In this episode of Only Healthcare, hosts Michael Navin and Dr. Randy Vogenberg welcome guest Deborah Williams, a leading healthcare strategy and policy expert, to explore the explosive growth and complex economics of GLP-1 medications like Ozempic and Wegovy.
With her extensive background working on Medicare Part D legislation and with major pharmaceutical companies, Deborah breaks down how these breakthrough diabetes and weight loss drugs exemplify everything wrong with America's healthcare incentive structure.
Key Topics Discussed:
- Explosive Market Growth & Cost Impact - GLP-1 scripts increased 442% between 2021-2023, creating a market three times larger than cancer spending, with list prices reaching $1,400 monthly while costing only $60 in Germany
- Coverage vs. Affordability Crisis - Only 33% of employers cover obesity indications, with 17 state employee plans dropping coverage due to budget constraints, while patients face full list prices until hitting deductibles
- PBM-Driven Pricing Distortion - Real-world example of a CEO needing to charge $930 monthly to net $200 profit due to PBM rebate demands, while a $63 diabetes alternative (Steglatro) gets excluded because it offers no rebate opportunity
- Direct-Pay Solutions & Reform - Analysis of Lilly Direct and Novo Cares programs that bypass traditional middlemen, offering vial-and-syringe options at net pricing similar to post-rebate costs but as cash-pay transactions
The fundamental problem isn't just drug pricing, it's a system where every stakeholder is incentivized to maximize revenue rather than patient health outcomes, with PBMs controlling access based on rebate potential rather than clinical effectiveness.
🎧 Listen now: onlyhealthcarepodcast.com
Chapters:
(00:00) Introduction
(02:00) GLP-1 category overview and 442% script growth explosion
(06:00) Patient engagement challenges: lifestyle vs. medication approach
(10:00) Coverage gaps: employer plans dropping obesity coverage
(16:00) PBM rebate demands forcing artificial price inflation
(23:00) Compounding alternatives and FDA policy changes
(27:00) Direct-pay programs: Lilly Direct and Novo Cares analysis
(31:00) Future outlook and policy reform recommendations
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Sponsored by:
Peek: A game-changing prescription shopping solution that allows its members to view all their prescription cost options across cash discount programs and their insurance in one easy-to-use platform. Peek is currently being offered to organizations to help both employees and plan sponsors save money on their prescription spend. https://peekmeds.com/.
Institute for Integrated Health (IIH): Health care benefits, insurance coverage regulations, and doing business in the healthcare industry can be complicated. At IIH, Dr. Randy Vogenberg and his team understand these unique challenges and provides strategic guidance customized to every client. To help overcome your unique challenges, IIH delivers education, planning and advisory on market trends, and U.S. health care market intelligence. The firm’s decades of proven success are due to strategic collaboration with associates from the business, clinical, and scientific communities. https://iih-online.com/.
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