November 21, 2024 • 29 mins
In Episode 53 of the Pound of Cure Weight Loss Podcast, Dr. Weiner and Zoe dive into meaningful topics, from celebrating non-scale victories to understanding the limits of BMI and exposing the troubling influence of pharmacy benefit managers (PBMs) on healthcare costs. This engaging episode not only informs listeners about these issues but also empowers them to advocate for a better, patient-centered healthcare system.
Celebrating Non-Scale Victories on Your Weight Loss Journey
Weight loss is about more than numbers on the scale, and non-scale victories (NSVs) are a powerful reminder of the progress often missed. Dr. Weiner and Zoe discuss these achievements, which include everything from improvements in flexibility to walking up stairs without fatigue. Zoe suggests keeping a running list of NSVs to stay motivated, especially during weight loss stalls. This practice can give you a balanced perspective on success, showing that even small victories matter. Tracking NSVs is a great way to remember that you’re moving forward, even when the scale doesn’t reflect it.
The Limits of BMI as a Health Measure
The Body Mass Index (BMI) has been widely used to assess health, but it’s far from perfect. Dr. Weiner and Zoe critique the BMI’s shortcomings, explaining how this 200-year-old formula, which simply compares weight to height, fails to account for muscle mass, body composition, and other essential factors. Dr. Weiner points out that BMI often mislabels individuals, especially those with high muscle mass, as “overweight.” They discuss alternatives, like the Body Roundness Index (BRI), that consider waist and hip measurements, offering a more nuanced health picture. Dr. Weiner underscores the importance of moving beyond BMI and adopting more accurate, holistic measures.
Pharmacy Benefit Managers: Putting Profits Over Patients
In their discussion on pharmacy benefit managers (PBMs), Dr. Weiner and Zoe reveal how these intermediaries have shifted from helping lower drug prices to prioritizing profits. PBMs now control nearly 80% of pharmacy claims, often inflating prices to serve their bottom line. For example, PBMs have been known to hike up the cost of drugs like Zytiga from a wholesale price of $229 to as high as $6,000, placing a heavy burden on patients and taxpayers. Dr. Weiner argues that PBMs’ monopolistic practices highlight the urgent need for more transparency and regulation in healthcare. By better understanding the role PBMs play, patients can advocate for policies to lower drug costs and improve access to care.
How to Advocate for a Patient-Centered Healthcare System
In the final segment, Dr. Weiner and Zoe encourage listeners to take an active role in changing healthcare. They urge you to research healthcare legislation, support representatives pushing for lower drug prices, and vote for candidates focused on putting patients over profits. Advocacy, they emphasize, is essential for reforming healthcare to make it more accessible and affordable for everyone.
Episode Takeaways
This episode tackles the critical issues of weight loss success, BMI’s limitations, and the role of PBMs, leaving listeners with actionable steps to navigate the healthcare system and celebrate their own achievements. Episode 53 of the Pound of Cure Weight Loss Podcast is a must-listen for those interested in health reform, practical weight loss advice, and a more compassionate approach to healthcare.
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Zoe (00:00):
Keep a running note on your phone or on a notepad.
Anytime you experiencesomething you're proud of,
whether that's on the scale, achange in body composition, any
of those other non-scale victorymeasures.
Jot it down, because then youcan go back and remember that
you are making progress.
(00:21):
Hi there, welcome back to thePound of Cure Weight Loss
Podcast.
Profits Over Patience, drWeiner.
What are we talking about today?
Dr. Weiner (00:32):
Well, we talk about profits over patience A lot.
I mean, you know, I don't know,sometimes I feel like part of
me.
I started this podcast to likehelp educate people.
I always try to keep it frombeing a little bit of a pardon
my language but a bitch sessionabout the healthcare system.
We're in private practice, werun our own practice, we do our
(00:57):
own billing, we deal withinsurance companies.
I mean we are really, I think,just ground zero in terms of the
health care crisis, because wesee lots of patients in our
practice and we're constantlybattling insurance.
We're fighting for these GLP-1meds and we're seeing how it
impacts people's lives.
And it's so frustrating to mebecause we got the technology.
(01:19):
It's there Like we sharedobesity.
I mean we really have.
It's just a matter of theindustries that surround the
payment for healthcare, whetherit's pharma, health insurance.
They've just extracted so muchmoney.
They're all publicly traded.
Their CEOs are making $10million, $20 million bonuses
(01:44):
every year, maybe even more, andthey must keep driving their
stock price up.
There's just this intensepressure on the people who run
these companies to just be moreand more and more profitable and
less about the patient, and sothey have to.
That's just the nature ofhealth care is, if the companies
(02:05):
and the health insurancecompanies and direct it in the
(02:32):
right way, we can do this.
And so one of the hopes of thispodcast is that we bring
attention to this.
And again, I keep saying this,but we've got an election cycle
coming up and I urge all of youout there to look over the
candidates in your district, andnot so much than the
presidential candidates, butyour congresspeople, your
(02:54):
senators, your statecongresspeople, your state
senators.
Look at them and see what theystand for, and see if there's
anybody out there who's going tohelp you with your health care
issues.
So, anyway, so let's move intotheir in the news segment.
Our article comes from the NewYork Times and it's very
cleverly titled Is it time tosay goodbye to BMI and?
Zoe (03:18):
I'd say yes, yes, I vote yes.
Dr. Weiner (03:20):
You, I think.
On one episode in the past yousaid the BMI is trash.
Zoe (03:24):
And I stand by it.
It still is trash.
Dr. Weiner (03:28):
I think this article would certainly support that
statement.
So first of all, let's talkabout what the BMI is.
So body mass index is yourweight over your height squared,
and they use a metric system.
And if you really got to breakdown the math and I'm a math guy
, so I like this kind of stuffit's essentially designing or
(03:50):
measuring the density of acylinder.
That's more or less where BMIcomes from, and so really, some
people are cylinders.
If you're thin, you're acylinder, but if you're
overweight you're thin, you're acylinder, but if you're
overweight you're not reallyshaped like a cylinder.
And so they're looking at someother options.
(04:10):
Now BMI is 200 years old, so goback to 200 years ago.
If you're going to calculatesomeone's BMI, they could do it.
Long division, longmultiplication, you can figure
it out.
But now we have computers, wehave calculators, we have a lot
of other stuff we're going tocover on this episode, and so
there's the option to come upwith a much more sophisticated
(04:33):
measure of obesity.
I'll tell you in the operatingroom, I'll go in sometimes I'll
do a bmi 60 case and boom, easypeasy, no problem whatsoever.
And then I'll do a patient witha bmi of and it's a difficult
case.
There's lots of abdominal fat,it's a very challenging surgery,
and so I learned a long timeago that BMI alone is just not
(04:54):
going to do it.
There's other things at playthat determine the difficulty of
a surgery the severity of theobesity, the texture of the
tissue, all of these things.
So this article talks about thebody roundness index, and it
was developed by a mathematician, and she basically created a
formula that essentially helpsto measure the human body as a
(05:17):
more of a circle an oval, Ithink, is actually what it's
based on, which makes sense.
Makes sense.
Yeah, it's a much morecomplicated formula.
You really have to plug it intoa computer and they do have
some websites.
If you look it up bodyroundness index, you can plug
your info in and it looks atyour first of all.
It looks at your age, it looksat your gender, it looks at your
(05:39):
waist circumference, it looksat your hip circumference.
So it's looking at a lot ofdifferent measurements and comes
up with this body roundnessindex, and normal is less than
three, but the number goes allthe way to 20.
I like the idea that there's ahuge range.
Zoe (05:56):
It makes it able to be more specific.
Dr. Weiner (05:58):
Yeah, Most people will fall between one and 10.
And they've shown that a BRIbody roundness index greater
than seven shows increasedmortality, increased cancer
rates, increased risk of heartdisease.
We also see that, as you, Ithink.
What also is interesting, ifyour BRI is less than 3.4 and
(06:21):
you're over 65, that that alsoshows increased mortality.
Zoe (06:27):
Because we know that some fat as you get into those elder
years has a protective effect.
Dr. Weiner (06:34):
Yes, absolutely, and so when we know these things
and this starts to, that'sconsistent with things that we
know that also shows that thishas some value.
It's a complicated formula.
It really is a measurement ofyour visceral fat, your
intra-abdominal fat, and I thinkit's a much better way.
(06:58):
I think there may be some.
My hunch is this may be just astep along the way.
Zoe (07:04):
Might not be like Apex.
Dr. Weiner (07:07):
But it was an interesting article.
I like seeing it.
They talk about how ArnoldSchwarzenegger at his peak
bodybuilding would have beenclassified as obese.
I think there's a largepercentage of the football
players are technically obese,even though these are really
elite athletes, and so itdetracts from the fact that
there's a lot more to someone'shealth and fitness than just
(07:27):
their height and their weight.
I mean, what do you think whenyou were in school, did they put
a lot of stock in BMI, or didthey kind of pull back and say,
hey, maybe it's more complicated?
Zoe (07:40):
No, it absolutely was kind of one of those main measures.
And then it was, of course,discussion around well, this is
not a good measurement, but yet,well, that's what the health
care system uses and that'swhat's so ingrained in medicine.
So you have to use it formalnutrition diagnoses, for,
(08:02):
obviously, the diagnosis ofobesity and different things
like that.
But of course the conversationswere had, but it was yeah, yeah
that's.
We know that BMI is trash, butyou still have to use it anyway.
But I like what you said aboutthis BRF, bri.
It mostly measures the visceralfat, which is what you have to
(08:27):
dig through, which can make thesurgery more difficult, as
opposed to subcutaneous fat,which is the fat underneath the
skin.
Dr. Weiner (08:34):
Right.
It's also the fat that'sassociated with heart disease,
diabetes and the comorbiditiesas well, and so we continue to
use the same criteria forbariatric surgery.
They're now using not the samecriteria, but they're using BMI
for GLP-1 indications, and so wecontinue to just be stuck in
(08:57):
this BMI rut.
It's going to take a long timefor us to get out of it because,
as you pointed out, there'sdogma in medicine and when
you've been doing something for200 years, it's hard to get out
of it.
Because, as you pointed out,you know there's there's dogma
in medicine and when you've beendoing something for 200 years,
it's hard to break out of it.
Zoe (09:08):
It's in every emr that bmi is built into every emr, you
type in the height, you type inthe weight and it's going to
spit out the bmi for you yeah,well, and I recently was having
a conversation with somebody andwe were talking about what you
know, their goals, theirlong-term goals and that kind of
thing and, um, they were sayinghow they just want to get into
the normal range of BMI and allthe time.
(09:29):
Can we please like you're?
And then they had been liftingweights and really working on
their nutrition and their bodycomposition was changing and I
was like you're going to?
You're going to set yourself upfor disappointment If we're
really only looking at BMI andweight as your measure.
Dr. Weiner (09:46):
We see that a lot, particularly with women.
With 200 pounds, the wonderlandRight.
So many women are like I justneed to have my weight.
Start with a one.
But if you take a step back andyou zoom out, as you say, and
look at it, well, that's becausesomeone wants to find a pound
is whatever a pound is and wedecided on a base 10 numerical
system.
Well, that's because someoneonce defined a pound as whatever
(10:07):
a pound is and we decided on abase 10 numerical system.
And you know so manyassumptions have come that make
that weight 200 pounds.
Zoe (10:14):
Your gravitational pull to the earth in that one moment.
Dr. Weiner (10:17):
Exactly.
It's all you know.
There's a lot of randomness towhat makes 200 pounds, but yet
we are putting so much energyinto that number as like, my
measure of success.
And I am not successful if I'm201, but I am successful if I'm
199.
And there's so many other moreimportant things.
Zoe (10:37):
And I often like to ask people like okay, if you were to
visualize yourself, would yourather see a certain number on
the scale, or see a certainphysique, or like, look a
certain way or feel a certainway?
You know, have your diabetes goaway, whatever it is?
So there are so many morepowerful ways to measure
progress and success.
Dr. Weiner (10:57):
Well, I think that segues very much into our
nutrition segment.
Perfect.
So, Zoe, what do we have todayfor nutrition?
Zoe (11:03):
very much into our nutrition segment.
Perfect.
So, zoe, what do we have todayfor nutrition?
Well, I did just want tofurther dig into those non-scale
ways to measure success,specifically non-BMI, because
we're going out with the BMI,right.
So, again, that BMI, as DrWeiner had explained, is a
mathematical equation, basicallya ratio of your height and your
(11:25):
weight, if you will.
What your weight does not takeinto consideration is your body
composition, which is your fatmass versus your muscle mass,
right?
And so if we wanted to have amore accurate measure of
progress, it would be reallygreat to be able to measure body
composition changes, and thereare many ways to do that.
(11:47):
There's like the DEXA scan.
That's pretty expensive forpeople to go and do.
There are, you know, differentscanners, like an in-body some
gyms have, or a little handheldbioelectrical impedance.
There is a.
There's a pretty good margin oferror with that, you know,
right, but it's better than it'sat least another data point,
right.
But we are now seeing these 3Dscanners that basically map out,
(12:13):
take your measurements, map outyour body composition, which is
a really interesting and coolnew way to see those changes
over time in body composition.
Dr. Weiner (12:24):
Right, you can essentially measure every inch
of your body.
Zoe (12:27):
Right, because think about the human error.
I say all the time, if you wantto be tracking measurements
over time, probably a betteridea or not a better idea than
the scale, but in addition to sowe have more data points is
maybe taking your waistcircumference, but of course
there's human error there.
There's again all of thosefactors that could play a role
(12:48):
into that number not being superaccurate, but being able to
measure all of the data pointson your body and track that over
time, and then not only havingthe measurements but being able
to see you're with yourself allday, every day, like it's hard
to see your body change when,when you have that, um, that's
close proximity.
But if, maybe monthly orquarterly, you see these changes
(13:10):
in your body scanner, that tome is way not only cooler but
more significant to measureactual progress and change in
body composition, especially ifyou're really dialed in with
your nutrition and you'reworking on your building muscle
and that kind of thing.
So I think that's a veryinteresting area that I hope to
(13:31):
see more of soon.
Dr. Weiner (13:32):
Yeah, I think, especially with like weight loss
stalls.
Yeah, you know.
Zoe (13:36):
Oh, all the time I hear people oh, I only lost a pound
this month, but I lost threeinches.
What do I need to do?
Dr. Weiner (13:44):
I'm like that's amazing, but.
But I lost three inches.
What do I need to do?
I'm like that's amazing, butsomething like that, these
secondary endpoints that we'relooking at, because it's not
just about what happens on thescale every month, especially
when you're looking monthly,which, truthfully, even weighing
yourself monthly, you'll stillsee stalls, you'll still see a
lot of noise in that signal andso everybody's got to weigh
themselves at least monthly.
(14:04):
It's hard when you're tryingeverybody's got to weigh
themselves at least monthly,like it's hard to when you're
trying to do this, to weighyourself less than once a month.
Zoe (14:09):
So, yeah, I think these, these scanners are interesting
and some of these other methodsof kind of measuring your body
and comparing is it's reallyhelpful, yeah, but also knowing
that just to remember andstaying motivated with the fact
that there are so many nonaesthetic or non body
composition ways to measure yourprogress on this journey your
(14:29):
health markers, your med, themedications you're able to get
off of your labs, yourperformance, whether you can
walk up a flight of stairswithout needing a break, or
maybe you signed up for a 5k, oryou're now lifting 20 pounds
and said, right, there are somany markers.
And so I just want to leave mynutrition segment with this
little tip to keep you motivatedon those days that, of course,
(14:53):
we're all going to experiencedown, like feeling down, feeling
frustrated, whether it'sthrough a stall or just you know
whatever.
Keep a running note on yourphone or on a notepad.
Anytime you experiencesomething you're proud of,
whether that's on the scale, achange in body composition, any
of those other non-scale victorymeasures that I was explaining,
(15:16):
or even just like a little ahamoment.
You're like, oh my gosh, I wasable to just bend down and put
my sock on.
So anytime you have a littlelike glimmering, exciting,
exciting moment, jot it down,because then you can go back and
remember that you are makingprogress, reinforce yourself
(15:38):
that you are doing the rightthings and it's okay to feel a
little bit down, but just kindof like reigniting that and
pumping yourself back up, likeyeah, I have done all of this, I
have made this much progress,and just kind of reminding
yourself I can find I findreally beneficial in terms of
reigniting that motivation.
Dr. Weiner (15:55):
Yeah, the human brain is kind of screwed up.
That one piece of bad news,that one bad thing that happens
to you, we'll let that ruin ourwhole day and we'll focus on
that for the rest of the day,even if three good things happen
to us on that same day.
Zoe (16:10):
Just same thing with compliments versus negative
comments yeah, absolutely Right.
Dr. Weiner (16:16):
Ten people say you look fantastic and one person
kind of gives you a nasty lookand all you can think about all
day is that nasty look.
Yeah, you're right.
So I think that's a great tipfor that.
All right, so our economics ofobesity segment is next.
This really comes from aMedPage Today article, and how
(16:40):
crooked they are and how muchthey're compromising our
healthcare and really where thetitle of our episode Profits
Over Patients comes from.
Pbms overpay their ownpharmacies to the detriment of
insurers, taxpayers.
Ftc says that's even a littletricky because the PBMs are the
insurers.
(17:01):
The PBM we've talked about thisbefore a lot.
I'll just kind of give youeverybody a quick reminder of
what a PBM or pharmacy benefitmanager is.
This is that Express Scripts,that OptumRx.
There's a separate phone numberyou have to call if you're
getting prescription coverageversus if you're seeing your
doctor.
That's your PBM.
(17:22):
You're calling, that's thatseparate phone number and they
regulate the price that you payand what you're covered for for
the medication.
Now why do we even have PBMs?
Pbms' job is to negotiate withthe pharma industry so that you
get the lowest price possiblefor the medication.
(17:42):
Now we all say, well, ourinsurance company pays it, I
don't pay it.
But that's not how insuranceworks.
If you're paying a lot for it,your insurance is going to go up
, and everybody you know.
Look at your health insurancepremiums over the last 10 years,
they have skyrocketed.
Look at your co-pays onmedications they have
skyrocketed.
Look at the price ofmedications in this country they
(18:04):
have skyrocketed.
So if PBM's job is to keep theprice of prescription drugs low,
they're doing a really crappyjob, and so this also points to
why we're seeing this.
So what's happened and I thinka big problem that we've had is
that the health insurancecompanies have bought all the
(18:26):
PBMs.
So there's six big PBMs andthey're responsible for, I think
, 94% 94% of all pharmacy claimscome through the six big PBMs.
So we really have essentiallynot a monopoly because there's
six companies, but they'rebehaving like monopolies.
So CVS, caremark I thinkthey're the biggest that's owned
by Aetna.
(18:46):
So Aetna owns Aetna, it ownsCVS and it owns Caremark.
It owns the whole pipeline, thewhole pipeline, every single
step.
It's got all of it.
And Cigna owns Express Scripts.
Optumrx is owned byUnitedHealthcare.
These three CVS, cigna andUnited that's 79% of all the
(19:08):
prescriptions in the US.
Humana Pharmacy, medimpact andPrime Therapeutics are the other
three.
In the article they talk aboutZytiga, which is a prostate
cancer medicine.
The wholesale price of Zytigais $229.
However, if they look at thetop three PBMs, the average
price is $6,000.
Wholesale $229.
However, if they look at thetop three PBMs, the average
(19:30):
price is $6,000.
Wholesale $229.
Average price paid.
That's a cancer medication,cancer medication.
So they know, cancer is money.
Got to get paid for it.
Got cancer, man, I'm sorry.
Oh, we got to pay.
It's cancer.
Oh, we got to pay for it.
Yeah Well, whatever it costs,we're going to pay for it.
It's cancer.
Make it happen.
Right right, obesity, you're onyour own.
(19:51):
Yeah, like cancer, it just eatless.
Yeah, it totally eat less.
So they pay twice as much forthis medication than if you go
to an unaffiliated pharmacy.
So what are the unaffiliatedpharmacies?
It's like your Safeway here inTucson, it's your grocery store
pharmacies.
(20:11):
In the past you would say, oh,you're locally owned pharmacies.
Those are all gone.
Zoe (20:18):
That doesn't exist anymore.
Do you remember that?
Dr. Weiner (20:21):
I think you're still-.
Zoe (20:23):
Well, I also grew up in a town of 10,000 people.
Dr. Weiner (20:25):
Right, but there was a pharmacy and it was a locally
owned small business.
That person who owned it wasoften the guy who was giving you
your medicines.
They were a pharmacist thatdoesn't exist anymore, and so
what happened with those is thatthe PBMs started buying up all
the pharmacies and they went tothese local owned pharmacies
like, oh, we're not paying you,we're paying you garbage for
(20:47):
these medications, we're notpaying you anything.
And they essentially ran themout of business.
And what happened is they moreor less ruined their business.
They're like oh, we're CVS,we'll buy you.
Zoe (20:57):
Yeah.
Dr. Weiner (20:58):
You know kind of mob boss stuff.
We're going to ruin yourbusiness and then offer to buy
you up, and so that's whythere's a CVS on every corner
and all these local pharmacieshave kind of been bought up by
CVS and Walgreens and eventhings like Rite Aid.
I feel like Rite Aids used tobe around, but they just didn't
play the insurance game rightand they got pushed out of this.
(21:20):
So all of this money is passedon to you, it's passed on to
taxpayers, it's passed on toemployers, it's passed on to
employees.
It's passed on to taxpayers,it's passed on to employers,
it's passed on to employees.
There's really, when you receiveyour salary, your payment,
you're actually receivingpayment two different ways.
You get your paycheck, which iswhat goes in your bank account,
but then you also get yourhealth insurance.
(21:41):
If you get your healthinsurance through the employer,
that's what you get, and so youremployer is paying money to the
health insurance company.
If your employer didn't have topay as much money to the health
insurance company, they couldpay you more wages and that
would absolutely happen.
I mean, we run our practice.
I know when I calculate whatsomeone's salary, I have to
(22:04):
calculate their health insurancecost into this.
So this money that's beingspent is your money.
It would otherwise go to you,whether it's paid by your
insurance company or not.
And here's the trick that theypay, and we've all seen this.
Oh, you want a 90-day supply.
What do you have to do?
If you want a 90-day supply?
You've got to use ourmail-order pharmacy.
(22:27):
You've got to use our OptumRx.
Oh, if you go through OptumRx,the copay is lower.
Yeah, that's $6,000 medicineInstead of a $60 copay.
We'll charge you a $40 copay,but we're charging your employer
, your insurance company, $6,000.
And so they incentivize youthrough longer, because who
(22:49):
wants to go to the pharmacyevery month?
Right Through 90-dayprescriptions, through reduced
co-pays, they incentivize you touse their own pharmacies, which
they then pay a substantiallyhigher rate to for the same drug
that they do if you went to alocally or non-PBM owned
pharmacy.
And so there's no question.
(23:10):
Pbms are doing a terrible jobat the thing that they're there
for, which is keeping the costof medications lower for
Americans.
That's the job.
That's why PBMs exist.
Zoe (23:22):
They're doing a terrible job.
Dr. Weiner (23:24):
A terrible job.
So I have a chart and it's themonthly list prices for weight
loss drugs in the US compared toevery other country.
To me this is just infuriating.
We know this.
The list price of Ozempic,which is a diabetes version of
semaglutide, is $936, and Wegoviis $1,349.
(23:47):
First of all, already sameexact drug $400 upcharge.
Zoe (23:52):
Yeah.
Dr. Weiner (23:54):
Just because it's for obesity.
But then we look at what itcosts in other countries Canada,
Ozempic $936.
$147.
I want a Canadian PBM.
How do I sign up for a CanadianPBM Right, Sweden, ninety six
dollars.
Zoe (24:15):
It's not just that the US is double, it's like it's not
double.
Dr. Weiner (24:19):
It's five times higher.
Zoe (24:21):
Exactly, it's sickening, sickening.
Dr. Weiner (24:23):
And so these medicines literally are five
times more expensive in ourcountry than in any other
country, and it's not even twice.
I would love if it was twice asexpensive.
Fine, that'd be amazing.
Yeah, twice as expensive.
Japan's the next highestcountry for Ozempic $169.
$340 for Ozempic Boom Done,everybody, everybody.
(24:48):
Yeah, I think it happened.
Dempick Boom Done, everybody,everybody.
Yeah, make it happen.
So it is time for us to startlooking for alternatives to our
traditional PBMs, these big sixPBMs.
They are not doing anybody anygood unless you own stock in the
companies or work for thecompanies, and so this stuff has
to stop, or work for thecompanies, and so this stuff has
(25:11):
to stop.
And I think it's time for us towrite letters to your
congresspeople to start taking astand against this and
recognize what's happening.
There's plenty of money in thesystem, it's just not being
allocated appropriately.
So, all right.
That wraps up another bitchsession.
I mean podcast.
Zoe (25:28):
We keep ending on such positive notes.
Yeah, but I think it'simportant we got to know it.
I know, and you know, I havelearned so much throughout this
podcast as well, about theinsurance and the PBMs and all
of those things.
So I mean, I know that ourlisteners are getting so much
value out of it and I think it'slearning which we're providing
(25:49):
the information.
But then that that call toaction of okay, what can I do to
actually make a difference?
And and writing a letter tryingto get some change, and I think
that's really important.
Dr. Weiner (26:01):
Yeah, yeah.
I think what we really need issome politicians who are not
bought and sold by the healthinsurance company in the farm
industry.
Zoe (26:08):
How many politicians do you think actually like take the
time to understand all of thatand care in the first place?
Dr. Weiner (26:14):
So you know, if you're interested in this,
google Bernie Sanders.
Bernie Sanders was the lion'srunning back, lions running back
(26:34):
bernie.
Bernie sanders letter to theceo of novo nordisk, september
24th.
He's going to be testifying inthe senate hearing and uh it he
really it's a great letter andhe hits on all of these points
like he nails, each and everyone of these points about about
the cost of these medications inour country versus other
countries, the difference in theprice, whether it's for
diabetes or obesity, for thesame exact medication.
(26:57):
And so it really only throughthis type of thing, only by
being brought in before Senate,by through legislation, is this
going to change.
That's the only way it's goingto change, because it's being
allowed because of the laws wehave, and only by changing those
laws can we put an end to PBMs,which is honestly they're
(27:18):
really stealing from theAmerican public.
Zoe (27:22):
Well, I'm excited for us to be able to update on that next,
after that happens.
Dr. Weiner (27:27):
We can do a podcast segment on it.
All right.
If you're having trouble withyour getting coverage for weight
loss medications, or if you'reable to do it successfully, let
us know.
Drop us a line on social media,on TikTok, instagram, on our
YouTube channel, through ourwebsite.
If you have a question you wantto see us answer on the podcast
, please reach out to us.
Zoe (27:48):
We'll see you next time.
Dr. Weiner (27:49):
See you.
Keep a running note on your phone or on a notepad.
Anytime you experiencesomething you're proud of,
whether that's on the scale, achange in body composition, any
of those other non-scale victorymeasures.
Jot it down, because then youcan go back and remember that
you are making progress.
(00:21):
Hi there, welcome back to thePound of Cure Weight Loss
Podcast.
Profits Over Patience, drWeiner.
What are we talking about today?
Dr. Weiner (00:32):
Well, we talk about profits over patience A lot.
I mean, you know, I don't know,sometimes I feel like part of
me.
I started this podcast to likehelp educate people.
I always try to keep it frombeing a little bit of a pardon
my language but a bitch sessionabout the healthcare system.
We're in private practice, werun our own practice, we do our
(00:57):
own billing, we deal withinsurance companies.
I mean we are really, I think,just ground zero in terms of the
health care crisis, because wesee lots of patients in our
practice and we're constantlybattling insurance.
We're fighting for these GLP-1meds and we're seeing how it
impacts people's lives.
And it's so frustrating to mebecause we got the technology.
(01:19):
It's there Like we sharedobesity.
I mean we really have.
It's just a matter of theindustries that surround the
payment for healthcare, whetherit's pharma, health insurance.
They've just extracted so muchmoney.
They're all publicly traded.
Their CEOs are making $10million, $20 million bonuses
(01:44):
every year, maybe even more, andthey must keep driving their
stock price up.
There's just this intensepressure on the people who run
these companies to just be moreand more and more profitable and
less about the patient, and sothey have to.
That's just the nature ofhealth care is, if the companies
(02:05):
and the health insurancecompanies and direct it in the
(02:32):
right way, we can do this.
And so one of the hopes of thispodcast is that we bring
attention to this.
And again, I keep saying this,but we've got an election cycle
coming up and I urge all of youout there to look over the
candidates in your district, andnot so much than the
presidential candidates, butyour congresspeople, your
(02:54):
senators, your statecongresspeople, your state
senators.
Look at them and see what theystand for, and see if there's
anybody out there who's going tohelp you with your health care
issues.
So, anyway, so let's move intotheir in the news segment.
Our article comes from the NewYork Times and it's very
cleverly titled Is it time tosay goodbye to BMI and?
Zoe (03:18):
I'd say yes, yes, I vote yes.
Dr. Weiner (03:20):
You, I think.
On one episode in the past yousaid the BMI is trash.
Zoe (03:24):
And I stand by it.
It still is trash.
Dr. Weiner (03:28):
I think this article would certainly support that
statement.
So first of all, let's talkabout what the BMI is.
So body mass index is yourweight over your height squared,
and they use a metric system.
And if you really got to breakdown the math and I'm a math guy
, so I like this kind of stuffit's essentially designing or
(03:50):
measuring the density of acylinder.
That's more or less where BMIcomes from, and so really, some
people are cylinders.
If you're thin, you're acylinder, but if you're
overweight you're thin, you're acylinder, but if you're
overweight you're not reallyshaped like a cylinder.
And so they're looking at someother options.
(04:10):
Now BMI is 200 years old, so goback to 200 years ago.
If you're going to calculatesomeone's BMI, they could do it.
Long division, longmultiplication, you can figure
it out.
But now we have computers, wehave calculators, we have a lot
of other stuff we're going tocover on this episode, and so
there's the option to come upwith a much more sophisticated
(04:33):
measure of obesity.
I'll tell you in the operatingroom, I'll go in sometimes I'll
do a bmi 60 case and boom, easypeasy, no problem whatsoever.
And then I'll do a patient witha bmi of and it's a difficult
case.
There's lots of abdominal fat,it's a very challenging surgery,
and so I learned a long timeago that BMI alone is just not
(04:54):
going to do it.
There's other things at playthat determine the difficulty of
a surgery the severity of theobesity, the texture of the
tissue, all of these things.
So this article talks about thebody roundness index, and it
was developed by a mathematician, and she basically created a
formula that essentially helpsto measure the human body as a
(05:17):
more of a circle an oval, Ithink, is actually what it's
based on, which makes sense.
Makes sense.
Yeah, it's a much morecomplicated formula.
You really have to plug it intoa computer and they do have
some websites.
If you look it up bodyroundness index, you can plug
your info in and it looks atyour first of all.
It looks at your age, it looksat your gender, it looks at your
(05:39):
waist circumference, it looksat your hip circumference.
So it's looking at a lot ofdifferent measurements and comes
up with this body roundnessindex, and normal is less than
three, but the number goes allthe way to 20.
I like the idea that there's ahuge range.
Zoe (05:56):
It makes it able to be more specific.
Dr. Weiner (05:58):
Yeah, Most people will fall between one and 10.
And they've shown that a BRIbody roundness index greater
than seven shows increasedmortality, increased cancer
rates, increased risk of heartdisease.
We also see that, as you, Ithink.
What also is interesting, ifyour BRI is less than 3.4 and
(06:21):
you're over 65, that that alsoshows increased mortality.
Zoe (06:27):
Because we know that some fat as you get into those elder
years has a protective effect.
Dr. Weiner (06:34):
Yes, absolutely, and so when we know these things
and this starts to, that'sconsistent with things that we
know that also shows that thishas some value.
It's a complicated formula.
It really is a measurement ofyour visceral fat, your
intra-abdominal fat, and I thinkit's a much better way.
(06:58):
I think there may be some.
My hunch is this may be just astep along the way.
Zoe (07:04):
Might not be like Apex.
Dr. Weiner (07:07):
But it was an interesting article.
I like seeing it.
They talk about how ArnoldSchwarzenegger at his peak
bodybuilding would have beenclassified as obese.
I think there's a largepercentage of the football
players are technically obese,even though these are really
elite athletes, and so itdetracts from the fact that
there's a lot more to someone'shealth and fitness than just
(07:27):
their height and their weight.
I mean, what do you think whenyou were in school, did they put
a lot of stock in BMI, or didthey kind of pull back and say,
hey, maybe it's more complicated?
Zoe (07:40):
No, it absolutely was kind of one of those main measures.
And then it was, of course,discussion around well, this is
not a good measurement, but yet,well, that's what the health
care system uses and that'swhat's so ingrained in medicine.
So you have to use it formalnutrition diagnoses, for,
(08:02):
obviously, the diagnosis ofobesity and different things
like that.
But of course the conversationswere had, but it was yeah, yeah
that's.
We know that BMI is trash, butyou still have to use it anyway.
But I like what you said aboutthis BRF, bri.
It mostly measures the visceralfat, which is what you have to
(08:27):
dig through, which can make thesurgery more difficult, as
opposed to subcutaneous fat,which is the fat underneath the
skin.
Dr. Weiner (08:34):
Right.
It's also the fat that'sassociated with heart disease,
diabetes and the comorbiditiesas well, and so we continue to
use the same criteria forbariatric surgery.
They're now using not the samecriteria, but they're using BMI
for GLP-1 indications, and so wecontinue to just be stuck in
(08:57):
this BMI rut.
It's going to take a long timefor us to get out of it because,
as you pointed out, there'sdogma in medicine and when
you've been doing something for200 years, it's hard to get out
of it.
Because, as you pointed out,you know there's there's dogma
in medicine and when you've beendoing something for 200 years,
it's hard to break out of it.
Zoe (09:08):
It's in every emr that bmi is built into every emr, you
type in the height, you type inthe weight and it's going to
spit out the bmi for you yeah,well, and I recently was having
a conversation with somebody andwe were talking about what you
know, their goals, theirlong-term goals and that kind of
thing and, um, they were sayinghow they just want to get into
the normal range of BMI and allthe time.
(09:29):
Can we please like you're?
And then they had been liftingweights and really working on
their nutrition and their bodycomposition was changing and I
was like you're going to?
You're going to set yourself upfor disappointment If we're
really only looking at BMI andweight as your measure.
Dr. Weiner (09:46):
We see that a lot, particularly with women.
With 200 pounds, the wonderlandRight.
So many women are like I justneed to have my weight.
Start with a one.
But if you take a step back andyou zoom out, as you say, and
look at it, well, that's becausesomeone wants to find a pound
is whatever a pound is and wedecided on a base 10 numerical
system.
Well, that's because someoneonce defined a pound as whatever
(10:07):
a pound is and we decided on abase 10 numerical system.
And you know so manyassumptions have come that make
that weight 200 pounds.
Zoe (10:14):
Your gravitational pull to the earth in that one moment.
Dr. Weiner (10:17):
Exactly.
It's all you know.
There's a lot of randomness towhat makes 200 pounds, but yet
we are putting so much energyinto that number as like, my
measure of success.
And I am not successful if I'm201, but I am successful if I'm
199.
And there's so many other moreimportant things.
Zoe (10:37):
And I often like to ask people like okay, if you were to
visualize yourself, would yourather see a certain number on
the scale, or see a certainphysique, or like, look a
certain way or feel a certainway?
You know, have your diabetes goaway, whatever it is?
So there are so many morepowerful ways to measure
progress and success.
Dr. Weiner (10:57):
Well, I think that segues very much into our
nutrition segment.
Perfect.
So, Zoe, what do we have todayfor nutrition?
Zoe (11:03):
very much into our nutrition segment.
Perfect.
So, zoe, what do we have todayfor nutrition?
Well, I did just want tofurther dig into those non-scale
ways to measure success,specifically non-BMI, because
we're going out with the BMI,right.
So, again, that BMI, as DrWeiner had explained, is a
mathematical equation, basicallya ratio of your height and your
(11:25):
weight, if you will.
What your weight does not takeinto consideration is your body
composition, which is your fatmass versus your muscle mass,
right?
And so if we wanted to have amore accurate measure of
progress, it would be reallygreat to be able to measure body
composition changes, and thereare many ways to do that.
(11:47):
There's like the DEXA scan.
That's pretty expensive forpeople to go and do.
There are, you know, differentscanners, like an in-body some
gyms have, or a little handheldbioelectrical impedance.
There is a.
There's a pretty good margin oferror with that, you know,
right, but it's better than it'sat least another data point,
right.
But we are now seeing these 3Dscanners that basically map out,
(12:13):
take your measurements, map outyour body composition, which is
a really interesting and coolnew way to see those changes
over time in body composition.
Dr. Weiner (12:24):
Right, you can essentially measure every inch
of your body.
Zoe (12:27):
Right, because think about the human error.
I say all the time, if you wantto be tracking measurements
over time, probably a betteridea or not a better idea than
the scale, but in addition to sowe have more data points is
maybe taking your waistcircumference, but of course
there's human error there.
There's again all of thosefactors that could play a role
(12:48):
into that number not being superaccurate, but being able to
measure all of the data pointson your body and track that over
time, and then not only havingthe measurements but being able
to see you're with yourself allday, every day, like it's hard
to see your body change when,when you have that, um, that's
close proximity.
But if, maybe monthly orquarterly, you see these changes
(13:10):
in your body scanner, that tome is way not only cooler but
more significant to measureactual progress and change in
body composition, especially ifyou're really dialed in with
your nutrition and you'reworking on your building muscle
and that kind of thing.
So I think that's a veryinteresting area that I hope to
(13:31):
see more of soon.
Dr. Weiner (13:32):
Yeah, I think, especially with like weight loss
stalls.
Yeah, you know.
Zoe (13:36):
Oh, all the time I hear people oh, I only lost a pound
this month, but I lost threeinches.
What do I need to do?
Dr. Weiner (13:44):
I'm like that's amazing, but.
But I lost three inches.
What do I need to do?
I'm like that's amazing, butsomething like that, these
secondary endpoints that we'relooking at, because it's not
just about what happens on thescale every month, especially
when you're looking monthly,which, truthfully, even weighing
yourself monthly, you'll stillsee stalls, you'll still see a
lot of noise in that signal andso everybody's got to weigh
themselves at least monthly.
(14:04):
It's hard when you're tryingeverybody's got to weigh
themselves at least monthly,like it's hard to when you're
trying to do this, to weighyourself less than once a month.
Zoe (14:09):
So, yeah, I think these, these scanners are interesting
and some of these other methodsof kind of measuring your body
and comparing is it's reallyhelpful, yeah, but also knowing
that just to remember andstaying motivated with the fact
that there are so many nonaesthetic or non body
composition ways to measure yourprogress on this journey your
(14:29):
health markers, your med, themedications you're able to get
off of your labs, yourperformance, whether you can
walk up a flight of stairswithout needing a break, or
maybe you signed up for a 5k, oryou're now lifting 20 pounds
and said, right, there are somany markers.
And so I just want to leave mynutrition segment with this
little tip to keep you motivatedon those days that, of course,
(14:53):
we're all going to experiencedown, like feeling down, feeling
frustrated, whether it'sthrough a stall or just you know
whatever.
Keep a running note on yourphone or on a notepad.
Anytime you experiencesomething you're proud of,
whether that's on the scale, achange in body composition, any
of those other non-scale victorymeasures that I was explaining,
(15:16):
or even just like a little ahamoment.
You're like, oh my gosh, I wasable to just bend down and put
my sock on.
So anytime you have a littlelike glimmering, exciting,
exciting moment, jot it down,because then you can go back and
remember that you are makingprogress, reinforce yourself
(15:38):
that you are doing the rightthings and it's okay to feel a
little bit down, but just kindof like reigniting that and
pumping yourself back up, likeyeah, I have done all of this, I
have made this much progress,and just kind of reminding
yourself I can find I findreally beneficial in terms of
reigniting that motivation.
Dr. Weiner (15:55):
Yeah, the human brain is kind of screwed up.
That one piece of bad news,that one bad thing that happens
to you, we'll let that ruin ourwhole day and we'll focus on
that for the rest of the day,even if three good things happen
to us on that same day.
Zoe (16:10):
Just same thing with compliments versus negative
comments yeah, absolutely Right.
Dr. Weiner (16:16):
Ten people say you look fantastic and one person
kind of gives you a nasty lookand all you can think about all
day is that nasty look.
Yeah, you're right.
So I think that's a great tipfor that.
All right, so our economics ofobesity segment is next.
This really comes from aMedPage Today article, and how
(16:40):
crooked they are and how muchthey're compromising our
healthcare and really where thetitle of our episode Profits
Over Patients comes from.
Pbms overpay their ownpharmacies to the detriment of
insurers, taxpayers.
Ftc says that's even a littletricky because the PBMs are the
insurers.
(17:01):
The PBM we've talked about thisbefore a lot.
I'll just kind of give youeverybody a quick reminder of
what a PBM or pharmacy benefitmanager is.
This is that Express Scripts,that OptumRx.
There's a separate phone numberyou have to call if you're
getting prescription coverageversus if you're seeing your
doctor.
That's your PBM.
(17:22):
You're calling, that's thatseparate phone number and they
regulate the price that you payand what you're covered for for
the medication.
Now why do we even have PBMs?
Pbms' job is to negotiate withthe pharma industry so that you
get the lowest price possiblefor the medication.
(17:42):
Now we all say, well, ourinsurance company pays it, I
don't pay it.
But that's not how insuranceworks.
If you're paying a lot for it,your insurance is going to go up
, and everybody you know.
Look at your health insurancepremiums over the last 10 years,
they have skyrocketed.
Look at your co-pays onmedications they have
skyrocketed.
Look at the price ofmedications in this country they
(18:04):
have skyrocketed.
So if PBM's job is to keep theprice of prescription drugs low,
they're doing a really crappyjob, and so this also points to
why we're seeing this.
So what's happened and I thinka big problem that we've had is
that the health insurancecompanies have bought all the
(18:26):
PBMs.
So there's six big PBMs andthey're responsible for, I think
, 94% 94% of all pharmacy claimscome through the six big PBMs.
So we really have essentiallynot a monopoly because there's
six companies, but they'rebehaving like monopolies.
So CVS, caremark I thinkthey're the biggest that's owned
by Aetna.
(18:46):
So Aetna owns Aetna, it ownsCVS and it owns Caremark.
It owns the whole pipeline, thewhole pipeline, every single
step.
It's got all of it.
And Cigna owns Express Scripts.
Optumrx is owned byUnitedHealthcare.
These three CVS, cigna andUnited that's 79% of all the
(19:08):
prescriptions in the US.
Humana Pharmacy, medimpact andPrime Therapeutics are the other
three.
In the article they talk aboutZytiga, which is a prostate
cancer medicine.
The wholesale price of Zytigais $229.
However, if they look at thetop three PBMs, the average
price is $6,000.
Wholesale $229.
However, if they look at thetop three PBMs, the average
(19:30):
price is $6,000.
Wholesale $229.
Average price paid.
That's a cancer medication,cancer medication.
So they know, cancer is money.
Got to get paid for it.
Got cancer, man, I'm sorry.
Oh, we got to pay.
It's cancer.
Oh, we got to pay for it.
Yeah Well, whatever it costs,we're going to pay for it.
It's cancer.
Make it happen.
Right right, obesity, you're onyour own.
(19:51):
Yeah, like cancer, it just eatless.
Yeah, it totally eat less.
So they pay twice as much forthis medication than if you go
to an unaffiliated pharmacy.
So what are the unaffiliatedpharmacies?
It's like your Safeway here inTucson, it's your grocery store
pharmacies.
(20:11):
In the past you would say, oh,you're locally owned pharmacies.
Those are all gone.
Zoe (20:18):
That doesn't exist anymore.
Do you remember that?
Dr. Weiner (20:21):
I think you're still-.
Zoe (20:23):
Well, I also grew up in a town of 10,000 people.
Dr. Weiner (20:25):
Right, but there was a pharmacy and it was a locally
owned small business.
That person who owned it wasoften the guy who was giving you
your medicines.
They were a pharmacist thatdoesn't exist anymore, and so
what happened with those is thatthe PBMs started buying up all
the pharmacies and they went tothese local owned pharmacies
like, oh, we're not paying you,we're paying you garbage for
(20:47):
these medications, we're notpaying you anything.
And they essentially ran themout of business.
And what happened is they moreor less ruined their business.
They're like oh, we're CVS,we'll buy you.
Zoe (20:57):
Yeah.
Dr. Weiner (20:58):
You know kind of mob boss stuff.
We're going to ruin yourbusiness and then offer to buy
you up, and so that's whythere's a CVS on every corner
and all these local pharmacieshave kind of been bought up by
CVS and Walgreens and eventhings like Rite Aid.
I feel like Rite Aids used tobe around, but they just didn't
play the insurance game rightand they got pushed out of this.
(21:20):
So all of this money is passedon to you, it's passed on to
taxpayers, it's passed on toemployers, it's passed on to
employees.
It's passed on to taxpayers,it's passed on to employers,
it's passed on to employees.
There's really, when you receiveyour salary, your payment,
you're actually receivingpayment two different ways.
You get your paycheck, which iswhat goes in your bank account,
but then you also get yourhealth insurance.
(21:41):
If you get your healthinsurance through the employer,
that's what you get, and so youremployer is paying money to the
health insurance company.
If your employer didn't have topay as much money to the health
insurance company, they couldpay you more wages and that
would absolutely happen.
I mean, we run our practice.
I know when I calculate whatsomeone's salary, I have to
(22:04):
calculate their health insurancecost into this.
So this money that's beingspent is your money.
It would otherwise go to you,whether it's paid by your
insurance company or not.
And here's the trick that theypay, and we've all seen this.
Oh, you want a 90-day supply.
What do you have to do?
If you want a 90-day supply?
You've got to use ourmail-order pharmacy.
(22:27):
You've got to use our OptumRx.
Oh, if you go through OptumRx,the copay is lower.
Yeah, that's $6,000 medicineInstead of a $60 copay.
We'll charge you a $40 copay,but we're charging your employer
, your insurance company, $6,000.
And so they incentivize youthrough longer, because who
(22:49):
wants to go to the pharmacyevery month?
Right Through 90-dayprescriptions, through reduced
co-pays, they incentivize you touse their own pharmacies, which
they then pay a substantiallyhigher rate to for the same drug
that they do if you went to alocally or non-PBM owned
pharmacy.
And so there's no question.
(23:10):
Pbms are doing a terrible jobat the thing that they're there
for, which is keeping the costof medications lower for
Americans.
That's the job.
That's why PBMs exist.
Zoe (23:22):
They're doing a terrible job.
Dr. Weiner (23:24):
A terrible job.
So I have a chart and it's themonthly list prices for weight
loss drugs in the US compared toevery other country.
To me this is just infuriating.
We know this.
The list price of Ozempic,which is a diabetes version of
semaglutide, is $936, and Wegoviis $1,349.
(23:47):
First of all, already sameexact drug $400 upcharge.
Zoe (23:52):
Yeah.
Dr. Weiner (23:54):
Just because it's for obesity.
But then we look at what itcosts in other countries Canada,
Ozempic $936.
$147.
I want a Canadian PBM.
How do I sign up for a CanadianPBM Right, Sweden, ninety six
dollars.
Zoe (24:15):
It's not just that the US is double, it's like it's not
double.
Dr. Weiner (24:19):
It's five times higher.
Zoe (24:21):
Exactly, it's sickening, sickening.
Dr. Weiner (24:23):
And so these medicines literally are five
times more expensive in ourcountry than in any other
country, and it's not even twice.
I would love if it was twice asexpensive.
Fine, that'd be amazing.
Yeah, twice as expensive.
Japan's the next highestcountry for Ozempic $169.
$340 for Ozempic Boom Done,everybody, everybody.
(24:48):
Yeah, I think it happened.
Dempick Boom Done, everybody,everybody.
Yeah, make it happen.
So it is time for us to startlooking for alternatives to our
traditional PBMs, these big sixPBMs.
They are not doing anybody anygood unless you own stock in the
companies or work for thecompanies, and so this stuff has
to stop, or work for thecompanies, and so this stuff has
(25:11):
to stop.
And I think it's time for us towrite letters to your
congresspeople to start taking astand against this and
recognize what's happening.
There's plenty of money in thesystem, it's just not being
allocated appropriately.
So, all right.
That wraps up another bitchsession.
I mean podcast.
Zoe (25:28):
We keep ending on such positive notes.
Yeah, but I think it'simportant we got to know it.
I know, and you know, I havelearned so much throughout this
podcast as well, about theinsurance and the PBMs and all
of those things.
So I mean, I know that ourlisteners are getting so much
value out of it and I think it'slearning which we're providing
(25:49):
the information.
But then that that call toaction of okay, what can I do to
actually make a difference?
And and writing a letter tryingto get some change, and I think
that's really important.
Dr. Weiner (26:01):
Yeah, yeah.
I think what we really need issome politicians who are not
bought and sold by the healthinsurance company in the farm
industry.
Zoe (26:08):
How many politicians do you think actually like take the
time to understand all of thatand care in the first place?
Dr. Weiner (26:14):
So you know, if you're interested in this,
google Bernie Sanders.
Bernie Sanders was the lion'srunning back, lions running back
(26:34):
bernie.
Bernie sanders letter to theceo of novo nordisk, september
24th.
He's going to be testifying inthe senate hearing and uh it he
really it's a great letter andhe hits on all of these points
like he nails, each and everyone of these points about about
the cost of these medications inour country versus other
countries, the difference in theprice, whether it's for
diabetes or obesity, for thesame exact medication.
(26:57):
And so it really only throughthis type of thing, only by
being brought in before Senate,by through legislation, is this
going to change.
That's the only way it's goingto change, because it's being
allowed because of the laws wehave, and only by changing those
laws can we put an end to PBMs,which is honestly they're
(27:18):
really stealing from theAmerican public.
Zoe (27:22):
Well, I'm excited for us to be able to update on that next,
after that happens.
Dr. Weiner (27:27):
We can do a podcast segment on it.
All right.
If you're having trouble withyour getting coverage for weight
loss medications, or if you'reable to do it successfully, let
us know.
Drop us a line on social media,on TikTok, instagram, on our
YouTube channel, through ourwebsite.
If you have a question you wantto see us answer on the podcast
, please reach out to us.
Zoe (27:48):
We'll see you next time.
Dr. Weiner (27:49):
See you.
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