UnitedHealth Claims First Amendment Right to Opaque Pricing, Novo Recycles Last Week's Announcement as 'Breaking News,' and Direct Contracting Stalls Because Healthcare Is Structurally Broken

Hey all,

Happy Tuesday! Transparency and competition are wonderful in theory, exhausting in practice. Novo and Lilly are racing to the bottom on cash-pay obesity drug prices—which is progress until you realize it's mostly PR strategy and the structural cost problems remain untouched—while UnitedHealth is suing Iowa to block PBM regulations on First Amendment grounds, and direct contracting models that actually work can't scale because the entire system is designed to prevent exactly that. We're in this strange moment where everyone agrees the current model is broken, a few promising alternatives exist in pilot form, but the infrastructure and incentives to actually implement them at scale might require burning down the existing system first.

Enjoy the rundown!

Jacob Brody (Co-Founder & CEO, ZorroRX)

(BenefitsPRO) UnitedHealth Challenges Iowa PBM Law

UnitedHealth subsidiaries, including OptumRx, are suing Iowa’s insurance commissioner to stop a new PBM law, arguing it violates ERISA and even infringes on their First Amendment rights. The lawsuit adds to a growing national fight over whether states can regulate PBMs, with the potential to end up before the U.S. Supreme Court. Because nothing says “free speech” like the right to not help patients save money on their meds. Full Article

(Bloomberg) Novo Undercuts Lilly’s Obesity Drug Price for Cash-Pay in US

Novo Nordisk has slashed prices for its popular obesity drugs Wegovy and Ozempic to $199/month for the first two months and $349/month thereafter, undercutting Eli Lilly’s Zepbound for cash-pay customers. This move is part of a broader pricing strategy to regain U.S. market share amid rising competition from both Lilly and compounding pharmacies, as well as to align with a recent price-cutting deal with the Trump administration. Of course, it’s basically the same announcement they made with President Trump last week—just repackaged for another lap around the media cycle. Full Article

(The Surgeon's Record) Why Direct Contracting Isn't Scaling Yet

Despite growing interest in direct contracting and transparent pricing in healthcare, structural barriers like lack of provider leverage, fragmented employer demand, and unsustainable cost structures continue to stall meaningful scale, especially in specialty care. While successful models exist in pockets—like direct primary care and surgery bundles—the broader system remains constrained by legacy incentives and infrastructure misalignment. To unlock a functioning healthcare marketplace, stakeholders must aggregate employer demand, standardize bundled care, reduce friction in access, and build financially sustainable care delivery models...which means, what, burn it down and start over? Full Article