Rx Revolution

Prescription drugs were not covered under the original design of Medicare.

Among the reasons were that there were limited prescription drugs in the mid-1960's, most private plans did not include a drug benefit and there were concerns about the trajectory of future costs.

Those concerns were well founded.

Spending on retail prescription drugs has increased from $3.7 billion in 1965 to almost $500 billion today.

Source: Peterson-KFF Health System Tracker

Prescription drugs were added to Medicare under Part D during the George W. Bush administration effective in 2006.

In the last 50 years prescription drugs have been developed and marketed for just about any human condition.

I remember back in the mid-1980's going through a one or two days when I lost my appetite.

I went to lunch with co-workers who were eagerly scanning the menu to bulk up as much as they could. 

I was perfectly content with a small cup of soup and saltines

I felt perfectly fine otherwise. No fever, No aches, No pain or anything else.

My thought at the time was that if I could develop a pill that curbed food cravings in the same way that I felt it would be worth billions of dollars.

Little did I know that 40 years later that day would arrive with the development of GLP-1 drugs.

A medication that curbs food cravings and helps you lose weight without all the mental requirements that usually accompany staying on a diet is worth a king's ransom.

Consider the market possibilities in the United States alone.

The CDC reports that 40.3% of the U.S. population of those age 20 or more is obese (BMI >30).

It is 46.9% for those between the ages of 40-59.

Source: https://www.cdc.gov/nchs/products/databriefs/db508.htm

This translates to more than 100 million adults in the United States with obesity.

74% of American adults are overweight according to the CDC (BMI 25.0-29.9).

There is a lot of money to be made by Pharma with GLP-1 drugs.

There is also tremendous potential for the United States to save on health care costs if fewer people are overweight.

One study calculated that obesity doubled the medical expenditures of adults relative to those of normal weight and raised expenditures on inpatient care, outpatient care, and prescription drugs.

GLP-1 drugs are revolutionary on many dimensions---improving self image, improving health and reducing health costs in addition to the money that Pharma can make by selling them.

Despite high initial costs for the medications of over $1,000 per month when they were first introduced, prices have become more affordable principally due to pressure from the Trump administration.

Understanding the potential cost benefits to Medicare, the Trump administration has negotiated lower costs for eligible enrollees in a pilot program beginning July 1 that will provide the drug for a $50 monthly co-pay.

The Pharma companies have also extended attractive self-pay discount prices.

This is a Google AI overview of typical pricing and a cost comparison overview for various GLP-1 drugs.

What results are patients seeing who are using GLP-1 drugs?

Clinical trials for the first generation of GLP-1 drugs showed typical weight loss of 15% for drugs such as Wegovy and Ozempic after one year.

The second generation GLP-1 drugs such as Mounjaro and Zepbound were more powerful and participants averaged a 20% weight loss.

In addition, many patients see improvements in blood sugar control and cardiovascular protection among other health benefits.

The third generation GLP-1, Retatrutide, is still in clinical trials and does not yet have FDA approval.

However, many believe this drug could eventually end up being the blockbuster medication in this sector.

Weight loss of as much as 25% in 48 weeks has been shown in the clinical trials.

Source: https://revolutionhealth.org/blogs/news/glp-1-weight-loss-medications?srsltid=AfmBOoqrz_Faf3iOtqasO50vSe_YM3uaRz0W8y1BXwneZIXxezjQqdiE

What are the downsides of these drugs?

Any new pharmaceutical comes with questions about possible longer term effects that might not have been discovered in the clinical trials.

Sometimes there are unexpected benefits.

For example, early studies suggest that GLP-1 usage may actually reduce the longer term risk of breast cancer in women.

The two concerns that I see the most involving these drugs are that the weight loss effects are not limited just to fat loss. 25%-40% of the weight loss can be in lean body mass due to the rapid weight loss.

The other concern is that these drugs may not just curb your appetite for food but also work on the portion of the brain that surrounds motivation, drive and pleasure.

Some employers have expressed concerns that some on the drug are not putting in the same effort at work they did before.

The flip side is that it has also been reported that the drug lowers general compulsiveness and cravings.

Some report less drinking, scrolling on their phone or shopping while on the drug.

I was surprised to learn that almost 1 in 5 American households already have had someone take a GLP-1 drug. That is 10 million people. However, that is still only about 10% of Americans who are obese.

The market potential is huge and it has been barely tapped to this point.

There will undoubtedly be further innovations and refinements beyond what Retatrutide will bring.

The costs of the drugs will become more affordable and accessible to more people over time.

Of course, nothing occurs in a vacuum.

What are the possible secondary and tertiary effects of an Rx Revolution of this magnitude?

This is an interesting question in that regard.

There is a basis for that question.

The reported changes in consumption of various food categories of those on GLP-1 medication is profound.

Fruits and vegetables up almost 75%.

Consumption of burgers and pizzas down by a similar percentage.

It appears that the financial impacts of GLP-1 drugs on the food industry are already being felt.

This is especially true in the snack foods sector.

However, this might also be the result of some states no longer allowing snack food to be food stamp eligible.

Frito-Lay has recently closed two plants. 

Smuckers has written down almost $3 billion in total of the $5.6 billion it paid in 2023 for Hostess which makes Twinkies and Ding Dongs.

We are in the midst of an Rx Revolution.

However, that revolution may eventually encompass much, much more beyond the pharmaceutical sector.