November 7, 2024 • 47 mins
In Episode 49 of the Pound of Cure Weight Loss Podcast, Dr. Weiner and Zoe examine the steep costs of obesity medications like Wegovy, the influence of pharmacy benefit managers (PBMs), and the role of big pharmaceutical companies in shaping healthcare. Highlighting recent Senate hearings led by Bernie Sanders with Novo Nordisk’s CEO Lars Fruergaard Jørgensen, this episode sheds light on how the current system prioritizes profit, often at the expense of patients’ access to care.
Wegovy Cost: Breaking Down High Prices in the U.S.
Wegovy, a GLP-1 medication, costs around $1,349 per month in the U.S., while in other countries like the U.K., prices are as low as $92. Dr. Weiner explains that this discrepancy illustrates a broken healthcare model, where the U.S. market fuels corporate profit but leaves millions unable to afford essential treatments. With 72% of Novo Nordisk’s revenue coming from U.S. sales, the company’s pricing strategy relies on American consumers, who are left paying significantly more for the same medications.
Big Pharma’s Influence on Policy and Profits
This episode delves into Big Pharma’s control over drug pricing, particularly the stark contrast between their research and development costs and their profits. For example, while Novo Nordisk spent $21 billion on R&D, they spent twice as much—$44 billion—on stock buybacks and dividends. Dr. Weiner highlights how political influence plays a crucial role, with both major parties receiving substantial donations from pharmaceutical companies, leading to stalled efforts in drug price regulation and patient access.
Pharmacy Benefit Managers (PBMs): Hidden Gatekeepers Driving Up Costs
PBMs, the intermediaries between insurers and pharmacies, are supposed to negotiate better prices, but Dr. Weiner and Zoe point out that they often drive costs higher through hidden fees. In many cases, PBMs have financial incentives to push higher-priced drugs, creating a “pay-to-play” system that limits patient access. For example, PBMs profit by taking a percentage of negotiated drug price savings, meaning higher drug list prices generate greater profits for them. Dr. Weiner underscores how PBMs complicate and inflate pricing, making it even harder for patients to get GLP-1 medications through insurance.
Do We Need Health Insurance Companies and PBMs?
Dr. Weiner questions the necessity of insurance companies and PBMs in the healthcare system, arguing that they don’t provide direct patient care yet extract billions from the system. He suggests that healthcare can function without these financial middlemen, allowing for a more transparent, patient-centered system where costs are lower and patients have better access to needed treatments.
The Morality of Obesity Treatment Costs
The episode closes with Dr. Weiner and Zoe discussing the stigma surrounding obesity and the moral implications of restricting access to life-changing medications like Wegovy. They emphasize that obesity is a complex, chronic disease requiring comprehensive treatment, not simply a “lifestyle” issue. Dr. Weiner advocates for recognizing obesity treatment as essential, which could lead to a shift in how these medications are accessed and covered.
Final Takeaways
While the healthcare landscape remains challenging, Dr. Weiner believes patient advocacy, legislative changes, and innovation can improve access to these life-saving treatments. This episode offers insights into navigating the current system while emphasizing the need for systemic change to prioritize patient health over profits.
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Dr. Weiner (00:00):
These prices are really the symptom of a broken
system, as opposed to a singleact or a single bad person kind
of taking advantage of ourhealthcare system.
Zoe (00:17):
Hello and welcome back to the Pound of Cure Weight Loss
Podcast.
Today's episode is NovaNordisk's Weekend at Bernie's.
Dr. Weiner (00:25):
Yes, so this is a little bit of a different show
than we've ever done.
I've been following this.
We've been talking about BernieSanders, you know bringing Lars
Jorgensen, the CEO of NovaNordisk, in front of a Senate
hearing, and so it finallyhappened at the end of September
(00:45):
.
And you know I watched thewhole thing.
It was like two and a halfhours long.
I watched the whole thing.
I pulled out some clips that Ithought would be interesting and
I was going to go throughbecause I think it.
You know as much as we look atpolicy and how laws are made and
how all this stuff happens, itis very understandable.
(01:09):
Anybody can kind of understandwhat's happening and where
they're going, and I think youcan really just see how much
bureaucracy there is in gettinganything done, anything done,
and our political situation,where neither party can stand
the other party, doesn't makefor us able to kind of come to
(01:31):
the middle and find some goodpolicies, which is how
historically this country hasworked.
So, anyway, I thought it wasinteresting.
There was a lot to learn, butin the end there is of you know,
they all kind of there is agroup think and they all kind of
come to a fairly similarconclusion.
So this was the Senate HealthCommittee and they are made up.
(01:55):
It's a bipartisan group andthere's kind of two leaders of
it.
The first leader is SenatorBernie Sanders and I think he's
like the main head, but thenthere's also Senator Cassidy.
He's a Republican constituentand so they were both kind of
the heads.
It actually is Dr Cassidy, he'sfrom Louisiana, and so the two
(02:21):
of them kind of headed up this.
But then they had differentmembers of the committee and
each one of them was given achance to kind of ask questions
and go through a line ofreasoning and it's partly
showboating and it's partlytrying to get to the bottom of
the problem.
So the big issue is and we'regoing to hear from Bernie in a
second that these medicationsare far more expensive in our
(02:45):
country than they are in anyother country, and so you know,
there's a lot of backgroundfacts that brought on these
hearings.
The first is that NovoNordisk's sale price, and I'll
show you right here, zoe, just ashot of Novo's sale price.
Zoe, just a shot of Novo's saleprice, novo's stock let's see,
(03:08):
we're going to go through thisIn 2022, the stock was somewhere
in the high 50s and they'vereached a high of like 140.
So they're running like 120,140.
So in the last few years,novo's stock has more than
doubled.
So in the last few years,novo's stock has more than
doubled.
(03:31):
So clearly this company has donevery very well as a result of
Ozempic Wegovi and I think overfive years it's up 368%.
So I saw this coming years ago.
I knew these drugs were goingto be amazing and I didn't buy
stock in it.
That kind of kills me, yeah,but it's a side point.
So 72% of the revenue from NovoNordisk comes from US sales, so
(03:56):
they make way more money fromus than any other country.
Zoe (04:00):
Right.
Dr. Weiner (04:01):
That's the first point, right?
That's the first point.
These drugs are anywhere fromfour to ten times more expensive
in our country than in anyother country.
We also spend twice as much onhealth care as any other country
in the world, and yet 85million Americans are either
(04:25):
uninsured or underinsured.
We still have to pay atremendous amount of out of
pocket um, and 65 000 people ayear die from lack of insurance
coverage and we're still sickeryes, and we are less healthy
than most other countries.
Our infant mortality rate is inline with some third world
countries.
I mean mean there's a lot goingon with our healthcare system.
(04:48):
And so when you see thishappening and Novo Nordisk is
making record breaking, profitsyou're going to get brought into
it.
So let's start by kind oflooking at what Bernie's
introduction to this was.
And he kind of outlines whywe're doing this.
Here's the video.
Bernie Sanders (05:07):
Which shows that Novo Nordisk's diabetes drug,
nozempic, is sold in Canada for$155, in Denmark for $122, in
France for $71, and in Germanyfor $59.
For $71, and in Germany for $59.
In the United States, novoNordisk charges us $969, over 15
(05:41):
times more than they sell thatproduct in Germany.
Regovi, novo Nordisk weightloss drug, is even more
expensive, as the chart behindme also shows.
Wegovy is sold for $265 inCanada, $186 in Denmark, $137 in
Germany and $92 in the UnitedKingdom.
(06:03):
In the US, the list price forVigovy is $1,349 a month, nearly
15 times as much as it cost inthe United Kingdom.
What we are dealing with todayis not just an issue of
(06:24):
economics.
It is not just an issue ofcorporate greed.
It is a profound moral issue.
Dr. Weiner (06:34):
What do you think about that Zoe?
Zoe (06:38):
I mean, obviously we've talked about it before on the
podcast.
It's just disgusting.
It's kind of a sad state ofaffairs.
Yeah, I just like.
I, I feel like it everything'sin so many ways I mean, I think
the health care system is.
Dr. Weiner (06:59):
It is starting to get a little bit to a tipping
point.
Zoe (07:03):
It's insane.
This is like something has tochange.
This is not okay.
It's not okay.
Dr. Weiner (07:08):
So I'm going to bring up a second image here and
I'm going to explain why Idon't really see it changing
much over the next five years.
So this is a chart of the top15 political candidates who have
received funding from thehealthcare industry.
(07:30):
This is just 2024.
Of course, the top two peopleare our current presidential
candidates, with Kamalareceiving over $5 million in
funding from the healthcareindustry in 2024.
Over $5 million in funding fromthe healthcare industry in 2024
.
Trump is substantially lower atabout $860,000, but still a lot
of money for Trump.
(07:50):
Some interesting things onthere.
Nikki Haley is also on thereand Bill Cassidy, who we're
going to hear from, is on there.
He's one of the people on theSenate committee.
Zoe (08:02):
That'll be interesting.
Dr. Weiner (08:03):
He's one of the people on the Senate committee.
That'll be interesting.
Yeah, so you know, we just havethe politicians are bought and
sold by the health care industry.
And if you look also at thatgraph, it's not Democrats, it's
not Republicans, it's like a50-50 split.
This is really not a partisanissue.
(08:25):
The winner of this electionit's not going to neither of the
candidates.
Whether we're talking aboutflipping the Senate or the House
or the presidential candidate,no matter what it's still,
they're still going to beheavily influenced by the
healthcare industry.
And so I, you know, I think thatI think that's really the state
(08:46):
of affairs.
So when we look at somethingthat's happening, and in many
ways I think what we're going tosee is that these prices are
really the symptom of a brokensystem, as opposed to a single
act or a single bad person kindof taking advantage of our
(09:06):
healthcare system.
It really is.
It's because and we've talkedabout that in the past with our
creative dosing strategies, howyou know when the system's
screwed up, there's sometimesthere's a little chink in the
armor and you can kind of takeadvantage and save some money,
and you have to do things alittle bit unusually, but it can
save a tremendous amount ofmoney and give you access to a
drug that you couldn't otherwiseafford.
(09:27):
And so there's something in ourhealthcare system the pricing
that doesn't make any sense, andyou can leverage that to your
advantage, and we do that everyday in our practice.
Zoe (09:39):
And it's kind of like this problem has probably been here
for a really, really, reallylong time, but now, with the
widespread use and like thislife-changing class of
medication and all these thesedrugs, it's now just really
having a spotlight on the it's.
(10:00):
It's utilizing the glp1s askind of this on the pedestal
look at this problem.
But there are probably so manyother drugs that this is
happening with as well, this ishappening with chemotherapeutics
, this is happening withradiation treatment after cancer
.
Dr. Weiner (10:14):
The problem is it's happening on these little
one-off situations.
It's this one case here, onecase there rare cancer, this
drug, that drug.
Millions and millions of peoplewe have millions and millions
of people who want the same drugand they really want it, really
really want it, and they can'tget it because of it.
So these GOP ones are reallyputting a spotlight, like you
(10:36):
said, on our healthcare systemand kind of focusing it around a
single issue, which is thisdrug.
Zoe (10:43):
But, like you, said yeah, it's a systemic issue.
Dr. Weiner (10:46):
I think you put it exactly right that way.
So let's see what LarsJorgensen has to say in his
initial response, and I'minterested to hear what you
think about this.
Lars Jorgensen (10:57):
Hard at work in making sure that patients have
access via the insurance schemes, and today 80% of all Americans
with insurance have access tothese medicines at $25 or less
for a month's supply.
So it's a price point at thepharmacy counter we have to talk
about.
Bernie Sanders (11:15):
Let me just interrupt you, if I might.
Okay, you're correct that manypeople pay $25 a month for
Zympic, but what you'reforgetting to mention is that
many of those people are payingoutrageously high prices for the
insurance that covers Ozempicand other drugs.
So, simply, this is apass-through to the insurance
(11:37):
companies.
Bottom line is you are chargingthe American people
substantially more for the sameexact drug than you are charging
people in other countries, andmy question is why?
Zoe (11:49):
I love how he just got straight to the point and asked
the question.
I mean that's.
I mean First of all.
Dr. Weiner (11:59):
I don't see people get this for $125 on average.
I don't see 80% of our patientsget it.
No way, I mean.
I don't think people get thisfor 25 bucks on average.
I don't see 80 of our patientsgetting no way.
I mean I don't think 80 of ourpatients get it for 100 bucks or
less right um, I have seen lotsof patients paying two, three
hundred dollars, uh, and so Idon't know where he gets that
number, but I I call bs on thatand then second I think bern
(12:21):
Bernie's response was exactlyright.
Yeah, health insurance is just.
It's a way to spread out thecost over time and so if it
costs more, health insurance isgoing to be more.
That's why anybody, if you havea cheap car, your car insurance
is less expensive than if youhave an expensive car, because
(12:43):
you're going to break it at somepoint and it's going to be more
expensive to break, and sothey're basically charging you
for the future cost of repairyeah, it's almost forced savings
to to some degree, um and so.
So anyway, there's 190 millionpeople do not have access to we
go, so that, wherever he'scoming from that, most people
can get it for 25 bucks.
(13:04):
That's not true.
And again, we pay.
Whether if you're on a statefunded plan like Medicaid or
access or Medicare plan, it'spaid for taxes.
Who pays our taxes?
We pay our taxes.
We pay our health insurancepremium.
You work for our practice.
You get a health insurancepremium paid for you by the
(13:24):
practice.
If our health insurance wascheaper, you would get a higher
salary.
So the idea that either youremployer or your insurance
company is paying for a drug,that's not how it works.
Zoe (13:35):
We're paying for it.
It's going to come fromsomewhere.
Dr. Weiner (13:38):
You pay for it.
You pay for it in lieu of wagesor in taxes, or somehow you are
paying for these drugs, okay.
So yeah, bernie has some otherinteresting points here, and I
think this is also some goodstuff.
Bernie Sanders (13:56):
This year, dr Alison Galvani, an
epidemiologist at YaleUniversity, conducted a study on
Wigovie and what she found andI hope Mr Jorgensen pays
attention to this is that over40,000 lives a year could be
saved if Wigovie were madewidely available at an
affordable price to Americanswho need the drug 40,000 lives I
(14:22):
ask unanimous consent to insertthat study into the record.
A few months ago, dr MelissaBarber, a health care economist
at Yale University, conducted astudy on the cost the cost of
manufacturing Ozempic and whatshe found is that Ozempic can be
profitably manufactured forless than $5 a month.
We all know the cost ofproduction is not the only
(14:43):
expense by far for a drugcompany.
Pharmaceutical companies spendgreat sums of money on research
and development to find newtreatments, with many of these
products not coming to market.
We all understand that newtreatments, with many of these
products not coming to market.
We all understand that.
But it is important to knowthat this drug can be
manufactured profitably for afew dollars a month.
(15:04):
We may hear from Mr Jorgensenthat Novo Nordisk spent $21
billion on research anddevelopment since 2018, and I
take his word on that.
What he may not tell you isthat Novo Nordisk spent $44
billion on stock buybacks anddividends over that same time
period.
Dr. Weiner (15:21):
So I think that's another great point, which is,
whatever they're spending onresearch and development,
they're spending twice that muchon buybacks and other things
that are going to increase theirsalary, their profit and and um
.
So clearly, if you're buyingback stock, it means you have
lots of extra money and andagain.
(15:43):
So so we're novo nora's stockis up 360 percent over the last
five years.
They're the price is five timesas high as what it is in the US
, and they're able to dobuybacks that are twice $20, $44
billion buybacks twice whatthey're spending on R&D.
So clearly, this company iscleaning up and, at the same
(16:08):
time, 40,000 people are dying.
And maybe if they made a littleless money I mean, as much as I
hate to sound like a socialistand I've God knows, I'm not a
socialist but maybe if they madea little less money.
Zoe (16:20):
I mean, if we think about it, 1 billion last dollars,
they'd still have their $43billion to do their stock
buyback with $1 billion to makethat.
I mean, I remember we did themath on a previous podcast,
where I can't remember exactlywhich one it was, but where it
was like if we took this smallamount.
Dr. Weiner (16:41):
If we could buy it, for what Canada can buy it for?
I think we put like 5 millionpeople or something I said,
could get the medication.
Yeah, just by getting rid ofthe PBM spend and paying what we
pay in Canada, so which isCanada is the second most
expensive country to get thisright.
Yeah, and I, and to me there'ssomething like, you know, as a
(17:05):
doctor and we I run my ownprivate practice here and, and
you know, you're certainlyinvolved in how we make
decisions and the money and allof that stuff and you understand
there's, there's a business andyou have to make money because
that's how businesses survive.
But at the same time, we alsohave core values, like putting
our patients first and alwaysmaking sure that the decisions
we make are in the best interestof the patients coming to us,
(17:27):
because we chose healthcare as aprofession and that comes with
a set of ethical guidelines thatyou have to follow, and so the
truth is, most doctors thinkthat way, most nurses think that
way, most healthcareprofessionals think that way.
The problem is health insurancecompanies and pharma companies
don't, and somehow the healthinsurance companies, because the
(17:49):
doctors have been asleep at thewheel just working and treating
patients, but somehow webasically said, oh, you can't
trust the doctors to make thesedecisions that are best for your
health, even though we are theones who took an oath.
We're the ones who see you, whofeel with you, who see your
suffering firsthand.
We can't be trusted to makefinancial decisions because
(18:10):
we'll make biased decisionsabout your health care.
Instead, we've basically giventhat control to the health
insurance company and the pharmacompany.
Zoe (18:18):
Who don't care?
Dr. Weiner (18:19):
They don't care, they don't see your suffering,
they don't sit with you at thebedside.
They don't see the pain.
They don't hear your stories ofdiscomfort or, if they do, they
outsource it to someone inanother country to answer the
phone on their customer supportline.
And so we've given this control, we've given them the financial
(18:42):
leverage to make all yourdecisions on health care, and
they have not been doing a verygood job.
You know it's illegal forphysicians to start a hospital
in the United States.
Zoe (18:52):
That's so stupid.
Dr. Weiner (18:54):
Isn't it stupid?
Zoe (18:54):
I was just thinking like I wonder how different things
could be if they had doctorsrunning like at least on the
board of Okay.
Dr. Weiner (19:05):
So here's the problem Doctors aren't immune
either.
This is a very you know, thisis a complex issue.
With every complex issue,there's going to be both sides
of it, Of course.
So let's hear from Dr SenatorCassidy.
Zoe (19:21):
Why shouldn't a doctor be able to start a hospital?
Dr. Weiner (19:26):
Because we might be biased.
Zoe (19:28):
And help patients.
Dr. Weiner (19:29):
And do too many surgeries that people don't need
.
That's the thinking.
But, anyway.
So this is Dr Senator Cassidy, Ibelieve.
Yeah, he's from Louisiana andhe is going to talk a little bit
(19:49):
about this.
He has received $258,000 fromFarm and Healthcare in 2024.
He's the 11th highest recipienton the list and he also voted
against the Inflation ReductionAct, which was a very big and
broad act.
It was Biden's Build BackBetter whatever act.
But that was also in.
That act was where Medicare cannow negotiate with the pharma
(20:11):
company.
We talked about that too on thepodcast.
Medicare can negotiate for upto 10 drugs, and talked about
that too on the podcast.
Medicare can negotiate for upto 10 drugs, and every year they
get to add 10 new drugs thatthey can negotiate with.
I think another important partof this whole hearing is that
you can pretty much count onthat when they release the next
set of medications, which shouldbe coming out fairly soon and I
(20:34):
think it's either 2026 or 2027when the negotiations could
begin, because they announced itand then two years later it
happens you can guess thatOzepic is going to be on the
list.
I think that's pretty much aforegone conclusion at this
point, but anyway.
So let's hear from Dr Cassidy.
Dr./Senator Cassidey (20:50):
But let me say, without a profit motive,
without something in return,it's unclear that these drugs,
or any drug, is going to bedeveloped.
There is a tension, a tensionbetween the need to incentivize
innovation and the ability toafford that innovation.
And we are here struggling withthat balance.
Now, if anyone thinks goingafter big pharma is the silver
(21:15):
bullet, that if you do that boom, health care costs or drug
costs go down, they don'tunderstand what happens with
pricing a drug.
There is no silver bullet, but,as my friend Angus King says,
there is silver buckshot.
You do a little bit here and alittle bit there and it adds up
so the drugs become moreaffordable.
You do a little bit here and alittle bit there and it adds up
(21:37):
so the drugs become moreaffordable.
Given that, we still have topreserve the profit incentive
for the creativity, for drugcompanies to invest in order to
develop the drugs that are goingto positively affect the burden
of disease in our society.
So, as this committee examinesthe affordability of GOPs, we
(21:59):
have to also examine how do wepreserve that incentive for the
innovation?
Zoe (22:04):
I agree.
Senator Hassan (22:04):
Yeah.
Zoe (22:05):
And it's very, very well put, because if there wasn't
that incentive, we wouldn't haveany new drugs.
Dr. Weiner (22:12):
Absolutely the problem is, and I think this is
something that we're gettingwrong as a country is that there
is this pendulum right, it'seither favoring the pharma
company, favoring the bigindustry, versus favoring the
people.
Right?
So in a perfect world, we wouldjust give Ozempic out for free
(22:33):
to everybody, because that'swhat's best for the people, but
of course that would reduce theinnovation, as Senator Dr
Cassidy has put.
When you're putting $21 billionin research and $44 billion in
buybacks, that pendulum hasshifted too far.
It's shifted too much in favorof innovation.
That pendulum has shifted toofar.
(22:54):
It's shifted too much in favorof innovation.
Right, right, on one hand, onceyou discover a drug, it's yours
for life and you're the onlyone who, for the rest of the
history of the world, canproduce that drug.
That's not good either, becausethat drug's never going to make
it out to market, it's not goingto get to the people, and so
there has to be this balance,and in my mind the balance has
(23:17):
shifted too far in favor of thepharma industry, in favor of the
patent holder, and we have toshift it back.
So I agree with him that therehas to be this tension, but I
think what we're seeing is thatthat tension is pulled too far
to one.
Zoe (23:28):
We're snapping.
It's like a rubber band andwe're on that end, about to let
go.
Dr. Weiner (23:32):
Yes, exactly, and one of the rubber bands is laxed
and the other one is pulling itall the way.
Yeah, so we need to move itback to the center not to the
point where Ozempic is free andscrew the patents and that's all
over, right.
But so I hear what he's saying,where he's coming from with
this, but I think that there'smore to this story, so let's
(23:56):
hear from Dr Marshall.
So there's a couple of docs onthis committee.
I do like there are physiciansin the government.
Zoe (24:06):
Is that going to be in your future?
Dr. Weiner (24:07):
It's like my total secret little fantasy.
Zoe (24:09):
Yeah, oh, my God, yes.
Dr. Weiner (24:11):
Like once I'm done with surgery like you know,
mid-60s, to run for Congress orsomething like that.
I would love that, Honestly, myGod.
Yes, Like once I'm done withsurgery.
Zoe (24:15):
Like you know, mid 60s to run for Congress or something
like that.
Bernie Sanders (24:16):
I would love that.
Dr. Weiner (24:18):
Honestly, I would love that I would create so much
trouble.
Ok, so here we have Senator DrMarshall, and this is where,
really, the hearing starts totake a turn and, I'll be honest,
I don't necessarily disagreewith it.
So let's hear what Dr Marshallhas to say.
Again, he's the senator, drMarshall is from Kansas and he's
(24:42):
a Republican.
So here we go.
Dr./Senator Marshall (24:45):
Novo Nordisk is not the villain in
this story.
Novo Nordisk is not the villainin this story.
They're a hero.
We should be here celebratingthis miracle innovation that's
responding to this diabeticepidemic we have in this country
.
It's a miracle drug.
Now we all agree on thiscommittee, across the Senate,
(25:06):
that the cost of health care istoo much and that prescription
drugs are too high, especiallythe out-of-pocket expenses.
But we need to figure out whothe villain is.
Who is the real culprit here?
Who's making the money?
So on this particular posteryou've said it once, you've said
it twice, everybody up heresaid the same thing Whatever the
(25:28):
cost is, whichever number wewant to use, novodortis keeps
24% of it and the PBMs extract76, 74%, 26 and 74%.
So really the PBMs are makingthe bank here.
So let's talk about PBMs for asecond here.
(25:48):
The real culprit in this room,in this story?
So these three big parentcompanies, the three big PBMs,
control 80, 85% of the industry.
Their gross revenue last yearwas $800 billion.
Their parent companies grossrevenue $800 billion.
Dr. Weiner (26:08):
So this is where it all shifts toward blaming the
PBM.
Zoe (26:11):
Well, I'm glad.
Dr. Weiner (26:12):
Yeah.
So I think a little bit ofhistory too is that this
committee also put out the pbmreform act, and we've covered
this also in past episodes.
It really asks for moretransparency.
So pbms and and we're going tohear a little bit more about
this make their money by sayingthe role of the PBM is these
(26:35):
pharma companies are screwingyou and we're going to negotiate
with them and we're going tobring the price down, which
clearly they're doing anabsolutely terrible job at, if
the drug costs four times morehere than in any other country.
So immediately, this whole, thepremise of this entire hearing,
really brings the necessity orneed for PBMs into question,
(27:01):
because they're clearly notdoing as good of a job as anyone
else in the world.
Zoe (27:06):
So it makes me think, like if the drug company was in
charge of setting the price oryou know, instead of the PBM
middleman, and we know that Xdrug could be, you know,
manufactured with a profitmargin at $5 a month without
that PBM middleman, like whatwould they?
Oh yeah, like what?
If we do $10 a month, we'llstill make buckets of money and
(27:29):
so we'll help so many people.
Dr. Weiner (27:31):
Right, and I think that's a little overly
optimistic at $10 a month, butmaybe it'd be $150.
Zoe (27:36):
Well, yeah.
Dr. Weiner (27:37):
And that would be a game changer for so many people
out there, but anyway.
So I think, another reallyimportant thing.
So back to the PBM Reform Act.
It hasn't gotten passed yet.
They're hoping that it's goingto get passed early next year.
Gotten passed yet, they'rehoping that it's going to get
passed early next year.
But you know, all of thepolitical machine is just kind
(28:02):
of grinding on this thing andagain, it's because these health
insurance companies and thesenumbers that I put up there,
with Kamala taking, you know,5.8 million and Trump with 800
something thousand of donationsthis year, that's not just
pharma, that's all health carefields.
So probably the majority of itis from these $800 billion
revenue companies of Cigna,aetna and United.
Zoe (28:25):
A drop in the bucket.
Dr. Weiner (28:26):
Right, and so which is also that's such a good point
it's $800 billion and they'repaying $8 million to influence,
right, so that's 10,000 times.
They're making 10,000 times asmuch in revenue.
One, 10,000 is what they'reusing.
They're using such a smallamount of money to get the
(28:49):
influence that they need totakes a relatively small amount
of 250 000 to a senator andyou're going to influence the
way he or she is going to vote,so, um, so anyway.
So there's some frustration inthis committee that this act has
(29:11):
not been passed too, and and sowe're going to really take a um
, a shift.
But I think one last thing onthe pbms.
They make their money on thatspread.
So what happens is nova nordicsays, oh, we go, these 1300, and
then the pbms negotiate it downto 600 bucks, and so then they
go back to the employer and thatwell, the health insurance
(29:33):
company which owns them.
But eventually this money getspassed to the employer where
they, hey, we saved you 700bucks, we get to keep 25% of it.
So the higher the startingprice, the more money they make
off of every prescription, andwe'll hear more about that in
these coming videos.
Senator Hassan (29:53):
CVS said lower list prices would open up access
for obesity treatment inparticular.
Unitedhealth Group Optumx said,given the significant price
differential for these productsacross borders, a decision by
Novo Nordisk to align US pricingmore closely with those in
other countries wouldmeaningfully increase access for
US patients.
So, with that in mind, wouldyou please commit to lowering
(30:16):
the list price of these drugs.
Lars Jorgensen (30:19):
So, senator, allow me to share a few points
before I answer your question.
Is that okay?
So the experience we have isone of losing access when we
lower price.
I know you can always findspecific plans that did include
insulin with a lower price, butthe broad totality is that less
(30:43):
patients have access to ourmedicines when we have lowered
the price.
I understand that perhaps thePBMs have changed their mind and
I'd be happy to collaboratewith them on this, because
anything that helps patients toget access and affordability we
are supportive of don't, I don'treally understand it's the
(31:04):
spread pricing.
Dr. Weiner (31:06):
So when he lowers the price, pbms make less money.
We've talked about that yeahbefore where the pbms will say,
oh you, you need to go throughour pharmacy for the 90 days, um
, and?
And what they'll end up doingis they will tell you, oh, we
don't cover this cheap medicine,we only cover the more
expensive medicine because thePBM profits more on that
(31:29):
medicine, because they get thatspread pricing difference, and
the cheap medicine they don'tmake any money on because it's
cheap to begin with.
And so that's what he's sayingand the problem is he's right.
He's right that that is likelowering the price of a
medication you may limit accessto patients.
(31:50):
Wow, which is when that is atrue statement.
That is so paradoxical.
It really shows you thatwhatever is going on with the
way drugs are bought, sold,distributed and authorized for
insurance payment, it's sototally broken.
Now what Bernie did and I don'tthink I have a video of it, but
he had secured from the PBMs inwriting a statement that said
(32:13):
that if you lower the price, wewill continue to cover and
provide access to Ozempic.
So he did secure this, whichhis goal, I think, is to get
them to lower the price.
But the truth is he's just kindof warming them up for the
Medicare negotiations comingdown the pipe.
But you know the fact thatthat's the explanation is, and
(32:38):
it's right, he's's not being,he's not being untrue, it's not
a lie yeah to me that's, that'sa kind of a crazy, it's a crazy
state reality crazy
Senator Budd (32:48):
reality exactly, yeah um, uh, okay, so let's go
to the next video are there waysto reduce these perversions and
, as we're asking forsuggestions here, perhaps this
will come in ongoing discussionswith the committee, but in your
time here.
Do you have some suggestions toreduce these perverse
(33:09):
incentives to deliver savingsand value to the patients in
need?
Lars Jorgensen (33:14):
Thank you, senator.
We should really unite aroundwhat helps patients.
And if you have the industrymaking big risks in R&D, making
big commitments intomanufacturing, and then we have
to negotiate against PBMs andtheir insurance companies, not
(33:35):
taking much risk and yetbenefiting from a significant
fee linked to the list price, Ithink that's absurd.
So if we could stop linkingtheir income to a list price, I
think that would create anincentive that is not as absurd
as it is today.
I would prefer doing businesson the net price, where I
(33:57):
compete against competitorsbased on what is the real price
for our medicine and what is thevalue of the medicine.
And these are medicines thatare addressing societal
challenges that are paramount.
And we talk about the cost ofthe medicine, but it's really
the cost of the diseases that'sbreaking the system and we have
(34:20):
to find a way where we transactin a way where it becomes much
more transparent, what is thereal price of the medicine, to
really adopt the medicine andmitigate the societal course
that diabetes and obesity isputting on the US healthcare
system and economy.
Dr. Weiner (34:36):
You know, I think this is where they really talk
about the PBMs.
I think you know, I think thisis where they really talk about
the PBMs.
I think one of his points,though, which I think is a total
BS point, is that, well, ifthey just, we have to talk about
the cost of the disease.
And so these medicines, eventhough they're expensive, the
(34:57):
disease is so much moreexpensive.
That, to me, is like if I'm onER call and a patient shows up
with appendicitis and I say, ohwell, it's going to be $100,000
for me to take out this person'sappendix, and they'll be like
that's crazy, it's a 45-minutesurgery.
Why would I ever pay you$100,000?
Well, because if I don't do thesurgery, then the patient is
(35:17):
going to end up in the ICU withsepsis and it's going to cost
$100,000 to take care of them,and that's a BS answer right.
And so when you say these drugsreduce the burden of cost of
diabetes, that ignores ourresponsibility to our patients.
That is a very financialdecision and the problem is with
(35:40):
health care is that it cannotsolely be a financial decision.
There is an obligation topatients and you cannot look at
every opportunity in health careas a mechanism to extract as
much money as you can out of thesystem.
Zoe (35:55):
Well, and I mean we can look at the cost of disease in
all of those other countriesthat are delivering this
medication to their patients.
Dr. Weiner (36:02):
They're not paying the full cost of the disease.
Yeah, that's a great point, Ithink kind of my final thoughts
on that and the cost and theperverse incentives is if you
really think about health careand let's look at every piece of
this, can we provide healthcare without pharma, without the
pharma industry?
We can't right how care withoutpharma, without the pharma?
(36:25):
Industry we can't right.
How about without doctors?
Of course not nurses.
How about speech therapists,audiologists, durable medical
equipment, hospice?
Can you provide health carewithout all those people?
Zoe (36:35):
it's a it's a ecosystem that requires everybody you
require require everything.
Dr. Weiner (36:40):
Can you provide healthcare without health
insurance, without PBMs?
Zoe (36:44):
Without PBMs.
Dr. Weiner (36:46):
No problem.
Without health insurance, youcan still provide healthcare.
Zoe (36:50):
Yeah, yeah.
Dr. Weiner (36:50):
And yet $800 billion of revenue is going into the
companies that aren't actuallyinvolved in providing the
healthcare they don't actuallyprovide.
In providing the health care,they don't actually provide
anything of value or use noservice, and so they really have
(37:12):
just figured out a way toinsert themselves into the
equation, into the paymentequation, and have it come up
with ways, through politicalmeans and business means, and
and, uh and and kind ofcontrolling the market, to
extract a huge amount of moneyout of the healthcare system
without actually contributinganything.
And so, in all honesty, I think, as much as you start watching
(37:35):
this and you want to be like thepharma industry, they're
screwing us.
This is a total ripoff.
Nova nordis, they should bethrown in jail.
I don't know that.
I really think that that's thetrue problem here right I think
they are a symptom of a brokensystem and they're just pricing
it.
You know they're, they'releveraging it, just like our
patients are leveraging ourcreative dosing strategies,
(37:57):
taking advantage of a littlechink in the armor, and that the
ultimate problem is with thecompanies who we've put in
charge of controlling ourhealthcare expense, and they
really have been derelict inthat duty.
So let's move on to video eight.
Senator Braun (38:13):
Making a profit on your Ozempic product when
you're selling it to Australiafor $87 and you're selling it to
the US for $9.36?
Are you making a profit at $87?
Lars Jorgensen (38:29):
Yes, we are, and the price you mentioned in the
US is not what we get.
That's the list price.
Senator Braun (38:38):
So what are you getting in the US?
What price?
So I mentioned that on averagefor our products we give 74% in
rebates to PBMs and that was achart that Senator Marshall held
up that PBMs are making 74% andyou're getting 26%, so you've
(38:58):
got a screwed up industry Numberone.
When I've talked to otherpharma folks, they regret that
PVMs ever came into it.
It would seem like, since youmake the product, that you could
disassemble them or dosomething that would go around
it if, in fact, this place won'tdo something about it.
Have you ever thought of that?
Lars Jorgensen (39:19):
It's very difficult, senator, because they
control what insurance is putin front of patients.
So they have integratedthemselves with insurance
companies and we negotiateagainst the PBMs, but they're
owned by the insurance companies, so no matter what we do, they
decide what products patientsuse mean a lot there, right?
Dr. Weiner (39:40):
so much there 85 bucks, and they're making a
profit.
Imagine that these drugs for 85bucks, what a difference that
would make.
Um, and and so even novonordisk, this gigantic pharma in
company that has theblockbuster drug of all
blockbuster drugs, is powerlesswhen it comes to fighting
(40:03):
against the pbms right and he'slike, yeah, I'm only making 26
percent of that.
Yeah, yeah, which I mean, whichmeans 74 percent of that cost
and it's probably not the full74 percent is going to to the
pbms and to the healthcareindustry.
I mean, unitedhealthcare is the11th or 12th biggest company in
(40:23):
the world, and they're just UShealthcare, you know.
So, anyway, a lot.
There a lot to learn from this.
So let's do our final video andwe'll wrap this episode up.
Dr./Senator Marsha (40:37):
Disappointed in your company.
All Big Pharma is the marketingthat they do.
I think that the marketing isvery influential.
I really think that Congressneeds to go back and revisit
that as well.
I think that the marketing isso good.
There's people on this drugthat shouldn't be on it and are
being taken advantage of, and soI do think we need to go back
(40:59):
and look at that Again.
Advantage of, and so I do thinkwe need to go back and look at
that Again.
Instead of coming after thehero of this story, we need to
look in a mirror.
America needs to look in amirror that nutrition is a big
problem in this country and lackof activity.
Zoe (41:13):
Amen.
Dr./Senator Marshall (41:13):
Yeah.
Zoe (41:14):
Amen yeah.
Dr. Weiner (41:16):
So I think so he's basically acknowledging that
healthcare marketing is aproblem.
And I think so he's basicallyacknowledging that health care
marketing is a problem.
Zoe (41:23):
And I think it is.
It's all reactive, it's notpreventative and it's not going
from the root of the nutritionand the movement and just our
kind of overall culture andwhat's being prioritized because
it's not making money.
Dr. Weiner (41:42):
Yeah, I mean, even think about your childhood.
You're younger than me.
When you were a kid, what kindof commercials were there that
were on TV?
It was Coca-Cola, mcdonald's.
It was, you know, jordachejeans that's probably before
your time, but it was, you know,clothing and very retail type
(42:02):
items.
Zoe (42:02):
Yeah, like um different, like toys, like there was, like
you know, the Barbie dream housethat I want Right, um, but, but
anyway, now it's all pharma.
Yeah.
Dr. Weiner (42:15):
All pharma.
I mean, go on and watch pharma.
Ads are what you see, and sothat's another issue, and so I
think you know.
The last thing I would say toSenator Marshall's comment,
though, is, if you, if we'regoing to look in the mirror at
our nutrition and our exercisewhich, again, absolutely needs
(42:37):
to happen, we also need to lookin the mirror at our political
system.
Zoe (42:40):
Well, I thought that's where he was going with it.
I thought he was going to saywe need to look in the mirror to
say let's fix something withthis PBM insurance, big pharma
situation and fix it.
I was, you know.
Yes, we do again need to lookin the mirror and look at the
nutrition and movement.
But like, can we look in themirror on those other like kind
of bigger items?
Dr. Weiner (43:03):
The thing that kind of struck me here too, is that
we've got the US Senate, we'vegot a huge mega pharma company,
and they both feel powerlesswhen they're battling against
the health insurance industry.
Zoe (43:18):
Can they not have representatives?
I mean, they don't need thatinsurance, people don't need to.
Why would we?
Dr. Weiner (43:25):
They've got all of the politicians bought and sold.
They figured this all out.
They've got lawyers up thewazoo, and that really, to me,
is when I watched this, that waskind of a take home message,
was like even these guys, whoreally should be kind of
captains of the universe, areunable to penetrate this crazy
(43:45):
health insurance thing we've gotgoing on.
And the problem is is this iswe're looking at.
To some degree, it almost feelsto me very much like what I saw
with the housing market like2005, 2006, where it was like
craziness, crazy, crazy prices,crazy profits, people making
crazy money and it was this youknow system that was just about
(44:09):
to break.
And then it did, and the problemis is, if they're making $800
billion and they want to get to$900 and a trillion dollars, and
they want to get to $900 and atrillion dollars, at some point
this will all come crumblingdown, and the problem is, you
know, and it's going to be badjust like the recession was our
homes, this is going to be ourhealthcare.
(44:30):
And so what happens?
People are still going to getsick, they're still going to
need hospitals, they're stillgoing to need doctors, and when
this whole thing comes crashingdown, what happens?
The people lose.
The people lose, and so I'mreally hopeful that at least we
get this PBM Reform Act passed.
I think that's a reallyimportant first step.
(44:52):
And then, you know, as much aswe're seeing the government kind
of going after some of themonopolies from Google and
Facebook and looking at them, Ithink it's just as important
probably more so that they startlooking at these health
insurance and maybe they're notmonopolies, because there's, you
know, three or four bigcompanies, but they really are.
They're duopolies.
They're controlling the marketwith their size at the detriment
(45:17):
of the US consumer, the USpatients, and so I'm hopeful
that we start to see someactivity there.
And you know, I don't know thatthis is all going to come
crashing down in a weekend likeit did with the recession.
It's going to fall apart, kindof brick by brick, and there's
(45:37):
going to be an opportunity forus to step in, and I really just
hope our political system isstrong enough to do it, because
we're counting on them.
Zoe (45:44):
Yeah.
Dr. Weiner (45:45):
All right, A lot, a big episode, a lot to unpack and
I think, for those of you whostuck with us and listened, I
appreciate you hearing this andyou know we're coming into an
election cycle and please makesure that you do your research
and you look at at people'svoting records when it comes to
(46:07):
pharma and when it comes tohealth insurance, when it comes
to your healthcare access.
All right, We'll see you nexttime.
These prices are really the symptom of a broken
system, as opposed to a singleact or a single bad person kind
of taking advantage of ourhealthcare system.
Zoe (00:17):
Hello and welcome back to the Pound of Cure Weight Loss
Podcast.
Today's episode is NovaNordisk's Weekend at Bernie's.
Dr. Weiner (00:25):
Yes, so this is a little bit of a different show
than we've ever done.
I've been following this.
We've been talking about BernieSanders, you know bringing Lars
Jorgensen, the CEO of NovaNordisk, in front of a Senate
hearing, and so it finallyhappened at the end of September
(00:45):
.
And you know I watched thewhole thing.
It was like two and a halfhours long.
I watched the whole thing.
I pulled out some clips that Ithought would be interesting and
I was going to go throughbecause I think it.
You know as much as we look atpolicy and how laws are made and
how all this stuff happens, itis very understandable.
(01:09):
Anybody can kind of understandwhat's happening and where
they're going, and I think youcan really just see how much
bureaucracy there is in gettinganything done, anything done,
and our political situation,where neither party can stand
the other party, doesn't makefor us able to kind of come to
(01:31):
the middle and find some goodpolicies, which is how
historically this country hasworked.
So, anyway, I thought it wasinteresting.
There was a lot to learn, butin the end there is of you know,
they all kind of there is agroup think and they all kind of
come to a fairly similarconclusion.
So this was the Senate HealthCommittee and they are made up.
(01:55):
It's a bipartisan group andthere's kind of two leaders of
it.
The first leader is SenatorBernie Sanders and I think he's
like the main head, but thenthere's also Senator Cassidy.
He's a Republican constituentand so they were both kind of
the heads.
It actually is Dr Cassidy, he'sfrom Louisiana, and so the two
(02:21):
of them kind of headed up this.
But then they had differentmembers of the committee and
each one of them was given achance to kind of ask questions
and go through a line ofreasoning and it's partly
showboating and it's partlytrying to get to the bottom of
the problem.
So the big issue is and we'regoing to hear from Bernie in a
second that these medicationsare far more expensive in our
(02:45):
country than they are in anyother country, and so you know,
there's a lot of backgroundfacts that brought on these
hearings.
The first is that NovoNordisk's sale price, and I'll
show you right here, zoe, just ashot of Novo's sale price.
Zoe, just a shot of Novo's saleprice, novo's stock let's see,
(03:08):
we're going to go through thisIn 2022, the stock was somewhere
in the high 50s and they'vereached a high of like 140.
So they're running like 120,140.
So in the last few years,novo's stock has more than
doubled.
So in the last few years,novo's stock has more than
doubled.
(03:31):
So clearly this company has donevery very well as a result of
Ozempic Wegovi and I think overfive years it's up 368%.
So I saw this coming years ago.
I knew these drugs were goingto be amazing and I didn't buy
stock in it.
That kind of kills me, yeah,but it's a side point.
So 72% of the revenue from NovoNordisk comes from US sales, so
(03:56):
they make way more money fromus than any other country.
Zoe (04:00):
Right.
Dr. Weiner (04:01):
That's the first point, right?
That's the first point.
These drugs are anywhere fromfour to ten times more expensive
in our country than in anyother country.
We also spend twice as much onhealth care as any other country
in the world, and yet 85million Americans are either
(04:25):
uninsured or underinsured.
We still have to pay atremendous amount of out of
pocket um, and 65 000 people ayear die from lack of insurance
coverage and we're still sickeryes, and we are less healthy
than most other countries.
Our infant mortality rate is inline with some third world
countries.
I mean mean there's a lot goingon with our healthcare system.
(04:48):
And so when you see thishappening and Novo Nordisk is
making record breaking, profitsyou're going to get brought into
it.
So let's start by kind oflooking at what Bernie's
introduction to this was.
And he kind of outlines whywe're doing this.
Here's the video.
Bernie Sanders (05:07):
Which shows that Novo Nordisk's diabetes drug,
nozempic, is sold in Canada for$155, in Denmark for $122, in
France for $71, and in Germanyfor $59.
For $71, and in Germany for $59.
In the United States, novoNordisk charges us $969, over 15
(05:41):
times more than they sell thatproduct in Germany.
Regovi, novo Nordisk weightloss drug, is even more
expensive, as the chart behindme also shows.
Wegovy is sold for $265 inCanada, $186 in Denmark, $137 in
Germany and $92 in the UnitedKingdom.
(06:03):
In the US, the list price forVigovy is $1,349 a month, nearly
15 times as much as it cost inthe United Kingdom.
What we are dealing with todayis not just an issue of
(06:24):
economics.
It is not just an issue ofcorporate greed.
It is a profound moral issue.
Dr. Weiner (06:34):
What do you think about that Zoe?
Zoe (06:38):
I mean, obviously we've talked about it before on the
podcast.
It's just disgusting.
It's kind of a sad state ofaffairs.
Yeah, I just like.
I, I feel like it everything'sin so many ways I mean, I think
the health care system is.
Dr. Weiner (06:59):
It is starting to get a little bit to a tipping
point.
Zoe (07:03):
It's insane.
This is like something has tochange.
This is not okay.
It's not okay.
Dr. Weiner (07:08):
So I'm going to bring up a second image here and
I'm going to explain why Idon't really see it changing
much over the next five years.
So this is a chart of the top15 political candidates who have
received funding from thehealthcare industry.
(07:30):
This is just 2024.
Of course, the top two peopleare our current presidential
candidates, with Kamalareceiving over $5 million in
funding from the healthcareindustry in 2024.
Over $5 million in funding fromthe healthcare industry in 2024
.
Trump is substantially lower atabout $860,000, but still a lot
of money for Trump.
(07:50):
Some interesting things onthere.
Nikki Haley is also on thereand Bill Cassidy, who we're
going to hear from, is on there.
He's one of the people on theSenate committee.
Zoe (08:02):
That'll be interesting.
Dr. Weiner (08:03):
He's one of the people on the Senate committee.
That'll be interesting.
Yeah, so you know, we just havethe politicians are bought and
sold by the health care industry.
And if you look also at thatgraph, it's not Democrats, it's
not Republicans, it's like a50-50 split.
This is really not a partisanissue.
(08:25):
The winner of this electionit's not going to neither of the
candidates.
Whether we're talking aboutflipping the Senate or the House
or the presidential candidate,no matter what it's still,
they're still going to beheavily influenced by the
healthcare industry.
And so I, you know, I think thatI think that's really the state
(08:46):
of affairs.
So when we look at somethingthat's happening, and in many
ways I think what we're going tosee is that these prices are
really the symptom of a brokensystem, as opposed to a single
act or a single bad person kindof taking advantage of our
(09:06):
healthcare system.
It really is.
It's because and we've talkedabout that in the past with our
creative dosing strategies, howyou know when the system's
screwed up, there's sometimesthere's a little chink in the
armor and you can kind of takeadvantage and save some money,
and you have to do things alittle bit unusually, but it can
save a tremendous amount ofmoney and give you access to a
drug that you couldn't otherwiseafford.
(09:27):
And so there's something in ourhealthcare system the pricing
that doesn't make any sense, andyou can leverage that to your
advantage, and we do that everyday in our practice.
Zoe (09:39):
And it's kind of like this problem has probably been here
for a really, really, reallylong time, but now, with the
widespread use and like thislife-changing class of
medication and all these thesedrugs, it's now just really
having a spotlight on the it's.
(10:00):
It's utilizing the glp1s askind of this on the pedestal
look at this problem.
But there are probably so manyother drugs that this is
happening with as well, this ishappening with chemotherapeutics
, this is happening withradiation treatment after cancer
.
Dr. Weiner (10:14):
The problem is it's happening on these little
one-off situations.
It's this one case here, onecase there rare cancer, this
drug, that drug.
Millions and millions of peoplewe have millions and millions
of people who want the same drugand they really want it, really
really want it, and they can'tget it because of it.
So these GOP ones are reallyputting a spotlight, like you
(10:36):
said, on our healthcare systemand kind of focusing it around a
single issue, which is thisdrug.
Zoe (10:43):
But, like you, said yeah, it's a systemic issue.
Dr. Weiner (10:46):
I think you put it exactly right that way.
So let's see what LarsJorgensen has to say in his
initial response, and I'minterested to hear what you
think about this.
Lars Jorgensen (10:57):
Hard at work in making sure that patients have
access via the insurance schemes, and today 80% of all Americans
with insurance have access tothese medicines at $25 or less
for a month's supply.
So it's a price point at thepharmacy counter we have to talk
about.
Bernie Sanders (11:15):
Let me just interrupt you, if I might.
Okay, you're correct that manypeople pay $25 a month for
Zympic, but what you'reforgetting to mention is that
many of those people are payingoutrageously high prices for the
insurance that covers Ozempicand other drugs.
So, simply, this is apass-through to the insurance
(11:37):
companies.
Bottom line is you are chargingthe American people
substantially more for the sameexact drug than you are charging
people in other countries, andmy question is why?
Zoe (11:49):
I love how he just got straight to the point and asked
the question.
I mean that's.
I mean First of all.
Dr. Weiner (11:59):
I don't see people get this for $125 on average.
I don't see 80% of our patientsget it.
No way, I mean.
I don't think people get thisfor 25 bucks on average.
I don't see 80 of our patientsgetting no way.
I mean I don't think 80 of ourpatients get it for 100 bucks or
less right um, I have seen lotsof patients paying two, three
hundred dollars, uh, and so Idon't know where he gets that
number, but I I call bs on thatand then second I think bern
(12:21):
Bernie's response was exactlyright.
Yeah, health insurance is just.
It's a way to spread out thecost over time and so if it
costs more, health insurance isgoing to be more.
That's why anybody, if you havea cheap car, your car insurance
is less expensive than if youhave an expensive car, because
(12:43):
you're going to break it at somepoint and it's going to be more
expensive to break, and sothey're basically charging you
for the future cost of repairyeah, it's almost forced savings
to to some degree, um and so.
So anyway, there's 190 millionpeople do not have access to we
go, so that, wherever he'scoming from that, most people
can get it for 25 bucks.
(13:04):
That's not true.
And again, we pay.
Whether if you're on a statefunded plan like Medicaid or
access or Medicare plan, it'spaid for taxes.
Who pays our taxes?
We pay our taxes.
We pay our health insurancepremium.
You work for our practice.
You get a health insurancepremium paid for you by the
(13:24):
practice.
If our health insurance wascheaper, you would get a higher
salary.
So the idea that either youremployer or your insurance
company is paying for a drug,that's not how it works.
Zoe (13:35):
We're paying for it.
It's going to come fromsomewhere.
Dr. Weiner (13:38):
You pay for it.
You pay for it in lieu of wagesor in taxes, or somehow you are
paying for these drugs, okay.
So yeah, bernie has some otherinteresting points here, and I
think this is also some goodstuff.
Bernie Sanders (13:56):
This year, dr Alison Galvani, an
epidemiologist at YaleUniversity, conducted a study on
Wigovie and what she found andI hope Mr Jorgensen pays
attention to this is that over40,000 lives a year could be
saved if Wigovie were madewidely available at an
affordable price to Americanswho need the drug 40,000 lives I
(14:22):
ask unanimous consent to insertthat study into the record.
A few months ago, dr MelissaBarber, a health care economist
at Yale University, conducted astudy on the cost the cost of
manufacturing Ozempic and whatshe found is that Ozempic can be
profitably manufactured forless than $5 a month.
We all know the cost ofproduction is not the only
(14:43):
expense by far for a drugcompany.
Pharmaceutical companies spendgreat sums of money on research
and development to find newtreatments, with many of these
products not coming to market.
We all understand that newtreatments, with many of these
products not coming to market.
We all understand that.
But it is important to knowthat this drug can be
manufactured profitably for afew dollars a month.
(15:04):
We may hear from Mr Jorgensenthat Novo Nordisk spent $21
billion on research anddevelopment since 2018, and I
take his word on that.
What he may not tell you isthat Novo Nordisk spent $44
billion on stock buybacks anddividends over that same time
period.
Dr. Weiner (15:21):
So I think that's another great point, which is,
whatever they're spending onresearch and development,
they're spending twice that muchon buybacks and other things
that are going to increase theirsalary, their profit and and um
.
So clearly, if you're buyingback stock, it means you have
lots of extra money and andagain.
(15:43):
So so we're novo nora's stockis up 360 percent over the last
five years.
They're the price is five timesas high as what it is in the US
, and they're able to dobuybacks that are twice $20, $44
billion buybacks twice whatthey're spending on R&D.
So clearly, this company iscleaning up and, at the same
(16:08):
time, 40,000 people are dying.
And maybe if they made a littleless money I mean, as much as I
hate to sound like a socialistand I've God knows, I'm not a
socialist but maybe if they madea little less money.
Zoe (16:20):
I mean, if we think about it, 1 billion last dollars,
they'd still have their $43billion to do their stock
buyback with $1 billion to makethat.
I mean, I remember we did themath on a previous podcast,
where I can't remember exactlywhich one it was, but where it
was like if we took this smallamount.
Dr. Weiner (16:41):
If we could buy it, for what Canada can buy it for?
I think we put like 5 millionpeople or something I said,
could get the medication.
Yeah, just by getting rid ofthe PBM spend and paying what we
pay in Canada, so which isCanada is the second most
expensive country to get thisright.
Yeah, and I, and to me there'ssomething like, you know, as a
(17:05):
doctor and we I run my ownprivate practice here and, and
you know, you're certainlyinvolved in how we make
decisions and the money and allof that stuff and you understand
there's, there's a business andyou have to make money because
that's how businesses survive.
But at the same time, we alsohave core values, like putting
our patients first and alwaysmaking sure that the decisions
we make are in the best interestof the patients coming to us,
(17:27):
because we chose healthcare as aprofession and that comes with
a set of ethical guidelines thatyou have to follow, and so the
truth is, most doctors thinkthat way, most nurses think that
way, most healthcareprofessionals think that way.
The problem is health insurancecompanies and pharma companies
don't, and somehow the healthinsurance companies, because the
(17:49):
doctors have been asleep at thewheel just working and treating
patients, but somehow webasically said, oh, you can't
trust the doctors to make thesedecisions that are best for your
health, even though we are theones who took an oath.
We're the ones who see you, whofeel with you, who see your
suffering firsthand.
We can't be trusted to makefinancial decisions because
(18:10):
we'll make biased decisionsabout your health care.
Instead, we've basically giventhat control to the health
insurance company and the pharmacompany.
Zoe (18:18):
Who don't care?
Dr. Weiner (18:19):
They don't care, they don't see your suffering,
they don't sit with you at thebedside.
They don't see the pain.
They don't hear your stories ofdiscomfort or, if they do, they
outsource it to someone inanother country to answer the
phone on their customer supportline.
And so we've given this control, we've given them the financial
(18:42):
leverage to make all yourdecisions on health care, and
they have not been doing a verygood job.
You know it's illegal forphysicians to start a hospital
in the United States.
Zoe (18:52):
That's so stupid.
Dr. Weiner (18:54):
Isn't it stupid?
Zoe (18:54):
I was just thinking like I wonder how different things
could be if they had doctorsrunning like at least on the
board of Okay.
Dr. Weiner (19:05):
So here's the problem Doctors aren't immune
either.
This is a very you know, thisis a complex issue.
With every complex issue,there's going to be both sides
of it, Of course.
So let's hear from Dr SenatorCassidy.
Zoe (19:21):
Why shouldn't a doctor be able to start a hospital?
Dr. Weiner (19:26):
Because we might be biased.
Zoe (19:28):
And help patients.
Dr. Weiner (19:29):
And do too many surgeries that people don't need
.
That's the thinking.
But, anyway.
So this is Dr Senator Cassidy, Ibelieve.
Yeah, he's from Louisiana andhe is going to talk a little bit
(19:49):
about this.
He has received $258,000 fromFarm and Healthcare in 2024.
He's the 11th highest recipienton the list and he also voted
against the Inflation ReductionAct, which was a very big and
broad act.
It was Biden's Build BackBetter whatever act.
But that was also in.
That act was where Medicare cannow negotiate with the pharma
(20:11):
company.
We talked about that too on thepodcast.
Medicare can negotiate for upto 10 drugs, and talked about
that too on the podcast.
Medicare can negotiate for upto 10 drugs, and every year they
get to add 10 new drugs thatthey can negotiate with.
I think another important partof this whole hearing is that
you can pretty much count onthat when they release the next
set of medications, which shouldbe coming out fairly soon and I
(20:34):
think it's either 2026 or 2027when the negotiations could
begin, because they announced itand then two years later it
happens you can guess thatOzepic is going to be on the
list.
I think that's pretty much aforegone conclusion at this
point, but anyway.
So let's hear from Dr Cassidy.
Dr./Senator Cassidey (20:50):
But let me say, without a profit motive,
without something in return,it's unclear that these drugs,
or any drug, is going to bedeveloped.
There is a tension, a tensionbetween the need to incentivize
innovation and the ability toafford that innovation.
And we are here struggling withthat balance.
Now, if anyone thinks goingafter big pharma is the silver
(21:15):
bullet, that if you do that boom, health care costs or drug
costs go down, they don'tunderstand what happens with
pricing a drug.
There is no silver bullet, but,as my friend Angus King says,
there is silver buckshot.
You do a little bit here and alittle bit there and it adds up
so the drugs become moreaffordable.
You do a little bit here and alittle bit there and it adds up
(21:37):
so the drugs become moreaffordable.
Given that, we still have topreserve the profit incentive
for the creativity, for drugcompanies to invest in order to
develop the drugs that are goingto positively affect the burden
of disease in our society.
So, as this committee examinesthe affordability of GOPs, we
(21:59):
have to also examine how do wepreserve that incentive for the
innovation?
Zoe (22:04):
I agree.
Senator Hassan (22:04):
Yeah.
Zoe (22:05):
And it's very, very well put, because if there wasn't
that incentive, we wouldn't haveany new drugs.
Dr. Weiner (22:12):
Absolutely the problem is, and I think this is
something that we're gettingwrong as a country is that there
is this pendulum right, it'seither favoring the pharma
company, favoring the bigindustry, versus favoring the
people.
Right?
So in a perfect world, we wouldjust give Ozempic out for free
(22:33):
to everybody, because that'swhat's best for the people, but
of course that would reduce theinnovation, as Senator Dr
Cassidy has put.
When you're putting $21 billionin research and $44 billion in
buybacks, that pendulum hasshifted too far.
It's shifted too much in favorof innovation.
That pendulum has shifted toofar.
(22:54):
It's shifted too much in favorof innovation.
Right, right, on one hand, onceyou discover a drug, it's yours
for life and you're the onlyone who, for the rest of the
history of the world, canproduce that drug.
That's not good either, becausethat drug's never going to make
it out to market, it's not goingto get to the people, and so
there has to be this balance,and in my mind the balance has
(23:17):
shifted too far in favor of thepharma industry, in favor of the
patent holder, and we have toshift it back.
So I agree with him that therehas to be this tension, but I
think what we're seeing is thatthat tension is pulled too far
to one.
Zoe (23:28):
We're snapping.
It's like a rubber band andwe're on that end, about to let
go.
Dr. Weiner (23:32):
Yes, exactly, and one of the rubber bands is laxed
and the other one is pulling itall the way.
Yeah, so we need to move itback to the center not to the
point where Ozempic is free andscrew the patents and that's all
over, right.
But so I hear what he's saying,where he's coming from with
this, but I think that there'smore to this story, so let's
(23:56):
hear from Dr Marshall.
So there's a couple of docs onthis committee.
I do like there are physiciansin the government.
Zoe (24:06):
Is that going to be in your future?
Dr. Weiner (24:07):
It's like my total secret little fantasy.
Zoe (24:09):
Yeah, oh, my God, yes.
Dr. Weiner (24:11):
Like once I'm done with surgery like you know,
mid-60s, to run for Congress orsomething like that.
I would love that, Honestly, myGod.
Yes, Like once I'm done withsurgery.
Zoe (24:15):
Like you know, mid 60s to run for Congress or something
like that.
Bernie Sanders (24:16):
I would love that.
Dr. Weiner (24:18):
Honestly, I would love that I would create so much
trouble.
Ok, so here we have Senator DrMarshall, and this is where,
really, the hearing starts totake a turn and, I'll be honest,
I don't necessarily disagreewith it.
So let's hear what Dr Marshallhas to say.
Again, he's the senator, drMarshall is from Kansas and he's
(24:42):
a Republican.
So here we go.
Dr./Senator Marshall (24:45):
Novo Nordisk is not the villain in
this story.
Novo Nordisk is not the villainin this story.
They're a hero.
We should be here celebratingthis miracle innovation that's
responding to this diabeticepidemic we have in this country
.
It's a miracle drug.
Now we all agree on thiscommittee, across the Senate,
(25:06):
that the cost of health care istoo much and that prescription
drugs are too high, especiallythe out-of-pocket expenses.
But we need to figure out whothe villain is.
Who is the real culprit here?
Who's making the money?
So on this particular posteryou've said it once, you've said
it twice, everybody up heresaid the same thing Whatever the
(25:28):
cost is, whichever number wewant to use, novodortis keeps
24% of it and the PBMs extract76, 74%, 26 and 74%.
So really the PBMs are makingthe bank here.
So let's talk about PBMs for asecond here.
(25:48):
The real culprit in this room,in this story?
So these three big parentcompanies, the three big PBMs,
control 80, 85% of the industry.
Their gross revenue last yearwas $800 billion.
Their parent companies grossrevenue $800 billion.
Dr. Weiner (26:08):
So this is where it all shifts toward blaming the
PBM.
Zoe (26:11):
Well, I'm glad.
Dr. Weiner (26:12):
Yeah.
So I think a little bit ofhistory too is that this
committee also put out the pbmreform act, and we've covered
this also in past episodes.
It really asks for moretransparency.
So pbms and and we're going tohear a little bit more about
this make their money by sayingthe role of the PBM is these
(26:35):
pharma companies are screwingyou and we're going to negotiate
with them and we're going tobring the price down, which
clearly they're doing anabsolutely terrible job at, if
the drug costs four times morehere than in any other country.
So immediately, this whole, thepremise of this entire hearing,
really brings the necessity orneed for PBMs into question,
(27:01):
because they're clearly notdoing as good of a job as anyone
else in the world.
Zoe (27:06):
So it makes me think, like if the drug company was in
charge of setting the price oryou know, instead of the PBM
middleman, and we know that Xdrug could be, you know,
manufactured with a profitmargin at $5 a month without
that PBM middleman, like whatwould they?
Oh yeah, like what?
If we do $10 a month, we'llstill make buckets of money and
(27:29):
so we'll help so many people.
Dr. Weiner (27:31):
Right, and I think that's a little overly
optimistic at $10 a month, butmaybe it'd be $150.
Zoe (27:36):
Well, yeah.
Dr. Weiner (27:37):
And that would be a game changer for so many people
out there, but anyway.
So I think, another reallyimportant thing.
So back to the PBM Reform Act.
It hasn't gotten passed yet.
They're hoping that it's goingto get passed early next year.
Gotten passed yet, they'rehoping that it's going to get
passed early next year.
But you know, all of thepolitical machine is just kind
(28:02):
of grinding on this thing andagain, it's because these health
insurance companies and thesenumbers that I put up there,
with Kamala taking, you know,5.8 million and Trump with 800
something thousand of donationsthis year, that's not just
pharma, that's all health carefields.
So probably the majority of itis from these $800 billion
revenue companies of Cigna,aetna and United.
Zoe (28:25):
A drop in the bucket.
Dr. Weiner (28:26):
Right, and so which is also that's such a good point
it's $800 billion and they'repaying $8 million to influence,
right, so that's 10,000 times.
They're making 10,000 times asmuch in revenue.
One, 10,000 is what they'reusing.
They're using such a smallamount of money to get the
(28:49):
influence that they need totakes a relatively small amount
of 250 000 to a senator andyou're going to influence the
way he or she is going to vote,so, um, so anyway.
So there's some frustration inthis committee that this act has
(29:11):
not been passed too, and and sowe're going to really take a um
, a shift.
But I think one last thing onthe pbms.
They make their money on thatspread.
So what happens is nova nordicsays, oh, we go, these 1300, and
then the pbms negotiate it downto 600 bucks, and so then they
go back to the employer and thatwell, the health insurance
(29:33):
company which owns them.
But eventually this money getspassed to the employer where
they, hey, we saved you 700bucks, we get to keep 25% of it.
So the higher the startingprice, the more money they make
off of every prescription, andwe'll hear more about that in
these coming videos.
Senator Hassan (29:53):
CVS said lower list prices would open up access
for obesity treatment inparticular.
Unitedhealth Group Optumx said,given the significant price
differential for these productsacross borders, a decision by
Novo Nordisk to align US pricingmore closely with those in
other countries wouldmeaningfully increase access for
US patients.
So, with that in mind, wouldyou please commit to lowering
(30:16):
the list price of these drugs.
Lars Jorgensen (30:19):
So, senator, allow me to share a few points
before I answer your question.
Is that okay?
So the experience we have isone of losing access when we
lower price.
I know you can always findspecific plans that did include
insulin with a lower price, butthe broad totality is that less
(30:43):
patients have access to ourmedicines when we have lowered
the price.
I understand that perhaps thePBMs have changed their mind and
I'd be happy to collaboratewith them on this, because
anything that helps patients toget access and affordability we
are supportive of don't, I don'treally understand it's the
(31:04):
spread pricing.
Dr. Weiner (31:06):
So when he lowers the price, pbms make less money.
We've talked about that yeahbefore where the pbms will say,
oh you, you need to go throughour pharmacy for the 90 days, um
, and?
And what they'll end up doingis they will tell you, oh, we
don't cover this cheap medicine,we only cover the more
expensive medicine because thePBM profits more on that
(31:29):
medicine, because they get thatspread pricing difference, and
the cheap medicine they don'tmake any money on because it's
cheap to begin with.
And so that's what he's sayingand the problem is he's right.
He's right that that is likelowering the price of a
medication you may limit accessto patients.
(31:50):
Wow, which is when that is atrue statement.
That is so paradoxical.
It really shows you thatwhatever is going on with the
way drugs are bought, sold,distributed and authorized for
insurance payment, it's sototally broken.
Now what Bernie did and I don'tthink I have a video of it, but
he had secured from the PBMs inwriting a statement that said
(32:13):
that if you lower the price, wewill continue to cover and
provide access to Ozempic.
So he did secure this, whichhis goal, I think, is to get
them to lower the price.
But the truth is he's just kindof warming them up for the
Medicare negotiations comingdown the pipe.
But you know the fact thatthat's the explanation is, and
(32:38):
it's right, he's's not being,he's not being untrue, it's not
a lie yeah to me that's, that'sa kind of a crazy, it's a crazy
state reality crazy
Senator Budd (32:48):
reality exactly, yeah um, uh, okay, so let's go
to the next video are there waysto reduce these perversions and
, as we're asking forsuggestions here, perhaps this
will come in ongoing discussionswith the committee, but in your
time here.
Do you have some suggestions toreduce these perverse
(33:09):
incentives to deliver savingsand value to the patients in
need?
Lars Jorgensen (33:14):
Thank you, senator.
We should really unite aroundwhat helps patients.
And if you have the industrymaking big risks in R&D, making
big commitments intomanufacturing, and then we have
to negotiate against PBMs andtheir insurance companies, not
(33:35):
taking much risk and yetbenefiting from a significant
fee linked to the list price, Ithink that's absurd.
So if we could stop linkingtheir income to a list price, I
think that would create anincentive that is not as absurd
as it is today.
I would prefer doing businesson the net price, where I
(33:57):
compete against competitorsbased on what is the real price
for our medicine and what is thevalue of the medicine.
And these are medicines thatare addressing societal
challenges that are paramount.
And we talk about the cost ofthe medicine, but it's really
the cost of the diseases that'sbreaking the system and we have
(34:20):
to find a way where we transactin a way where it becomes much
more transparent, what is thereal price of the medicine, to
really adopt the medicine andmitigate the societal course
that diabetes and obesity isputting on the US healthcare
system and economy.
Dr. Weiner (34:36):
You know, I think this is where they really talk
about the PBMs.
I think you know, I think thisis where they really talk about
the PBMs.
I think one of his points,though, which I think is a total
BS point, is that, well, ifthey just, we have to talk about
the cost of the disease.
And so these medicines, eventhough they're expensive, the
(34:57):
disease is so much moreexpensive.
That, to me, is like if I'm onER call and a patient shows up
with appendicitis and I say, ohwell, it's going to be $100,000
for me to take out this person'sappendix, and they'll be like
that's crazy, it's a 45-minutesurgery.
Why would I ever pay you$100,000?
Well, because if I don't do thesurgery, then the patient is
(35:17):
going to end up in the ICU withsepsis and it's going to cost
$100,000 to take care of them,and that's a BS answer right.
And so when you say these drugsreduce the burden of cost of
diabetes, that ignores ourresponsibility to our patients.
That is a very financialdecision and the problem is with
(35:40):
health care is that it cannotsolely be a financial decision.
There is an obligation topatients and you cannot look at
every opportunity in health careas a mechanism to extract as
much money as you can out of thesystem.
Zoe (35:55):
Well, and I mean we can look at the cost of disease in
all of those other countriesthat are delivering this
medication to their patients.
Dr. Weiner (36:02):
They're not paying the full cost of the disease.
Yeah, that's a great point, Ithink kind of my final thoughts
on that and the cost and theperverse incentives is if you
really think about health careand let's look at every piece of
this, can we provide healthcare without pharma, without the
pharma industry?
We can't right how care withoutpharma, without the pharma?
(36:25):
Industry we can't right.
How about without doctors?
Of course not nurses.
How about speech therapists,audiologists, durable medical
equipment, hospice?
Can you provide health carewithout all those people?
Zoe (36:35):
it's a it's a ecosystem that requires everybody you
require require everything.
Dr. Weiner (36:40):
Can you provide healthcare without health
insurance, without PBMs?
Zoe (36:44):
Without PBMs.
Dr. Weiner (36:46):
No problem.
Without health insurance, youcan still provide healthcare.
Zoe (36:50):
Yeah, yeah.
Dr. Weiner (36:50):
And yet $800 billion of revenue is going into the
companies that aren't actuallyinvolved in providing the
healthcare they don't actuallyprovide.
In providing the health care,they don't actually provide
anything of value or use noservice, and so they really have
(37:12):
just figured out a way toinsert themselves into the
equation, into the paymentequation, and have it come up
with ways, through politicalmeans and business means, and
and, uh and and kind ofcontrolling the market, to
extract a huge amount of moneyout of the healthcare system
without actually contributinganything.
And so, in all honesty, I think, as much as you start watching
(37:35):
this and you want to be like thepharma industry, they're
screwing us.
This is a total ripoff.
Nova nordis, they should bethrown in jail.
I don't know that.
I really think that that's thetrue problem here right I think
they are a symptom of a brokensystem and they're just pricing
it.
You know they're, they'releveraging it, just like our
patients are leveraging ourcreative dosing strategies,
(37:57):
taking advantage of a littlechink in the armor, and that the
ultimate problem is with thecompanies who we've put in
charge of controlling ourhealthcare expense, and they
really have been derelict inthat duty.
So let's move on to video eight.
Senator Braun (38:13):
Making a profit on your Ozempic product when
you're selling it to Australiafor $87 and you're selling it to
the US for $9.36?
Are you making a profit at $87?
Lars Jorgensen (38:29):
Yes, we are, and the price you mentioned in the
US is not what we get.
That's the list price.
Senator Braun (38:38):
So what are you getting in the US?
What price?
So I mentioned that on averagefor our products we give 74% in
rebates to PBMs and that was achart that Senator Marshall held
up that PBMs are making 74% andyou're getting 26%, so you've
(38:58):
got a screwed up industry Numberone.
When I've talked to otherpharma folks, they regret that
PVMs ever came into it.
It would seem like, since youmake the product, that you could
disassemble them or dosomething that would go around
it if, in fact, this place won'tdo something about it.
Have you ever thought of that?
Lars Jorgensen (39:19):
It's very difficult, senator, because they
control what insurance is putin front of patients.
So they have integratedthemselves with insurance
companies and we negotiateagainst the PBMs, but they're
owned by the insurance companies, so no matter what we do, they
decide what products patientsuse mean a lot there, right?
Dr. Weiner (39:40):
so much there 85 bucks, and they're making a
profit.
Imagine that these drugs for 85bucks, what a difference that
would make.
Um, and and so even novonordisk, this gigantic pharma in
company that has theblockbuster drug of all
blockbuster drugs, is powerlesswhen it comes to fighting
(40:03):
against the pbms right and he'slike, yeah, I'm only making 26
percent of that.
Yeah, yeah, which I mean, whichmeans 74 percent of that cost
and it's probably not the full74 percent is going to to the
pbms and to the healthcareindustry.
I mean, unitedhealthcare is the11th or 12th biggest company in
(40:23):
the world, and they're just UShealthcare, you know.
So, anyway, a lot.
There a lot to learn from this.
So let's do our final video andwe'll wrap this episode up.
Dr./Senator Marsha (40:37):
Disappointed in your company.
All Big Pharma is the marketingthat they do.
I think that the marketing isvery influential.
I really think that Congressneeds to go back and revisit
that as well.
I think that the marketing isso good.
There's people on this drugthat shouldn't be on it and are
being taken advantage of, and soI do think we need to go back
(40:59):
and look at that Again.
Advantage of, and so I do thinkwe need to go back and look at
that Again.
Instead of coming after thehero of this story, we need to
look in a mirror.
America needs to look in amirror that nutrition is a big
problem in this country and lackof activity.
Zoe (41:13):
Amen.
Dr./Senator Marshall (41:13):
Yeah.
Zoe (41:14):
Amen yeah.
Dr. Weiner (41:16):
So I think so he's basically acknowledging that
healthcare marketing is aproblem.
And I think so he's basicallyacknowledging that health care
marketing is a problem.
Zoe (41:23):
And I think it is.
It's all reactive, it's notpreventative and it's not going
from the root of the nutritionand the movement and just our
kind of overall culture andwhat's being prioritized because
it's not making money.
Dr. Weiner (41:42):
Yeah, I mean, even think about your childhood.
You're younger than me.
When you were a kid, what kindof commercials were there that
were on TV?
It was Coca-Cola, mcdonald's.
It was, you know, jordachejeans that's probably before
your time, but it was, you know,clothing and very retail type
(42:02):
items.
Zoe (42:02):
Yeah, like um different, like toys, like there was, like
you know, the Barbie dream housethat I want Right, um, but, but
anyway, now it's all pharma.
Yeah.
Dr. Weiner (42:15):
All pharma.
I mean, go on and watch pharma.
Ads are what you see, and sothat's another issue, and so I
think you know.
The last thing I would say toSenator Marshall's comment,
though, is, if you, if we'regoing to look in the mirror at
our nutrition and our exercisewhich, again, absolutely needs
(42:37):
to happen, we also need to lookin the mirror at our political
system.
Zoe (42:40):
Well, I thought that's where he was going with it.
I thought he was going to saywe need to look in the mirror to
say let's fix something withthis PBM insurance, big pharma
situation and fix it.
I was, you know.
Yes, we do again need to lookin the mirror and look at the
nutrition and movement.
But like, can we look in themirror on those other like kind
of bigger items?
Dr. Weiner (43:03):
The thing that kind of struck me here too, is that
we've got the US Senate, we'vegot a huge mega pharma company,
and they both feel powerlesswhen they're battling against
the health insurance industry.
Zoe (43:18):
Can they not have representatives?
I mean, they don't need thatinsurance, people don't need to.
Why would we?
Dr. Weiner (43:25):
They've got all of the politicians bought and sold.
They figured this all out.
They've got lawyers up thewazoo, and that really, to me,
is when I watched this, that waskind of a take home message,
was like even these guys, whoreally should be kind of
captains of the universe, areunable to penetrate this crazy
(43:45):
health insurance thing we've gotgoing on.
And the problem is is this iswe're looking at.
To some degree, it almost feelsto me very much like what I saw
with the housing market like2005, 2006, where it was like
craziness, crazy, crazy prices,crazy profits, people making
crazy money and it was this youknow system that was just about
(44:09):
to break.
And then it did, and the problemis is, if they're making $800
billion and they want to get to$900 and a trillion dollars, and
they want to get to $900 and atrillion dollars, at some point
this will all come crumblingdown, and the problem is, you
know, and it's going to be badjust like the recession was our
homes, this is going to be ourhealthcare.
(44:30):
And so what happens?
People are still going to getsick, they're still going to
need hospitals, they're stillgoing to need doctors, and when
this whole thing comes crashingdown, what happens?
The people lose.
The people lose, and so I'mreally hopeful that at least we
get this PBM Reform Act passed.
I think that's a reallyimportant first step.
(44:52):
And then, you know, as much aswe're seeing the government kind
of going after some of themonopolies from Google and
Facebook and looking at them, Ithink it's just as important
probably more so that they startlooking at these health
insurance and maybe they're notmonopolies, because there's, you
know, three or four bigcompanies, but they really are.
They're duopolies.
They're controlling the marketwith their size at the detriment
(45:17):
of the US consumer, the USpatients, and so I'm hopeful
that we start to see someactivity there.
And you know, I don't know thatthis is all going to come
crashing down in a weekend likeit did with the recession.
It's going to fall apart, kindof brick by brick, and there's
(45:37):
going to be an opportunity forus to step in, and I really just
hope our political system isstrong enough to do it, because
we're counting on them.
Zoe (45:44):
Yeah.
Dr. Weiner (45:45):
All right, A lot, a big episode, a lot to unpack and
I think, for those of you whostuck with us and listened, I
appreciate you hearing this andyou know we're coming into an
election cycle and please makesure that you do your research
and you look at at people'svoting records when it comes to
(46:07):
pharma and when it comes tohealth insurance, when it comes
to your healthcare access.
All right, We'll see you nexttime.
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