CMS Eyes Budget-Busting Drug Coverage, Big Pharma Discovers Consumer Sales, and One Doctor Dares to Say the Emperor Has No Clothes

Hey all,

Happy hump day! Decades of intermediaries, misaligned incentives, and entrenched systems are finally colliding with economic reality. Whether it's GLP-1s threatening to consume Medicare's budget, pharmaceutical companies realizing PBMs are optional, or obesity treatment strategies that demonstrably haven't worked since the Nixon administration, we're watching the slow-motion recognition that the current playbook isn't actually working. The problem is nobody can agree on a solution that doesn’t hurt entrenched interest and they’re not giving up without a fight.

Enjoy the rundown! 

Jacob Brody (Co-Founder & CEO, ZorroRX)

(Endpoints News) CMS GLP-1 Coverage Update

CMS chief Mehmet Oz announced that a decision on Medicare coverage for GLP-1 weight loss drugs will be released “very soon,” signaling potential expansion beyond current limits that cover obesity only when linked to diabetes or heart disease. The move could reshape federal healthcare spending, which has skyrocketed as GLP-1 drug use surged from $57 million in 2018 to $5.7 billion in 2022, and may influence drug pricing negotiations under the Inflation Reduction Act. Guess GLP-1s might be the miracle drugs that slim waistlines—and fatten Medicare’s bills enough to finally break the budget. Full Article

(CNBC – Healthy Returns) Amgen joins drugmakers selling directly to consumers

Amgen has become the latest pharmaceutical company to enter the direct-to-consumer market, launching its “AmgenNow” program to sell its cholesterol drug Repatha at a 60% discount directly to patients. The move reflects a broader industry shift—encouraged by President Trump’s push for lower drug prices and new models like TrumpRx.gov—toward bypassing pharmacy benefit managers and offering discounted cash prices through telehealth platforms. With Eli Lilly, Novo Nordisk, Pfizer, AstraZeneca, Novartis, and Bristol Myers Squibb already embracing similar models, it’s clear these drugmakers have all taken a seat at the Pharm-to-table buffet. Full Article

(Dr. Jason Fung’s Newsletter) Why We’re Losing the War (On Obesity, Type 2 Diabetes, and Cancer)

Dr. Jason Fung argues that despite decades of effort, the battles against obesity, type 2 diabetes, and cancer are failing because we refuse to acknowledge that our foundational approaches are broken. He criticizes the calorie-restriction model for obesity, the glucose-lowering medication model for diabetes, and the genetic mutation model for cancer—each pursued for over 50 years with little improvement in outcomes. Fung contends that progress requires first admitting the ineffectiveness of these entrenched strategies before adopting new paradigms focused on metabolic health and root causes rather than superficial markers. Full Article