not allowed to negotiate any drug prices by law which was/is crazy.

chvid2• 2 years ago

The US is trying to squeeze the Danes to get hold of Greenland.

chvid2• 2 years ago

It is front page news in dk - leaders from major Danish companies have been called in by the government … novo is the biggest exporter to the us and the most obvious squeeze.

Technically this is done by the Biden admin but obviously coordinated with the incoming Trump admin who has made their attention of using trade to squeeze Denmark in order to get full control of Greenland very clear.

xiphias2• 2 years ago

Novo is just worth $300B, it's nothing compared to the many trillions of dollars Greenland is worth.

But I guess politicians are much cheaper than that.

plandis• 2 years ago

I find it fascinating that Denmark believes Trump isn’t simply lying like he always does?

Why would the Biden administration coordinate with Trump in an attempt to control Greenland? That makes no sense.

renewiltord2• 2 years ago

This particular thing was always in the works but we should ask the Greenlanders where they’d rather be and pay them if they choose otherwise than us. The land is too strategic and Denmark cannot hold it usefully.

impossiblefork3• 2 years ago

There is no functional difference in likely effectiveness between the present EU, of which Denmark is a member state, or the present US holding Greenland against a Russian attack. The Russian attack would be smashed either way.

jajko2• 2 years ago

Maybe we should start asking very single tribe/minority across the world if they want to be independent. We would very quickly find that current states are rather fragile conglomerates sometimes holding together by surprisingly weak forces.

I can see few parts in US for example wanting independence under certain conditions. Or US could have given kurds Kurdistan in the middle east with all that crap it caused in past 2 decades, largely stabilizing (big part of) the region. Clearly not policy US cares about much, so lets stop pretending actual wants or needs of Greenland population are anybody's concern here.

refurb4• 2 years ago

It's not really a "squeeze".

The Danes agreed that Greenland can become independent if supported by a national referendum. Apparently there is a decent amount of interest in that idea.

So the US can come in and say "hey, instead of independent, you could be in a union with the US". There is enough interest in that that it's a serious concern for the Danes.

krapp• 2 years ago

The Danes aren't concerned because there's enough interest, they're concerned because a violent, hegemonic imperialist superpower run by an unstable authoritarian regime has decided Greenland should be theirs, apparently just because, and historically speaking having something the US wants means your cities get liberated into smoking rubble.

mh-• 2 years ago

Are people who pay for their own prescriptions able to purchase them at these Medicare-negotiated prices?

gnkyfrg• 2 years ago

A lot if times yes. Almost always cash buyers pay the least, even less than those with insurance.

hawski• 2 years ago

I understand that those drugs are very useful, but in a way it feels for me like ancient Rome with its orgies and vomit inducing so they can eat more. At least looking at USA from Europe. The problem of sugar content, dietary choices and portion sizes remains. It is similar to gas guzzling cars.

Sorry if it seems not empathic enough, that was not my intention. I know that the use of such drugs may be medically necessary.

Edit: To serious answers: I was wrong, I stay corrected.

rodonn• 2 years ago

These drugs (mostly) don't allow you to eat more unhealthy food, instead they make it easier to have the self control to avoid over eating / choose healthier foods.

unshavedyak2• 2 years ago

To add, they actually prevent you from eating some bad foods too. At least in the compound versions that i know people on.

If they eat a lot of foods (some even good), their gastro issues are significant. So not only has it had substantial mental shifts around what they desire, but a bunch of foods are just not edible even if they wanted them anyway.

platelminto• 2 years ago

From what I understand these medications make you want to eat less in the first place, so it's not quite the same thing.

unshavedyak2• 2 years ago

Yup. The people i know on this didn't even get it for the weight, but the behavior changes. This isn't letting them eat the same stuff and lose weight, this is changing what they want to eat.

They went from ADHD driven boredom eaters to not even thinking about food.

rendleflag• 2 years ago

My understanding is that the drugs keeps you from wanting to eat as much.

some_random2• 2 years ago

That's just not how these drugs work at all.

meroes• 2 years ago

If everyone 30+ bmi can get to 30 for “free” (not sure where the subsidizing stops, for me it’s free if I’m over 30 bmi), that’s just too tantalizing to pass up, even if the moral applies.

At least it takes a load off one problem (obesity related diseases). Could it actually exacerbate unethical farming even more or lead to even worse outcomes? Hope not.

johnnyb9• 2 years ago

This reminds me of my idea to replace EBT with unlimited amounts of soylent

readthenotes1• 2 years ago

"load off" groan...

I've read that obesity and smoking are net positives for the cost of state-supplied medical care because it causes people to die younger and quicker.

My real concern is what you stated: the by treating some of the symptoms of a toxic food system we will avoid treating the causes (in the USA, we would do well to take soft drinks out of schools and treat adding sugar to foods as an sin to be taxed)

ojbyrne• 2 years ago

The ancient Rome vomiting thing is a myth. https://en.m.wikipedia.org/wiki/Vomitorium

dboreham2• 2 years ago

These drugs reprogram the weights in the LLM between the gut and brain, leading to lower calorie intake.

mikestew• 2 years ago

Sorry if it seems not empathic enough…

You should apologize for making it obvious that you don’t know how the drugs work (as illustrated by sibling comments). If your analogy is “gas-guzzling cars”, I would suggest you revisit your reading on the topic.

mannyv• 2 years ago

One of the mechanisms of operation is to reduce your desire to eat.

Taking a step back, obesity actually is an adaptation. When food is scarce, you want your body to extract and store every gram of nutrition it can get. And that would provide a distinct advantage when you're trying to reproduce.

The thing is, GLPs don't only suppress eating. There are plenty of substances out there that can do that...and there are plenty of people who can't lose weight by starving themselves, because your body will try to maintain its weight.

The question should be "why isn't everyone obese, given the huge amount of calories available to humans?"

bluedino• 2 years ago

The question should be "why isn't everyone obese, given the huge amount of calories available to humans?"

We're close.

According to the CDC, approximately 73.6% of American adults are considered overweight, including those who are obese

samaltmanfried2• 2 years ago

obesity actually is an adaptation

Obesity is not an adaptation. It's a total aberration. Storing energy in the form of fat is an adaptation. Becoming obese is overloading your entire system.

why isn't everyone obese

Well... they sure are trying...

ceejayoz2• 2 years ago

I understand that those drugs are very useful, but in a way it feels for me like ancient Rome with its orgies and vomit inducing so they can eat more.

https://en.wikipedia.org/wiki/List_of_common_misconceptions

"Wealthy Ancient Romans did not use rooms called vomitoria to purge food during meals so they could continue eating and vomiting was not a regular part of Roman dining customs. A vomitorium of an amphitheatre or stadium was a passageway allowing quick exit at the end of an event."

svieira• 2 years ago

"Two of the most notable examples from Ancient Rome center on the emperors Vitellius and Claudius who were notorious for their binge eating and purging practices. Historian Suetonius writes that “Above all, however, he [Vitellius] was … always having at least three feasts, sometimes four in a day — breakfast, lunch, dinner, and a drinking party — and easily finding capacity for it all through regular vomiting” (Suetonius, Vit, 13) [1]. Similarly, the emperor Claudius was infamous for never leaving a meal until overfed, after which a feather was placed in his throat to stimulate his gag reflex (Suetonius, Claud, 33) [2]. In his writing, Suetonius takes on a disapproving tone when describing the eating habits of Claudius and Vitellius, as highlighted by the use of words such as “luxury,” “cruelty,” and “stuffed”(Crichton, 204). This tone indicates that although binge eating and purging were accepted, albeit uncommon in Roman culture, the practices were negatively associated with gluttony and a lack of self-control. "

~ Ancient Hunger, Modern World by Solia Valentine

Via: https://escholarship.org/content/qt2594j40t/qt2594j40t_noSpl...

[1] https://www.perseus.tufts.edu/hopper/text?doc=Perseus%3Atext... [2]: https://www.perseus.tufts.edu/hopper/text?doc=Perseus:abo:ph...

aantix• 2 years ago

Purely from a cost perspective - imagine a 79 year old grandma.

Heavily overweight. She is already partially immobile. Pre-diabetic. She may have other conditions, further complicated by her weight. She's on a fixed income.

Which is more probable -

1) A dietary intervention that she attends once a week that revamps her entire daily consumption (but remember, she's on a fixed income) along with some intense exercise?

2) put her on a single medication that changes her tastes for sugary and starchy foods, reduces her cravings, reduces inflammation, and in turn, will make her lighter and more mobile.

It is a no-brainer for Medicare. This will save so many downstream costs.

somewhereoutth• 2 years ago

You may be wrong in the specifics of the mechanism of calorie reduction (reducing appetite vs reducing calorific absorption), but not in the general philosophy.

The obesity crisis (specifically in the US, but elsewhere too) has been caused by bad food essentially - food that is not only nutrient deficient, but also engineered to be as cheap as possible and addictive as possible to get you to buy more of it.

As ever, the US is attempting to fix the symptoms, as opposed to the underlying cause, following the general idea of 'if everyone does what they like, things will turn out ok (somehow)'.

Probably negative health implications of these drugs will surface as people become habituated, and we can continue to shake our heads and wonder how it all went so wrong over there.

amanaplanacanal2• 2 years ago

It's unclear what the exact cause of the obesity epidemic is. Ultra processed foods are one theory, but not the only one. The US has been down the path before of making public policy from unsettled science, and it led to probably worse food.

chpatrick• 2 years ago

I think it's just a case of our ape bodies not being prepared for a modern world where calories are abundant - which is a good thing! It means people don't starve in developed countries.

We wear clothes because we evolved to not have hair. We wear glasses because we spend more time focusing on nearby objects. Some people need GLP-1 agonists because their body makes them consume food it doesn't need, and there's no scarcity to stop them. It's okay to use technology to adapt our bodies to a different world.

siliconc0w• 2 years ago

It would be easier to squeeze Novo if they included Zepbound from Eli Lilly in the mix - we could argue that if we're going to spend unfathomable amounts on these medications we might as well buy the more effective medication from an American company.

ein0p3• 2 years ago

There's no need to spend unfathomable amounts. We just need to establish and enforce the favored nation status if they want to sell their drugs here. No drug (least of all US developed drug) should cost more in the US than it does elsewhere. That's what Trump was proposing in his last term. Because the Congress is corrupt AF, that went nowhere, but maybe we could give it another try now that his mandate is much stronger? As things currently are, we're getting robbed.

alephnerd2• 2 years ago

Or we can offer to take Greenland off the table /s

tzs• 2 years ago

What about poor countries? If a drug company had to sell drugs for the same price in the US and a country like Sudan, the result would almost certainly be raising the price in Sudan up to US prices rather than lowering the price in the US to Sudan prices.

That would put the drug out of reach of most of the people in those poor countries.

soperj• 2 years ago

If it still has to go through congress you still have the same problem.

HDThoreaun2• 2 years ago

This will just make it impossible for poor countries to get drugs.

mrweasel• 2 years ago

It would be easier to squeeze Novo

Didn't Novo pretty much tell congress that the only reason why the high price for Ozempic and Wegovy is the US system of middlemen and that lowering it's prices won't necessarily benefit the patients? The CNN reporting from the hearing is pretty interesting[1]. According to Novo Nordisk when they tried lowering the prices of their insulin product, pharmacy benefit managers dropped their products out of coverage, resulting in fewer people having access to the medication overall.

It's not entirely clear that Novo Nordisk is the company that needs to be squeezed.

1) https://edition.cnn.com/2024/09/24/health/ozempic-novo-nordi...

tonymet8• 2 years ago

my favorite part of ozempic is that it settled the debate on calorie reduction.

parpfish2• 2 years ago

Did it? The drugs clearly lead to reduced appetite, therefore reduced calories. But do we know that the drugs aren’t also causing other important metabolic changes?

nradov• 2 years ago

The drugs seem to cause a small increase in resting heart rate. Whether that is due to metabolic or neurologic changes (or something else) isn't completely clear.

bitmasher9• 2 years ago

Was it ever really a debate? There’s tons of experimental evidence that shows calorie reduction leads to weight loss, even without pharmaceuticals. The Ozempic data can be explained simply by this factor. There doesn’t seem to be enough data fluctuation between the two sets to indicate a significant set of unknown variables impacting the data.

spondylosaurus2• 2 years ago

It's not even appetite per se; GLP-1s regulate blood sugar for more sustained levels, which is upstream of appetite. Safe to say that blood sugar impacts a bunch of other stuff too.

tonymet8• 2 years ago

Occam's razor

paulpauper10• 2 years ago

I think it confers some metabolic boost, but more data is needed

arcticbull3• 2 years ago

The debate has never been "will consuming less calories than you expend make you lose weight" -- the debate has been "will just telling people to consume less calories, patting yourself on the back and calling it a day make them lose weight."

The latter was settled in a 2023 cohort study that showed doing is completely ineffective. [1]

There's been tons of data on this. The scientific consensus has been pretty clear for a hundred years, but nobody wanted to listen. Probably in part because there was no good solution before.

[1] https://pmc.ncbi.nlm.nih.gov/articles/PMC10407685/

Aurornis• 2 years ago

The debate has never been "will consuming less calories than you expend make you lose weight"

If you missed the whole "calories in, calories out" debate, consider yourself lucky. The comment above isn't helpful, but there really was a period of time where the topic du jour among health influencers was debating that calories didn't explain weight gain or loss. It played into the popular idea that blame for the obesity epidemic rested squarely on the food industry and "chemicals" in our food.

At one point, I had a podcast-obsessed coworker who tried to tell us all that even when he ate 1000 calories per day he couldn't lose weight. He had a long list of influencers and podcasters who supported this claim.

The CICO debate was especially popular among influencers pushing their own diet. Debating CICO was a convenient gateway to selling people your special diet that supposedly avoids the "bad" calories and replaces them with "good" calories, making you lose weight.

ragnese3• 2 years ago

The debate has never been "will consuming less calories than you expend make you lose weight"

Maybe the debate amongst actual doctors and researchers. But, the debate amongst dummies on the internet (social media) CERTAINLY had people arguing that it was somehow about more than the number of calories in and out.

s1artibartfast11• 2 years ago

I dont think anyone has agued that the follow through is the hard part.

The whole debate seems like people violently agreeing with each other aside from some fringe idiots that dont believe in thermodynamics.

tonymet8• 2 years ago

there are plenty of obese people who claim that no amount of calorie reduction works. Ozempic has put that to rest. The truth is they were overeating the entire time.

loeg8• 2 years ago

No, there are definitely lots of people that straight up claim that CICO is a myth, some magic force makes some calories turn into fat or not turn into fat. Totally aside from the "'eat less' is hard advice to take" crowd (which is true). That former group has been proven incorrect.

phil212• 2 years ago

Unfortunately it didn’t. Seems to have actually emboldened the “CICO isn’t a thing” crowd even more.

The amount of woo-woo “science” in laymen communities on the subject is utterly astounding considering the evidence directly in front of them. Check out the various subreddits for a casual glimpse - anyone saying stuff like “the primary method of action is eating less” is downvoted and the woo woo “metabolism” or “hormones” stuff is upvoted and celebrated.

In the end I think there is a lot of weird guilt around overeating I never really understood existed before. I lost 100lbs using Mounjaro but never once thought it was anything other than me eating too much and moving too little while I was obese. It’s just a lot of damn work and willpower for me to change that. Tirzepatide was simply a performance enhancing drug for my diet that finally put me over escape velocity to make lifestyle changes that so far have stuck for a couple years now.

kjkjadksj4• 2 years ago

I’ve been flamed here on HN for asserting CICO is valid. In truth there are few scientists among us.

SkyPuncher• 2 years ago

I don't think it was ever really a debate.

"Reduce calories" is about as useful as "exercise more", "sit less", "drink less", etc, etc. All are obviously good, but for various reasons it can be hard for people to achieve them.

GLP-1's basically take the "how" out of the equation. Take this drug, eat less without fighting your own desires.

s1artibartfast11• 2 years ago

All of them are essential as an objective to implement or improve the how.

tonymet8• 2 years ago

there are plenty of people who claim that no amount of calorie reduction results in weight loss. Often it's people who are claiming to eat starvation amounts of food while gaining weight. Of course researchers have known it was delusional, but the belief persisted in pop culture. Ozempic is putting that to rest.

this is a case where more personal / colloquial / folk evidence was needed to convince people.

paulpauper10• 2 years ago

Yes, "eat less" is the answer, but this is harder to do yeah if your metabolism is slow or always being hungry. this drugs makes it easier to eat less and hence lose weight .

rs999gti2• 2 years ago

settled the debate on calorie reduction.

Really? Because GLP1s reduce hunger and food cravings, less of those means less eating, less eating means less calories. The drug just makes people involuntarily fast, it has no thermogenic of lipolysis abilities.

jncfhnb• 2 years ago

Ozempic tends to change not just the total number of calories but also the timing and the cravings for shitty food.

Calories in / calories used is NOT a complete model because different foods can have different caloric retention. The most extreme example being corn that comes out entirely undigested. Further, shittier foods that the body craves most are also the least satiating over the longer term.

Reducing calories is three or four steps removed from the actual problem. Like arguing the problem is organ failure when in the first order problem is that you got shot. You have to deal with the wound; and you have to deal with the blood loss. That will, in turn, address the organ failure.

tonymet8• 2 years ago

I should get more karma for this sub thread

aurizon2• 2 years ago

The USA is a racket cubed. https://www.healthsystemtracker.org/brief/prices-of-drugs-fo...

The pharmacies are also in on it https://pmc.ncbi.nlm.nih.gov/articles/PMC11147645/

thrance3• 2 years ago

Don't forget the tariffs that are bound to make it 30% more expensive.

aurizon2• 2 years ago

The Pharma chains get product at world wholesale, and in the case of Ozempic = about $100 at the pharmacy where it is picked up = pharmacy pays $75. Same cost base = $500-900 in the USA. 30% tariff will be based on the $75 base import cost = small

samaltmanfried2• 2 years ago

I find something really gross and dystopian about the idea of Ozempic. Developing the willpower to resist short-term gratification, and the ability to make long-term decisions about your diet and health are some of the most important ingredients to living a good life. The idea of letting a drug do the thinking for you because you just can't trust yourself really horrifies me.

firesteelrain• 2 years ago

I took compounded Mounjaro for two months. It was like a jolt to the system and got me back on track. I learned how to eat better and alter what I eat plus tracking it. Started walking and going to the gym. Started with 7k steps and now easily over 12k a day on average. I don’t drink soda and if I do it js Coke Zero, Pepsi Zero or Diet Coke. We just don’t buy it. I didn’t know about maximizing my protein and fiber.

It wasn’t short term at all like you say. Something was seriously wrong.

It’s everything though - if it was that easy to just start doing it then people would.

I needed a jolt and impetus to get better. I was depressed, worryful, everything.

I have lost 40 lb. I went from 255 to 229 with the assistance of Mounjaro. I stopped taking it but kept up with the regimen. I am now down to 214.

Some people who take it don’t do it right, they still eat crap and so those are the people who rebound or think they need to go up to 15. I was taking 2.5 then 5 when I stopped.

Yea it is willpower and discipline. Being on the medicine as an assistant along with a lot of research spurred by the community such as maximizing protein, fiber and water intake to become satiated was all that did it with exercise.

foxyv3• 2 years ago

Consider the fact that, if a drug can make you skinny, perhaps a drug can also make you fat. Or, even your own body can make you fat. Sometimes, what we think are our choices, have more to do with our biology and environment.

Just like you can't will yourself to be healthy if you are sick with the Flu. Some people can't just will themselves to be skinny. This is why we have drugs and treatments, because our bodies are not perfect machines that work the way we want them to.

pkaye• 2 years ago

Consider the fact that, if a drug can make you skinny, perhaps a drug can also make you fat.

Yes that would be Prednisone. People call it the devils tic-tac. Its a wonder drug with terrible long term costs to your body especially at higher doses.

timewizard4• 2 years ago

with our biology and environment.

Our biology hasn't changed much in recent years. Our environment has. So has our obesity levels. I mean, it's an "environment" that has "super size," as a default option.

JofArnold• 2 years ago

This is the kind of comment that can change a person's life. Really thoughtful. I'm going to quote it in future. Thanks.

steveklabnik• 2 years ago

Do you object to pencil and paper because people write down reminders because their memory isn't good enough to remember everything?

paulpauper10• 2 years ago

Just flip it around: what if there were a drug that made people fat? Is it an insufficient willpower issue then? Willpower works for some, but the drugs make it easier.

crooked-v• 2 years ago

Telling everyone "just get better willpower" is about as useful on a societal level as looking at a disabled person at the bottom of a set of steep stairs and telling them that the struggle is good for them.

orwin2• 2 years ago

You just don't understand how food addiction works. Going from 34 BMI to 28 (I'm at 26 now) was the hardest thing I ever done, and I had money, great friends, a great family and a doctor that followed me twice a month.

Willpower is not a muscle, it's a well that fill doing what you enjoy, and clear when used. During my diet, my work ethic was at the bottom, and I couldn't force myself to go out meet new people.

Now that I have a healthier weight and stopped dieting hard (I'm still constantly hungry, but now it's my life), I'm a great coworker, I met a lot of people, made life-changing decisions and I have a lot of willpower left to do all the little things right. If I had a drug that helped me control my appetite at the time, i would have taken it.

timewizard4• 2 years ago

You just don't understand how food addiction works.

Would you concede that some foods are more addictive than others? Doesn't this suggest other remedies like food regulations, at the very least, should be deployed in concert with seeming "miracle drugs" like GLP-1 agonists?

Funes-2• 2 years ago

How have fat people gotten thinner without those meds up until now, then? Was their addiction not as strong as yours, as you seem to imply? They just didn't "understand"? Look, I went from being an absolute fucking fatass to 8% body fat out of willpower alone when I was 17. It took a lot, namely destroying every bad habit I upheld for years regarding food and exercise, but I wanted to do it bad enough, so I did. It was a really extreme and sudden change of mindset, like a flip of a switch, actually, because I had enough of the bullying and lack of self confidence. One day I just got mad enough and changed my whole life.

titanomachy5• 2 years ago

Willpower is not a muscle, it's a well that fill doing what you enjoy, and clear when used.

I won't negate your experience, since this is such a personal thing, and it's not like we have a rigorous scientific understanding of these things. But to me, willpower does feel like a trainable thing. Doing hard things seems to make me better at doing other hard things. Limiting my TV makes me less likely to compulsively eat later. Working out hard makes me less likely to lie in bed scrolling on my phone. Doing hard coursework makes me more focused at work.

The caveat is that these changes seem to happen pretty gradually, and the gains can be lost pretty easily, just like with muscle.

But being in a perpetual caloric deficit can be pretty rough and can definitely sap your energy. Glad you found your way to a healthier weight.

tjpnz• 2 years ago

I do make good decisions and put in 10k steps everyday, which according to my stepcounter puts me in the top 5% for people my age. I've managed to slow my progression into the abyss; but I'm still going there.

Truth be told, my body can't effectively lose and maintain weight unless I'm eating a strict 1500 calories and replacing the walking with an hour long run each day. I know this because I've tried it and managed to maintain it for 6-months. It was a herculean effort and despite the results I paid a toll both physically and mentally. This isn't to say that the laws of thermodynamics don't apply to me; but my body will fight against them harder than most.

(I believe I would be a good candidate for these drugs. The only thing stopping me is the thought of having to be on them indefinitely.)

AlisdairO3• 2 years ago

Respectfully, have you ever had anything in your life that you have struggled desperately with, and needed help? Anything at all that might give you a little empathy on the topic?

I was obese twenty years ago, and lost the weight via diet and exercise. Keeping that weight off is the single hardest thing I have ever done, and a battle I still have to consciously fight every single day. Doing so causes me a great deal of pain and frustration, and I know that I'm someone who is right on the edge of not being able to control my weight. Why should it be that difficult? So that I can pass some kind of purity test?

The fact is that the food we eat has evolved over time, and is too hard to resist overconsuming for a large fraction of our population. If we can create more addictive food, why not create antidotes? If we could easily treat alcohol addiction with a pill, would we tell alcoholics to just apply willpower instead? Why would we want people to suffer like that?

est31• 2 years ago

There is multiple effects fighting against people who want to lose weight:

* habits. often times, obese people use food as a stress response, as a reward, etc. this then makes them relapse.

* "target weight" of the body. there is a memory effect where once you have built up fat tissue, your body wants you to return to that weight. In other words, it's not just the first step that's hard, but all the steps thereafter. Relapse is easy.

* fat tissue makes you more hungry.

* environmental issues, like unwalkable cities, an entire industry putting chemicals into foods that make you addicted to them, its excessive marketing, missing availability of non-processed foods (large percentage of US population lives in food deserts), etc.

It's not just discipline of the individual holding them back.

throw101010• 2 years ago

It's also unlike most addictions, you have to eat few times a day if you don't want to die... alcohol, drugs, gambling are not required to survive, eating is.

latentcall• 2 years ago

I don’t understand why the USA doesn’t just ban processed foods? I know USA only cares about profit but come on. Other countries don’t eat like we do.

amanaplanacanal2• 2 years ago

Obesity is not just a USA problem.

djur6• 2 years ago

Because there's no coherent regulatory framework to "ban processed foods", no country has ever done such a thing, and it would be political suicide to be the party that banned cheeseburgers, french fries, and Coca-Cola.

loeg8• 2 years ago

Ozempic helps many people make better long-term decisions about their diet than they would otherwise. Do you think no one without extraordinary willpower should be able to "live a good life?" The drug doesn't "do the thinking for you."

plantwallshoe• 2 years ago

Would you be horrified at drug that made heroin addicts not want to do heroin anymore?

jeroenhd• 2 years ago

I know it's an unpopular opinion, but I agree, at least partially. I think you're underestimating the "developing willpower" part, but I do think that helping people lose weight the themselves should be the solution, not chemicals.

These weight loss drugs are conditioning people to feel satisfied with less food in their stomachs, but only while they take the medication. If you don't put the same serious effort into improving your lifestyle, you're going to end up overeating again, gaining all that weight back, and probably going back on weight loss pills. Instead of solving the unhealthy dependency on food that most seriously overweight people struggle with, you're adding a dependency on medication.

Where I live, these drugs haven't even passed medical review for weight loss yet, they're purely prescribed for diabetics. That doesn't stop the illegal second hand market (taking drugs out of the hands of diabetics that are much better served with them) unfortunately.

In general, I do think weight loss drugs are better for society as a whole, as they save people from the ticking time bomb that is obesity, but I wish we could come up with a better solution.

djur6• 2 years ago

The best way to change your lifestyle is to change it, and GLP-1 agonists make it easier to change your lifestyle. In fact, they don't work at all if you don't. Someone who's unable to change their diet and exercise routines while taking a GLP-1 agonist wasn't going to be able to do it without the medication, either.

And this talk of "dependency on medication" is ridiculous. Lots of people take medication every day to live a better life, or they use medical devices like eyeglasses and hearing aids, etc. That's one of the blessings of modern society.

rs999gti2• 2 years ago

Not the lifeline for us fatties.

Medicare enrollees, however, still won’t be able to access the drugs for obesity under a federal law that prohibits the program from paying for weight loss treatments

Also, you have to be severely ill or elderly to get Medicare. This is for their diabetic treatment.

knuckleheadsmif3• 2 years ago

That’s because Medicare only covers drugs for approved FDA usage. It’s covered for diabetes but not weight loss. In general this is good policy. It is possible to challenge for some cases but generally that is the rule. It’s a perfectly reasonable way to both control costs and prevent harm.

If the drug manufacturers wanted it to be covered for weight loss there IS a process. File the correct paperwork with the FDA and do the rigorous studies that were don’t for the approved usage.

djur6• 2 years ago

Wegovy is approved for weight loss (since 2021).

wormius3• 2 years ago

My ACA insurance (because I was unemployed) covered Rybelsus (pill form, which is a much higher dose due to lack of absorption through the stomach), then in like October or November they said "nah" and said "go to Ozempic" I had just completed my first two sets of increases before the final uppage to be on the stable dose, when insurance said "Nah." So my doc RX'd Trulicity to see if they would cover that, which, for some reason they also didn't. I haven't had the time or energy during the holidays to deal with it, so now I'm dealing with increased hunger from going cold turkey off these things all because of bullshit micromanagement from shitty insurance companies on the market place.

If this makes it better and easier for companies to actually pay out for this I am 100% for it, there should not be a constant jerking about for what is or isn't paid. Also - this wasn't for weightloss (which I assume would have been Wegovy approved), this was for diabetes, and it was under control with Rybelsus, and I assume Ozempic, though we were still in the process of building up to it (I was on max dose of Rybelsus and I'm pretty sure I needed the max Ozempic as well). If they had given a reason for the denial it'd be one thing but it was just a blanket denial.

I just hope this makes it easier for folks who need it to be able to obtain it.

ddorian433• 2 years ago

Just do keto diet. Assuming T2D. Its the easiest disease it fixes.

Some people cant have it all in life. You gotta sacrifice. The carbs in our case.

Source: I do it for other reasons.

solresol• 2 years ago

When I last looked up the literature, Keto diet was one of the least effective interventions.

That is, if you follow it, I'm sure it works.

But the vast majority of people drop out of keto diets very quickly. So it's lousy advice and an unsuccessful intervention.

It's a bit like saying to a patient "you gotta sacrifice -- you should doing 3 hours a day of cardio". If they do follow through with it, it will work. But the vast majority of people won't be able to maintain doing that.

dbg314152• 2 years ago

100% agree.

Insurance companies shouldn't get to pick and choose what drugs are in or out.

I was at a company, and Wegovy was covered.

Then randomly I got an email from HR, "Your medication is no longer covered."

The fuck is my insurance company doing telling my HR what medication I'm on? Even if they didn't say it outright, it wouldn't be hard to figure out giving the drugs that came off the list that were paid for that quarter. =P

Going cold turkey on these drugs is hard... like the doctors tell you that once you start taking them, you really aren't supposed to stop taking them. Or if you do, you have to do so gradually.

The drugs mimic the feeling of being satisfied from being full, by overloading your system with a synthetic version of that hormone that makes you feel that way.

Now... imagine going from "my parents used food to control my behavior growing up, and 40 years of bad behavior cemented that conditioning in place, so now it takes a lot of food to make me feel full / content," to "Oh this is nice, thank you drugs! Now I don't have to eat so much!" to "You're on your own, kid! And by the way, now that your body was used to the drugs, virtually no amount of food will make you feel full / content now. Let's see what happens!"

Fucking insurance companies. People are nothing but pre-existing conditions and behavioral patterns. It shouldn't be up to the insurance companies which ones they elect to cover. "Oh, did you think smoking was cool as a kid? Too bad, hope you die from lung cancer!" It just shouldn't be on them to choose.

nextaccountic2• 2 years ago

Then randomly I got an email from HR, "Your medication is no longer covered."
The fuck is my insurance company doing telling my HR what medication I'm on?

Isn't this a straightforward HIPAA violation?

alluro2• 2 years ago

I know it's a worn-out stereotype to point out, but from an European, I just hope you realize how jarring it sounds that there is a medication that a doctor determined you need, and TWO companies - entities driven by and existing exclusively for profit - are involved in deciding and communicating with each other on whether you will get it or not.

I do think that this should still actively be regarded as scary and abnormal, even if it's the norm for so many people in the US.

gscott• 2 years ago

There are these weight loss companies producing the stuff you should buy it from them cost about $350 a month.

https://ro.co/weight-loss/checker-path/

Spooky23• 2 years ago

The insurance company is the face, the villain is your company. Most bigger companies are self insured. These drugs are expensive and blow up plan costs when everyone is on them.

A relative has a self-insured Cigna plan that randomly fucks with you. The company hired another company to argue with them on your behalf. End of the day, Cigna is administering the plan they established.

Beijinger6• 2 years ago

I partly agree with Kennedy. Ozempic will not make America healthy again. You will have to look into lifestyle choices.

This being said, if you want to go the medication route, there are not patents for medications in India. You could try to obtain it from India: https://dir.indiamart.com/impcat/semaglutide-tablet.html

I am not an MD and this is not medical advise.

QUESTION: If I live in the US in state XZ, what is the best, easiest way (zoom?) to get a valid prescription to order drugs from Mark Cuban? https://www.costplusdrugs.com

criddell• 2 years ago

Ozempic will not make America healthy again

Will it help a significant net number of Americans be healthier? If so, then it should be made available to those people.

You will have to look into lifestyle choices

That's not being questioned, is it? Who doesn't understand that exercise and eating well is better than not exercising and eating garbage all day?

op00to4• 2 years ago

Ozempic is only effective with lifestyle changes. The medication makes those changes easier. You should understand the effects of medication before you spout falsehoods.

tracker1• 2 years ago

I had some really bad side effects on those meds... was on for over three years when I realized that was causing my gastroparesis and other issues. I felt like I was starving 24/7 for 8 months coming off. I wouldn't ever go back. Throwing up fermented crap nearly daily isn't fun, let alone the pain and nausea.

honestSysAdmin• 2 years ago

  https://www.vox.com/22553793/gila-monster-lizard-venom-inspired-obesity-drug-semaglutide

BurningFrog2• 2 years ago

The tradeoff with these price controls is that they make current medications cheaper, but make future medications substantially less profitable, making them less likely to be developed.

It's rare to see this mentioned, so I'm trying to build awareness.

thrance3• 2 years ago

You believe in a lie, most of the insane margins go towards sharholders of private laboratories or insurance companies and other parasites. Very little of it goes toward actual R&D, and the foundational part of it is done by public labs anyway, that are payed for by taxes.

BurningFrog2• 2 years ago

Developing an approved drug costs 1-2 billion dollars.

If you can't recoup that by selling the drug, developing drugs is not sustainable and will not happen. And the US is really the only country where you can sell for substantially more than manufacturing cost.

Ozempic manufacturers do make huge profits now, but that's quite rare. This is a tough industry to make money in.

loeg8• 2 years ago

Interesting that they're negotiating semaglutide (Ozempic/Wegovy) but not tirzepatide (Zepbound/Mounjaro). Cynically, maybe a ploy to bolster a US pharma (Lily) as opposed to Danish Novo? I don't know anything about how this program selects drugs to negotiate.

lstamour2• 2 years ago

It wouldn't surprise me if they picked who would be included based on which drugs should be relatively price flexible yet cost a lot. I've noticed that ozempic/wegovy prices have dropped in many markets recently, even price controlled ones, especially compared to Mounjaro, as the latter is seen as more effective and in short supply and has fewer generics available still.

In fact, by introducing new multi-dose versions to different regions, I'm starting to see Mounjaro prices reportedly double for some. The real kicker is that for some brands/doses the price doesn't vary whether you get more or less of the drug - so people end up asking to for a prescription to the highest dose off-label and then split the dose themselves.

For example, you can click the auto-injector pen a fewer number of clicks to measure out a smaller dose than what is normally injected by the pen, then relatively safely save it in the fridge for longer than recommended even without preservatives (some pens have and some don't).

It's frustrating when pricing decisions are made assuming insurance benefits and yet insurance isn't always available, e.g. unemployment. This thinking even applies in places that do regulate drug prices. But hey, you can always sign up for the manufacturer's discount program to get it cheaper, so, win-win right?

loeg8• 2 years ago

As others have pointed out, the drugs on this list go into effect in 2027, which is after the EU semaglutide patents expire (2026), so that might be a pretty compelling reason for semaglutide pricing to be more flexible than tirzepatide.

The real kicker is that for some brands/doses the price doesn't vary whether you get more or less of the drug - so people end up asking to for a prescription to the highest dose off-label and then split the dose themselves.

FWIW, I'm paying cash buying it directly from Lily, and they charge $400/mo for the 2.5mg dose and $550/mo for the 5mg dose. So, some price differentiation between dose sizes, but not linear.

dbg314152• 2 years ago

The fact that it's up to the insurance provider to choose what medication they cover is so absurd. Your doctor can prescribe medication, and the insurance company can say, "Nah, we choose not to cover that. And we don't cover the generic versions either!"

It's so shitty when you have to change insurance plans, and then get stuck holding the bill for medication that you were taking, but is no longer covered under your new plan -- especially for weight loss drugs that don't seem to be even like 80% covered under any plan you can get on your own.

Insurance should cover everything. Period. Full stop. Just because you change jobs doesn't mean you should ever have to change medications.

Anyway, Free Luigi! =P

bdauvergne3• 2 years ago

Just coming here to say that most of the world (outside the USA) does not need Ozempic at all to be healthy. So maybe this medication is really a luxury.

mateus1• 2 years ago

I'm not in the US and know plenty of people that use it. It's also maybe a 1/5 of the US cost, even accounting for the exchange rate.

bdauvergne3• 2 years ago

In France it's reimbursed but only if you are diabetic. I'm not sure people talking about it here are diabetic.

nojito2• 2 years ago

This isn't true at all.

The obesity epidemic is international.

https://en.wikipedia.org/wiki/List_of_countries_by_obesity_r...

bdauvergne3• 2 years ago

Self inflicted epidemic...

hackeraccount• 2 years ago

If you were a drug company how much money would you spend on developing an Ozempic/Wegovy follow on drug?

Price controls like this are popular because the benefits are easy to see and the costs are distributed and nebulous. Excepting things like the fires in LA which are distributed and obvious.

Ozempic and Wegovy are selected for Medicare's price negotiations

Related Stories