PBM Malfeasance Data, 340B Data, & GLP-1 Coverage

Hey all,

Yesterday’s 46 Brooklyn report and the great state of Minnesota’s 340B report was an early Christmas for pharmacy nerds. They show what happens in opaque markets. Enjoy the rundown!

Jacob Brody (Co-Founder & CEO, ZorroCard)

Medicare Drug Prices Vary Wildly, Costing Patients Thousands (WSJ)

Research by 46Brooklyn shows Medicare pays vastly different prices for the same drugs, with some medications showing price variations of thousands of dollars depending on the plan, pharmacy benefit manager (PBM), and region. Pharmacy benefit managers have truly mastered the art of negotiation—taking an already confusing system and somehow managing to make it both more expensive and less understandable. This fragmented system forces patients to navigate a maze of options, often facing significant out-of-pocket costs, while critics argue it unfairly benefits intermediaries at the expense of patients and taxpayers. Full Article.

Minnesota’s 340B Report (Cost Curve) Brian Reid dives into the newly released Minnesota state report on the 340B drug discount program. The report reveals $630 million in net profits for providers, a figure the state itself calls a “substantial underestimate” due to gaps in reporting on office-administered drugs, which constitute the bulk of 340B spending. While the report highlights the program’s profitability, it also underscores inequities, such as middlemen siphoning off 16% of profits and some safety-net grantees incurring losses despite purchasing 340B medicines for underserved patients. Hospitals like U of M Medical Center made $129 million in 340B profits while spending just 0.5% of operating revenue on charity care, compared to a national average of 2.3%, while drugs like Humira and Eliquis netted $3,400 and $558 in profits per prescription, respectively. Full Article

Biden’s Proposal to Expand Medicare and Medicaid Coverage for Anti-Obesity Drugs (CNN)

President Joe Biden has proposed expanding Medicare and Medicaid to cover anti-obesity medications, potentially reducing out-of-pocket expenses by up to 95% for millions of Americans. The aim is to improve access to treatments like Mounjaro, Ozempic, and Wegovy, which are currently covered for diabetes but not for obesity. However, the expansion could cost over $3 billion per year. Full Article

Cardiology and Semaglutide Eligibility Across All Current Indications for US Adults (JAMA)

A recent study estimates that approximately 137 million U.S. adults qualify for semaglutide therapy. This massive eligibility for Semaglutide and other GLP-1s like Tirzepatide reflects the broad potential to influence public health and improve outcomes for millions. Naturally, pharmaceutical companies must be thrilled to see half the country added to their customer base. Full Article