Ozempic and Wegovy are selected for Medicare's price negotiations
110 comments
·January 17, 2025some_random
Someone1234
It is worth noting that Compounded Semaglutide sold in the US is still more expensive than branded Semaglutide sold in other markets, where national price negotiations occur. For example, it can be under $100/month in several European nations.
The US just has no mechanism to control prices. There isn't really competition for specific drugs.
s1artibartfast
I think it is critical to differentiate price controls and purchasing controls.
Most other markets with state insurance have purchasing controls. That is to say, if the price is too high, the government doesn't buy it.
Very few places have price controls e.g. "products cant be sold for more than X".
The US government is the outlier in that it situationally states it will pay the price no matter the cost.
Reasonable government policy needs to start with putting a price on human life (QALY), and purchasing goods and services that come in under that price. This is how it works in other state insurance systems.
simfree
We aren't other state insurance systems, though.
Instead, we have a divided and fractured jigsaw and heavy lobbying to keep it that way.
chriscappuccio
The research peptide sites are about the only reasonable places to buy this stuff
malfist
Nonsetrile compounding, like you'd do from the peptide sites is only safe for immediate use, and semaglutide is not that way. You mix up a vial and use it for a month or so.
Can you do it? Sure. Are you going to get an infection from it? Probably not. Is it riskier than having a compounding pharmacy doing it the right way? Absolutely, and in a meaningful amount of risk. The type of infections you get from contaminated injections are not something you want to deal with
gnkyfrg
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MichaelZuo
I’ve seen these comparisons a lot, but how is it determined that the actual quality of a name brand medicine is the same in the two different markets…?
i.e. The price difference could be reflecting a real qualitative difference such as being produced in different facilities, slightly less pure ingredients, less stringent QC, etc…
Someone1234
It feels very conspiratorial to suggest multinational pharmaceutical companies are creating low quality versions of their own branded drugs in Europe.
We know that these drugs cost roughly $10/dose to produce, and most of that is the auto-injector pens. Hardly seems worth ruining their reputation and getting punished be regulators to save a few dollars on something with a 600-6000% markup.
siliconc0w
It would be easier to squeeze Novo if they included Zepbound from Eli Lilly in the mix - we could argue that if we're going to spend unfathomable amounts on these medications we might as well buy the more effective medication from an American company.
ein0p
There's no need to spend unfathomable amounts. We just need to establish and enforce the favored nation status if they want to sell their drugs here. No drug (least of all US developed drug) should cost more in the US than it does elsewhere. That's what Trump was proposing in his last term. Because the Congress is corrupt AF, that went nowhere, but maybe we could give it another try now that his mandate is much stronger? As things currently are, we're getting robbed.
tzs
What about poor countries? If a drug company had to sell drugs for the same price in the US and a country like Sudan, the result would almost certainly be raising the price in Sudan up to US prices rather than lowering the price in the US to Sudan prices.
That would put the drug out of reach of most of the people in those poor countries.
ein0p
They can do what India and some other countries do, and legislatively ignore pharmaceutical patents when it comes to public health if drug is deemed unaffordable.
rs999gti
Not the lifeline for us fatties.
> Medicare enrollees, however, still won’t be able to access the drugs for obesity under a federal law that prohibits the program from paying for weight loss treatments
Also, you have to be severely ill or elderly to get Medicare. This is for their diabetic treatment.
qeternity
Why is there a specific list? Why don't we just let Medicare negotiate.
twoodfin
Because this isn’t really a “negotiation” as configured by the statute: Medicare doesn’t have a formulary, it doesn’t pay for drugs, the Part D plan providers (some quite large and with their own negotiating heft) do.
It’s a price-setting exercise. Yes, the drug-maker can walk away, but at the cost of massive punitive excise taxes on selling their drug to anyone in the US, not just Medicare Part D plans.
gnkyfrg
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mportela
Unfortunately, that's all the Biden administration could get written into law. The Big Pharma lobby is too strong and definitely battled to keep this list as small as possible.
ourmandave
At least the door is cracked open and it's a start.
Of course, Big Pharma will fight to slam it shut again.
dboreham
Because corruption.
croissants
Pat and cynical oversimplifications are bad for discourse, because they suggest that a default angry response is correct and, coincidentally, frees you from having to think harder about anything.
Don't give in!
gnkyfrg
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chvid
The US is trying to squeeze the Danes to get hold of Greenland.
chvid
It is front page news in dk - leaders from major Danish companies have been called in by the government … novo is the biggest exporter to the us and the most obvious squeeze.
Technically this is done by the Biden admin but obviously coordinated with the incoming Trump admin who has made their attention of using trade to squeeze Denmark in order to get full control of Greenland very clear.
xiphias2
Novo is just worth $300B, it's nothing compared to the many trillions of dollars Greenland is worth.
But I guess politicians are much cheaper than that.
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renewiltord
This particular thing was always in the works but we should ask the Greenlanders where they’d rather be and pay them if they choose otherwise than us. The land is too strategic and Denmark cannot hold it usefully.
impossiblefork
There is no functional difference in likely effectiveness between the present EU, of which Denmark is a member state, or the present US holding Greenland against a Russian attack. The Russian attack would be smashed either way.
renewiltord
That seems unlikely. Peace in Europe exists because the United States threatens its absence with a fist by its heart. America had to save Europe from destroying itself once and now the US has pacified Europe by placing its troops and weapons there lest the nations turn on each other in uncivilized violence again. And then again, when they dragged their feet, the US had to blow up their gas pipelines pour encourager les autres. The continent is incapable of protecting its own shipping lanes without US support and NATO acts as a deterrent solely because the US is in it. Take it out and the Europeans will spend the majority of their time telling everyone how it's not a big deal that Ukraine will fall to Russia, and Poland, and so on.
DrBenCarson
Would rather have Mounjaro and Zepbound
RobotToaster
The cynic in me thinks they are only going for Semaglutide because the patent expires in several places in 2026, tirzepatide has another ten years.
Retric
Cheap drugs have massive downward price pressure on alternatives.
Someone1234
Or do both, and let them compete with each other for Medicare's business.
arcticbull
That's been so effective so far.
samaltmanfried
I find something really gross and dystopian about the idea of Ozempic. Developing the willpower to resist short-term gratification, and the ability to make long-term decisions about your diet and health are some of the most important ingredients to living a good life. The idea of letting a drug do the thinking for you because you just can't trust yourself really horrifies me.
firesteelrain
I took compounded Mounjaro for two months. It was like a jolt to the system and got me back on track. I learned how to eat better and alter what I eat plus tracking it. Started walking and going to the gym. Started with 7k steps and now easily over 12k a day on average. I don’t drink soda and if I do it js Coke Zero, Pepsi Zero or Diet Coke. We just don’t buy it. I didn’t know about maximizing my protein and fiber.
It wasn’t short term at all like you say. Something was seriously wrong.
It’s everything though - if it was that easy to just start doing it then people would.
I needed a jolt and impetus to get better. I was depressed, worryful, everything.
I have lost 40 lb. I went from 255 to 229 with the assistance of Mounjaro. I stopped taking it but kept up with the regimen. I am now down to 214.
Some people who take it don’t do it right, they still eat crap and so those are the people who rebound or think they need to go up to 15. I was taking 2.5 then 5 when I stopped.
Yea it is willpower and discipline. Being on the medicine as an assistant along with a lot of research spurred by the community such as maximizing protein, fiber and water intake to become satiated was all that did it with exercise.
foxyv
Consider the fact that, if a drug can make you skinny, perhaps a drug can also make you fat. Or, even your own body can make you fat. Sometimes, what we think are our choices, have more to do with our biology and environment.
Just like you can't will yourself to be healthy if you are sick with the Flu. Some people can't just will themselves to be skinny. This is why we have drugs and treatments, because our bodies are not perfect machines that work the way we want them to.
steveklabnik
Do you object to pencil and paper because people write down reminders because their memory isn't good enough to remember everything?
aurizon
The USA is a racket cubed. https://www.healthsystemtracker.org/brief/prices-of-drugs-fo...
The pharmacies are also in on it https://pmc.ncbi.nlm.nih.gov/articles/PMC11147645/
mh-
Are people who pay for their own prescriptions able to purchase them at these Medicare-negotiated prices?
gnkyfrg
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null
tonymet
my favorite part of ozempic is that it settled the debate on calorie reduction.
arcticbull
The debate has never been "will consuming less calories than you expend make you lose weight" -- the debate has been "will just telling people to consume less calories, patting yourself on the back and calling it a day make them lose weight."
The latter was settled in a 2023 cohort study that showed doing is completely ineffective. [1]
There's been tons of data on this. The scientific consensus has been pretty clear for a hundred years, but nobody wanted to listen. Probably in part because there was no good solution before.
ragnese
> The debate has never been "will consuming less calories than you expend make you lose weight"
Maybe the debate amongst actual doctors and researchers. But, the debate amongst dummies on the internet (social media) CERTAINLY had people arguing that it was somehow about more than the number of calories in and out.
segasaturn
We should probably stop treating debates among "dummies on the internet" as anything other than noise that muddies up the conversation.
Edit: to be clear, this also applies to comment sections on HN :-)
Aurornis
> The debate has never been "will consuming less calories than you expend make you lose weight"
If you missed the whole "calories in, calories out" debate, consider yourself lucky. The comment above isn't helpful, but there really was a period of time where the topic du jour among health influencers was debating that calories didn't explain weight gain or loss. It played into the popular idea that blame for the obesity epidemic rested squarely on the food industry and "chemicals" in our food.
At one point, I had a podcast-obsessed coworker who tried to tell us all that even when he ate 1000 calories per day he couldn't lose weight. He had a long list of influencers and podcasters who supported this claim.
The CICO debate was especially popular among influencers pushing their own diet. Debating CICO was a convenient gateway to selling people your special diet that supposedly avoids the "bad" calories and replaces them with "good" calories, making you lose weight.
arcticbull
Ah, gotcha.
For what it's worth CICO sucks because (1) nobody can stick to it, ever (2) humans are awful at estimating their calories in, studies show only 1/5 of people can properly estimate the calorie content of their food [1] and (3) your metabolism slows down in response to, specifically, caloric restriction diets and your hunger rises which makes it difficult to estimate your calories out without indirect calorimetry.
Yes, CICO works in a lab, and for some weird people. It's a matter of thermodynamics. However you are a far more complex system than a coal powered furnace. And yes certain types of food will be more or less satiating and may influence the amount of total calories you consume. It's really really hard to overeat if you just eat lean protein, for instance.
CICO is, in practice, a tool that is roughly impossible for most people to leverage to lose a meaningful amount of weight and keep it off.
Which brings us back to the difference between maintaining a persistent caloric deficit -- and instructing people to do so.
NoMoreNicksLeft
I'm still sympathetic to those arguments. Humans have, for at least the last several million years, been taught in the evolutionary sense to never let a calorie go uneaten. Too many famines. "Just don't do that thing that every gene in your body screams at you to do, and feel miserable for it" isn't really good advice, and isn't all that insightful. One can't even necessarily make judgements about how many calories they themselves can eat based on what they see other people around them eating. "That other person stays skinny, and I'm eating about the same amount as them" is not an on-the-surface unreasonable assumption... but it doesn't work, even if you could eliminate human misperceptions.
>At one point, I had a podcast-obsessed coworker who tried to tell us all that even when he ate 1000 calories per day he couldn't lose weight. He had a long list of influencers and podcasters who supported this claim.
The week after Thanksgiving, I had a heart attack (age 50). I was in the CICU for nearly a week before they let me go home. On the day I was released, they sent a nutritionist in to tell me that I shouldn't try to eat one meal a day, that I really needed to be eating 3 meals a day, and to eat bread at least for two of those (or other carbs). Don't eat butter, eat margarine though. Yadda yadda. This was what, 8 weeks ago? Not 1962 in any event.
Do you know what 1000 calories looks like spread across 3 meals? Or how long you have to run on a treadmill to make up 300 calories if you bump that up to 1300? Or that, even sitting in an office chair every day, I can't lose weight (of any significance) at caloric intake much above that? I'm willing to concede that any problems I'm having here are in my own head, that I can't change my behavior or habits or whatever (to literally save my own life), but this isn't the sort of problem that can be handled by any but the most godlike of willpowers (which I do not have, if that doesn't go without saying). Right now, I probably need to be eating just one meal every other day, as I'm not really gaining any weight back but I'm not losing much either. My meal, such as it is, is a salad that fits in a small bowl (less than 2 cups of lettuce and uncooked vegetables). None of this is helped by knowing that people who are so-called medical professionals are giving me is absolute horseshit.
The truth of the matter is that we are adapted to eat only once every few days, and for even that meal to be meager and less than appetizing. But we live in a world that has mastered abundance and flavor, and uses marketing science to constantly try to get us to to buy all that. When you tell people "just eat less", really you're just doing the r/fatpeoplehate but in a covert way where you don't have to feel like an asshole. We (all of us, sympathizers, haters, acceptance activists) turn this into a morality tale, and can't think about this rationally. For anyone that cares, I wear 33" jeans, but I probably need to drop another 20-25lbs realistically.
PS Just giggled thinking about what it would mean to the US economy if suddenly every adult over the age of 28 started eating one small meal every 2-3 days... even our stock market is arrayed against us.
s1artibartfast
I dont think anyone has agued that the follow through is the hard part.
The whole debate seems like people violently agreeing with each other aside from some fringe idiots that dont believe in thermodynamics.
tonymet
who do you mean by "anyone". it sounds that you mean "nutritionists". There are plenty of laypeople who have supernatural beliefs about calories.
tonymet
there are plenty of obese people who claim that no amount of calorie reduction works. Ozempic has put that to rest. The truth is they were overeating the entire time.
phil21
Unfortunately it didn’t. Seems to have actually emboldened the “CICO isn’t a thing” crowd even more.
The amount of woo-woo “science” in laymen communities on the subject is utterly astounding considering the evidence directly in front of them. Check out the various subreddits for a casual glimpse - anyone saying stuff like “the primary method of action is eating less” is downvoted and the woo woo “metabolism” or “hormones” stuff is upvoted and celebrated.
In the end I think there is a lot of weird guilt around overeating I never really understood existed before. I lost 100lbs using Mounjaro but never once thought it was anything other than me eating too much and moving too little while I was obese. It’s just a lot of damn work and willpower for me to change that. Tirzepatide was simply a performance enhancing drug for my diet that finally put me over escape velocity to make lifestyle changes that so far have stuck for a couple years now.
SkyPuncher
I don't think it was ever really a debate.
"Reduce calories" is about as useful as "exercise more", "sit less", "drink less", etc, etc. All are obviously good, but for various reasons it can be hard for people to achieve them.
GLP-1's basically take the "how" out of the equation. Take this drug, eat less without fighting your own desires.
s1artibartfast
All of them are essential as an objective to implement or improve the how.
tonymet
there are plenty of people who claim that no amount of calorie reduction results in weight loss. Often it's people who are claiming to eat starvation amounts of food while gaining weight. Of course researchers have known it was delusional, but the belief persisted in pop culture. Ozempic is putting that to rest.
this is a case where more personal / colloquial / folk evidence was needed to convince people.
rs999gti
> settled the debate on calorie reduction.
Really? Because GLP1s reduce hunger and food cravings, less of those means less eating, less eating means less calories. The drug just makes people involuntarily fast, it has no thermogenic of lipolysis abilities.
parpfish
Did it? The drugs clearly lead to reduced appetite, therefore reduced calories. But do we know that the drugs aren’t also causing other important metabolic changes?
spondylosaurus
It's not even appetite per se; GLP-1s regulate blood sugar for more sustained levels, which is upstream of appetite. Safe to say that blood sugar impacts a bunch of other stuff too.
bitmasher9
Was it ever really a debate? There’s tons of experimental evidence that shows calorie reduction leads to weight loss, even without pharmaceuticals. The Ozempic data can be explained simply by this factor. There doesn’t seem to be enough data fluctuation between the two sets to indicate a significant set of unknown variables impacting the data.
parpfish
yeah, but do ozempic et al only rely on calorie reduction? i find it hard to believe that hormones only affect one thing in isolation. it may be doing something like a) suppressing appetite to reduce caloric intake AND b) shielding against a lowered metabolism due to calorie restriction.
tonymet
Occam's razor
nradov
The drugs seem to cause a small increase in resting heart rate. Whether that is due to metabolic or neurologic changes (or something else) isn't completely clear.
gnkyfrg
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hawski
I understand that those drugs are very useful, but in a way it feels for me like ancient Rome with its orgies and vomit inducing so they can eat more. At least looking at USA from Europe. The problem of sugar content, dietary choices and portion sizes remains. It is similar to gas guzzling cars.
Sorry if it seems not empathic enough, that was not my intention. I know that the use of such drugs may be medically necessary.
Edit: To serious answers: I was wrong, I stay corrected.
ceejayoz
> I understand that those drugs are very useful, but in a way it feels for me like ancient Rome with its orgies and vomit inducing so they can eat more.
https://en.wikipedia.org/wiki/List_of_common_misconceptions
"Wealthy Ancient Romans did not use rooms called vomitoria to purge food during meals so they could continue eating and vomiting was not a regular part of Roman dining customs. A vomitorium of an amphitheatre or stadium was a passageway allowing quick exit at the end of an event."
svieira
"Two of the most notable examples from Ancient Rome center on the emperors Vitellius and Claudius who were notorious for their binge eating and purging practices. Historian Suetonius writes that “Above all, however, he [Vitellius] was … always having at least three feasts, sometimes four in a day — breakfast, lunch, dinner, and a drinking party — and easily finding capacity for it all through regular vomiting” (Suetonius, Vit, 13) [1]. Similarly, the emperor Claudius was infamous for never leaving a meal until overfed, after which a feather was placed in his throat to stimulate his gag reflex (Suetonius, Claud, 33) [2]. In his writing, Suetonius takes on a disapproving tone when describing the eating habits of Claudius and Vitellius, as highlighted by the use of words such as “luxury,” “cruelty,” and “stuffed”(Crichton, 204). This tone indicates that although binge eating and purging were accepted, albeit uncommon in Roman culture, the practices were negatively associated with gluttony and a lack of self-control. "
~ Ancient Hunger, Modern World by Solia Valentine
Via: https://escholarship.org/content/qt2594j40t/qt2594j40t_noSpl...
[1]: https://www.perseus.tufts.edu/hopper/text?doc=Perseus%3Atext... [2]: https://www.perseus.tufts.edu/hopper/text?doc=Perseus:abo:ph...
ceejayoz
Hit pieces aren't a modern invention.
https://blog.oup.com/2014/11/roman-emperor-tiberius-capri-su...
> Stories of this kind were part of the common currency of Roman political discourse. Suetonius devotes similar space to the sexual transgressions of Caligula, Nero, and Domitian – such behaviour is to be expected of a tyrant. The remoteness of the emperor’s residence itself must have fuelled the most lurid imaginations back in Rome.
Suetonius was born in 69 AD; Vitellius was emperor in 69 AD and Claudius was emperor from 41-54. They weren't contemporaries.
Smithalicious
If you think that's bad just wait until you hear what Hillary was doing in that pizzeria basement!
The Romans were no stranger to just making shit up.
aantix
Purely from a cost perspective - imagine a 79 year old grandma.
Heavily overweight. She is already partially immobile. Pre-diabetic. She may have other conditions, further complicated by her weight. She's on a fixed income.
Which is more probable -
1) A dietary intervention that she attends once a week that revamps her entire daily consumption (but remember, she's on a fixed income) along with some intense exercise?
or
2) put her on a single medication that changes her tastes for sugary and starchy foods, reduces her cravings, reduces inflammation, and in turn, will make her lighter and more mobile.
It is a no-brainer for Medicare. This will save so many downstream costs.
rodonn
These drugs (mostly) don't allow you to eat more unhealthy food, instead they make it easier to have the self control to avoid over eating / choose healthier foods.
unshavedyak
To add, they actually prevent you from eating some bad foods too. At least in the compound versions that i know people on.
If they eat a lot of foods (some even good), their gastro issues are significant. So not only has it had substantial mental shifts around what they desire, but a bunch of foods are just not edible even if they wanted them anyway.
platelminto
From what I understand these medications make you want to eat less in the first place, so it's not quite the same thing.
unshavedyak
Yup. The people i know on this didn't even get it for the weight, but the behavior changes. This isn't letting them eat the same stuff and lose weight, this is changing what they want to eat.
They went from ADHD driven boredom eaters to not even thinking about food.
cjbgkagh
I have ADHD and the dopamine dysregulation really makes it hard to avoid eating things with sugar in it.
The semaglutide really helps, I'm on a lower dose of it 0.5mg/week and have been on it for over a year. I've lost a fair bit of weight but that has stabilized. It costs me ~$30 per month and I save much more than that on eating less food.
For me it really helps with chronic fatigue which was destroying my life. I think it really is a wonder drug for people with auto-immune issues. I was insanely sensitive to it when I started which I think is common with people with ADHD so I started really low and only very slowly worked my way up.
mikestew
Sorry if it seems not empathic enough…
You should apologize for making it obvious that you don’t know how the drugs work (as illustrated by sibling comments). If your analogy is “gas-guzzling cars”, I would suggest you revisit your reading on the topic.
ojbyrne
The ancient Rome vomiting thing is a myth. https://en.m.wikipedia.org/wiki/Vomitorium
rendleflag
My understanding is that the drugs keeps you from wanting to eat as much.
some_random
That's just not how these drugs work at all.
Very glad to see this, it's worth noting that the compounded semiglutide pricing (think generic, although it's more complicated than that) has been plummeting ever since it was introduced onto the market. We've seen some pretty incredible results and I really hope they get cheap enough to be prescribed more widely.