The Business & Science Behind the GLP-1 Boom

1 00:00:00,080 - > 00:00:02,799 SPEAKER_00: CVS CareMark is restoring coverage of Zetbound, 2 00:00:03,040 - > 00:00:06,160 reversing a formulary decision from last summer that saved 3 00:00:06,160 - > 00:00:09,759 employers money but prompted patient anger and a class action 4 00:00:09,759 - > 00:00:10,480 lawsuit. 5 00:00:10,640 - > 00:00:14,320 It's a useful window into how GLP1 coverage is decided. 6 00:00:14,560 - > 00:00:17,440 We're going to also talk about the compounding market, the rise 7 00:00:17,440 - > 00:00:21,199 of microdosing, and the latest clinical research on GLP1s in 8 00:00:21,199 - > 00:00:23,679 cancer, long COVID, and beyond. 9 00:00:37,759 - > 00:00:39,600 SPEAKER_01: And I'm John Driscoll, the Chairman of UConn 10 00:00:39,679 - > 00:00:39,920 Health. 11 00:00:40,000 - > 00:00:42,000 David, this is a great topic. 12 00:00:42,159 - > 00:00:45,200 Everybody's taking these drugs, and they seem to be miracle 13 00:00:45,200 - > 00:00:45,679 drugs. 14 00:00:46,000 - > 00:00:53,039 How could CVS CareMark have the Hutzpah to actually say no when 15 00:00:53,039 - > 00:00:56,000 the rest of America and apparently the clinical 16 00:00:56,000 - > 00:00:57,759 establishment is saying yes? 17 00:00:57,840 - > 00:00:59,280 SPEAKER_00: Aaron Powell Well, John, I didn't know if you were 18 00:00:59,280 - > 00:01:00,079 going to go with Yiddish. 19 00:01:00,240 - > 00:01:01,520 I thought maybe you'd say temerity. 20 00:01:01,600 - > 00:01:04,480 There's a lot of words that could be it could be done there. 21 00:01:04,959 - > 00:01:08,719 I mean, what happens, I think, is that on the one hand, these 22 00:01:08,719 - > 00:01:09,920 drugs are great. 23 00:01:10,159 - > 00:01:13,760 On the other hand, you know, you're supposed to be managing 24 00:01:13,760 - > 00:01:16,640 the pharmacy benefit, which means just not just saying yes 25 00:01:16,640 - > 00:01:18,319 to everything and paying all this money. 26 00:01:18,480 - > 00:01:20,239 SPEAKER_01: And so they said, hey, you got drugs that weren't 27 00:01:20,959 - > 00:01:21,359 a PBM. 28 00:01:21,439 - > 00:01:23,120 It isn't about saying no to everything either. 29 00:01:23,359 - > 00:01:23,920 SPEAKER_00: I mean, come on. 30 00:01:24,799 - > 00:01:25,040 It isn't. 31 00:01:25,280 - > 00:01:26,000 So how could they do it? 32 00:01:26,159 - > 00:01:28,480 I mean, I think what happened is you had two drugs that were 33 00:01:28,480 - > 00:01:32,799 really great, and they saw a big financial opportunity, and they 34 00:01:32,799 - > 00:01:33,920 said, let's actually go for it. 35 00:01:34,079 - > 00:01:37,120 It was a little bit of a head scratcher for me, John, even at 36 00:01:37,120 - > 00:01:38,319 the time that they did it. 37 00:01:38,480 - > 00:01:38,640 Trevor Burrus, Jr. 38 00:01:39,760 - > 00:01:40,400 Like you? 39 00:01:41,840 - > 00:01:42,000 Yeah. 40 00:01:42,239 - > 00:01:44,159 Because they don't usually like to say no, like you said, 41 00:01:44,319 - > 00:01:46,799 especially if they're because there are differences between 42 00:01:46,799 - > 00:01:47,280 the products. 43 00:01:47,439 - > 00:01:50,159 SPEAKER_01: But aren't they all the same? 44 00:01:51,680 - > 00:01:52,719 SPEAKER_00: I'm not a physician. 45 00:01:53,200 - > 00:01:56,719 But uh no, they show different uh they sh they they show 46 00:01:57,280 - > 00:01:59,280 different results in trials. 47 00:01:59,519 - > 00:02:03,120 SPEAKER_01: And when you're on your you the are the the the 48 00:02:03,120 - > 00:02:07,120 doctors who we do consult, what's interesting about the GLP 49 00:02:07,120 - > 00:02:10,800 ones as a category is they do appear to have, although 50 00:02:10,800 - > 00:02:19,039 generally the same opportunities for um uh weight reduction and 51 00:02:19,039 - > 00:02:22,319 all the other corollary stuff that that appears to be going 52 00:02:22,319 - > 00:02:27,280 well, and some of the similar clinical challenges, uh, that 53 00:02:27,599 - > 00:02:30,560 they do seem to the the different the different chemical 54 00:02:30,560 - > 00:02:33,840 composition appears to to have slightly different results. 55 00:02:34,000 - > 00:02:38,479 But as a category, Dave, wasn't the the miss here that they 56 00:02:38,479 - > 00:02:39,520 didn't embrace it? 57 00:02:39,680 - > 00:02:42,400 Because gosh, this seems to be these seems to be pretty 58 00:02:42,400 - > 00:02:43,199 remarkable drugs. 59 00:02:43,280 - > 00:02:44,240 SPEAKER_00: Aaron Ross Powell I don't know, John. 60 00:02:44,319 - > 00:02:46,400 So I mean I I actually want to let's dwell on the financial 61 00:02:46,400 - > 00:02:48,080 aspect a little bit more, because the other thing that 62 00:02:48,080 - > 00:02:51,120 we're seeing is whether people bring on coverage because it 63 00:02:51,120 - > 00:02:54,800 seems like, well, it's a it's a drug that's gonna help somebody 64 00:02:54,879 - > 00:02:58,080 and it's also maybe gonna save money even in the near term. 65 00:02:58,319 - > 00:03:00,960 But then on the other hand, you see a lot of employers that are 66 00:03:00,960 - > 00:03:03,680 dropping coverage and health plans because they can't afford 67 00:03:03,680 - > 00:03:03,840 it. 68 00:03:03,919 - > 00:03:07,759 And I'm I'm assuming that what happened was CVS was trying to 69 00:03:07,759 - > 00:03:11,919 say, hey, employers, keep it on your formulary, keep a GLP one 70 00:03:12,000 - > 00:03:13,840 on your formulary, but we're gonna do something where we're 71 00:03:13,840 - > 00:03:16,240 gonna get you a good value and you're gonna be able to afford 72 00:03:16,240 - > 00:03:16,560 to do that. 73 00:03:16,719 - > 00:03:19,039 SPEAKER_01: I mean, I do think it is between the So let's give 74 00:03:19,199 - > 00:03:23,039 let's give the PBMs uh uh some some credit here. 75 00:03:23,439 - > 00:03:29,199 The GLP one manufacturers, Lily, Novo, Nordisk, they were jamming 76 00:03:29,199 - > 00:03:30,159 people on price. 77 00:03:30,319 - > 00:03:34,080 I mean, they were clearly charging an extortionate amount 78 00:03:34,159 - > 00:03:34,479 initially. 79 00:03:34,719 - > 00:03:38,319 Well, you could see because they immediately were charging 70 to 80 00:03:38,319 - > 00:03:40,639 80 percent less in the in like Europe. 81 00:03:40,800 - > 00:03:44,000 So you fly to London, you can pay for your Zeppelin 82 00:03:44,080 - > 00:03:45,919 prescription a few times over. 83 00:03:46,639 - > 00:03:49,759 But and so it punched a hole in the budget. 84 00:03:49,919 - > 00:03:53,840 Budgets for pharmaceuticals and healthcare are set a year 85 00:03:53,840 - > 00:03:54,080 before. 86 00:03:54,159 - > 00:03:55,280 That's when people underwrite. 87 00:03:55,360 - > 00:04:00,319 And so when you have this hugely popular drug that is very 88 00:04:00,560 - > 00:04:05,759 expensive and it's being relentlessly, you know, marketed 89 00:04:05,759 - > 00:04:10,960 by dancing people on TV, that the that there would be a you 90 00:04:10,960 - > 00:04:15,199 know uh a fear that the it would be a budget buster. 91 00:04:15,439 - > 00:04:17,920 And so, you know, you gotta you gotta give them some credit. 92 00:04:18,000 - > 00:04:22,240 But but these the and and and you know, we don't know yet, at 93 00:04:22,240 - > 00:04:25,680 least you know, last year, this is happening all in real time, 94 00:04:25,839 - > 00:04:28,480 that the prices would come down and the and the and the 95 00:04:28,480 - > 00:04:30,000 implications would be would be great. 96 00:04:30,160 - > 00:04:35,759 But why what else is behind that decision for CVS Care Mark and 97 00:04:36,720 - > 00:04:38,720 what's the state of play right now? 98 00:04:39,439 - > 00:04:42,879 SPEAKER_00: Well, it sounded like there's actually a lawsuit 99 00:04:42,879 - > 00:04:46,079 that was alleging that there were ERISA violations. 100 00:04:46,319 - > 00:04:48,399 So people's rights are being uh affected. 101 00:04:48,480 - > 00:04:51,680 So I think that is probably a good reason uh for them to 102 00:04:51,680 - > 00:04:52,720 reverse course on that. 103 00:04:52,800 - > 00:04:54,959 SPEAKER_01: And it's also just you know you can't just 104 00:04:55,120 - > 00:04:58,800 contextually for folks, most larger employers are 105 00:04:58,800 - > 00:04:59,600 self-insured. 106 00:04:59,680 - > 00:05:04,720 They're covered under ERISA, which is the the the federal 107 00:05:04,720 - > 00:05:08,879 exemption from local state insurance regulations, because 108 00:05:08,879 - > 00:05:12,560 most health insurance policies are regulated on a state basis. 109 00:05:12,639 - > 00:05:15,439 But for the large multi-state employers, there's something 110 00:05:15,439 - > 00:05:17,680 called an ERISA exemption, and they're covered under a 111 00:05:17,680 - > 00:05:18,319 different category. 112 00:05:18,480 - > 00:05:22,959 However, that the the the assumption is if you're paying a 113 00:05:22,959 - > 00:05:25,040 ton of money for health insurance, which everybody does, 114 00:05:25,199 - > 00:05:27,759 both the combination of out-of-pocket and the employer, 115 00:05:27,920 - > 00:05:30,959 that those health policies would promote your health, and the 116 00:05:30,959 - > 00:05:35,120 drugs that you would expect or that your doctor and others are 117 00:05:35,120 - > 00:05:38,879 prescribing would be covered as part of the health insurance 118 00:05:38,879 - > 00:05:39,680 that you're paid for. 119 00:05:39,839 - > 00:05:43,600 And so that's, I think, the basis of what that lawsuit was 120 00:05:43,600 - > 00:05:44,240 all about. 121 00:05:45,199 - > 00:05:47,759 SPEAKER_00: I think there's a fascinating, I mean, as 122 00:05:47,759 - > 00:05:50,560 fascinating as these drugs are and their clinical impact, it's 123 00:05:50,560 - > 00:05:52,319 fascinating what's going on on the business side. 124 00:05:52,480 - > 00:05:55,600 Because you've got the typical dynamics uh here, let's say, 125 00:05:55,680 - > 00:05:58,879 between the PBMs, the employers, the drug companies, then you've 126 00:05:58,879 - > 00:06:03,199 also got the substantial consumer program because you've 127 00:06:03,199 - > 00:06:05,759 got the compounded drugs that people have essentially been 128 00:06:05,759 - > 00:06:07,519 shopping for on their own thing. 129 00:06:07,600 - > 00:06:09,360 SPEAKER_01: Trevor Burrus, Jr.: What do you mean compounded 130 00:06:09,360 - > 00:06:09,759 drugs? 131 00:06:09,839 - > 00:06:12,639 SPEAKER_00: Aaron Ross Powell Well, what I mean is that a 132 00:06:13,040 - > 00:06:16,399 there are pharmacies that are allowed to actually make the 133 00:06:16,399 - > 00:06:19,439 equivalent product in certain circumstances. 134 00:06:19,600 - > 00:06:23,040 And the circumstance here was there was a shortage of these 135 00:06:23,040 - > 00:06:26,160 name-brand products initially because it's insanely popular. 136 00:06:26,959 - > 00:06:27,199 SPEAKER_01: Exactly. 137 00:06:40,720 - > 00:06:44,800 Um the the potential for diabetes, which is overwhelming, 138 00:06:45,439 - > 00:06:48,800 we've never seen diabetes in in such a large swath of the 139 00:06:48,800 - > 00:06:51,600 population, even getting down to kids. 140 00:06:51,920 - > 00:06:56,399 It used to be a disease of older people, uncontrolled sugar, too 141 00:06:56,399 - > 00:07:01,279 much food, leading to major weight gain and general. 142 00:07:01,439 - > 00:07:05,680 I mean, that's why these drugs were designed and they seem to 143 00:07:05,680 - > 00:07:05,839 work. 144 00:07:06,000 - > 00:07:09,920 They have they have remarkably consistent weight loss results. 145 00:07:10,160 - > 00:07:14,079 I mean, this this this is and and and and they were e they 146 00:07:14,079 - > 00:07:15,519 were very popular. 147 00:07:16,240 - > 00:07:17,120 SPEAKER_00: Absolutely, John. 148 00:07:17,279 - > 00:07:20,639 And unlike some expensive products that are out there, 149 00:07:20,800 - > 00:07:24,560 these drugs are not actually expensive or complicated to 150 00:07:24,560 - > 00:07:25,600 manufacture. 151 00:07:25,839 - > 00:07:28,800 And so a compounder can basically get the raw 152 00:07:28,800 - > 00:07:31,839 ingredients and put something together that's similar. 153 00:07:32,079 - > 00:07:35,920 And when there was a shortage, they were allowed to do so. 154 00:07:36,160 - > 00:07:38,160 And so they built up a big business there. 155 00:07:38,319 - > 00:07:40,319 And then the shortage was declared over. 156 00:07:41,040 - > 00:07:44,959 SPEAKER_01: So context here, then the the inputs are cheap. 157 00:07:45,199 - > 00:07:50,079 The price ceiling that Lily and Novo, the branded manufacturers, 158 00:07:50,240 - > 00:07:51,439 was very high. 159 00:07:51,680 - > 00:07:55,279 So these compounders, which is just a weird way of thinking, 160 00:07:55,360 - > 00:07:58,160 but think of it, the mortar and pestle that you'd see as a sign 161 00:07:58,160 - > 00:08:01,439 of people grinding things up and creating drugs, which hasn't 162 00:08:01,439 - > 00:08:06,639 been true probably since the time of of uh of the Greeks in 163 00:08:06,639 - > 00:08:07,360 terms of the way. 164 00:08:07,519 - > 00:08:10,959 But but you know, it is a is a is a is the is the sign of 165 00:08:10,959 - > 00:08:11,600 compounding. 166 00:08:12,160 - > 00:08:15,040 Became super popular, and then there were there was a lot of 167 00:08:15,040 - > 00:08:19,839 direct-to-consumer advertising because the compounders figured 168 00:08:19,839 - > 00:08:23,839 out that that the the big brand folks were having a lot of fun 169 00:08:23,839 - > 00:08:27,439 with the the all that direct-to-consumer advertising 170 00:08:27,519 - > 00:08:31,600 with mu cute ditties and people dancing and music seemed to 171 00:08:31,600 - > 00:08:32,159 really work. 172 00:08:32,480 - > 00:08:36,000 So they got into the game as well, and the compounding 173 00:08:36,000 - > 00:08:38,879 business exploded as well, because these drugs are, 174 00:08:39,200 - > 00:08:42,879 although there's a very high rate of people who quit using 175 00:08:42,879 - > 00:08:47,440 them for the pope people who for whom could tolerate it, it's 176 00:08:47,600 - > 00:08:50,320 they've been in in transformational in terms of 177 00:08:50,320 - > 00:08:51,120 people's health. 178 00:08:51,759 - > 00:08:53,440 SPEAKER_00: So here's a weird thing that happened, John. 179 00:08:53,600 - > 00:08:57,360 So once the shortage period ended, and FDA declared, you 180 00:08:57,360 - > 00:08:59,360 know, it's not a shortage anymore, you can't make these 181 00:08:59,360 - > 00:09:03,919 products, the prescriptions for the compounded versions actually 182 00:09:03,919 - > 00:09:04,799 went up. 183 00:09:05,200 - > 00:09:08,399 And so IQVIA showed in, you know, so the compound the 184 00:09:08,399 - > 00:09:11,600 shortage period ended in February 2025, but then data 185 00:09:11,600 - > 00:09:15,279 from October 2025 shows that actually uh the number of 186 00:09:15,279 - > 00:09:16,480 prescriptions went up. 187 00:09:16,639 - > 00:09:20,960 And it's basically because it was affordable for people, and 188 00:09:20,960 - > 00:09:24,240 the compounders didn't want to get out of this business any too 189 00:09:24,240 - > 00:09:24,559 quickly. 190 00:09:24,639 - > 00:09:28,000 And they did a few things like make a dose that isn't exactly 191 00:09:28,000 - > 00:09:31,039 available or put vitamin B in it to say it's actually a different 192 00:09:31,279 - > 00:09:32,480 a different product. 193 00:09:32,639 - > 00:09:35,039 And uh it's basically been tough to shut down. 194 00:09:35,200 - > 00:09:37,679 SPEAKER_01: So it's beneficial for the compounders. 195 00:09:38,320 - > 00:09:38,639 SPEAKER_00: Yeah. 196 00:09:38,879 - > 00:09:40,399 Yeah, exactly. 197 00:09:40,720 - > 00:09:43,919 So there's a lot of action going on on that side. 198 00:09:44,080 - > 00:09:44,480 So all right. 199 00:09:44,559 - > 00:09:47,840 So that's now there's another thing, John, that's uh this 200 00:09:47,840 - > 00:09:49,519 microdosing trend. 201 00:09:49,600 - > 00:09:51,840 SPEAKER_01: Aaron Ross Powell You should not be dispensing 202 00:09:51,840 - > 00:09:52,879 medical advice, David. 203 00:09:52,960 - > 00:09:53,679 SPEAKER_00: Aaron Ross Powell I'm not. 204 00:09:53,840 - > 00:09:56,080 And just but people are saying, okay, well let's do let's do a 205 00:09:56,080 - > 00:09:56,480 micro dose. 206 00:09:56,639 - > 00:09:57,519 Now I wish I could do it. 207 00:09:58,080 - > 00:10:00,159 SPEAKER_01: But but but step back a little bit. 208 00:10:00,320 - > 00:10:03,440 What's the difference between a microdose, a normal dose, and a 209 00:10:03,440 - > 00:10:04,159 macrodose? 210 00:10:04,240 - > 00:10:05,919 SPEAKER_00: Aaron Ross Powell The micro dose is very small. 211 00:10:06,000 - > 00:10:09,120 So the idea is that you say, hey, maybe and this has been 212 00:10:09,120 - > 00:10:11,759 true in other things, like this is some you know, homeopathic uh 213 00:10:11,840 - > 00:10:14,159 people try to do this, which is say, I'm just gonna take like a 214 00:10:14,159 - > 00:10:16,639 little tiny amount of something and it's gonna have the effect. 215 00:10:16,879 - > 00:10:19,679 Now, I actually, John, I love the idea of micro-dosing, and I 216 00:10:19,679 - > 00:10:21,600 tried with my, you know, the price of gas has gone up. 217 00:10:21,759 - > 00:10:24,720 So I I have a kind of gas guns when I tried to microdose it, 218 00:10:24,799 - > 00:10:27,279 and it it stopped on the side of the road. 219 00:10:27,440 - > 00:10:32,720 But um so basically, there what I'm suggesting is that there's 220 00:10:32,720 - > 00:10:35,039 all sorts of things going on between social media, 221 00:10:35,200 - > 00:10:38,639 compounders, et cetera, that it's making this a weird type of 222 00:10:38,639 - > 00:10:41,679 a market, um, which also can mean that people aren't 223 00:10:41,679 - > 00:10:44,240 necessarily getting the benefits uh the products that they might 224 00:10:44,320 - > 00:10:44,480 otherwise. 225 00:10:44,879 - > 00:10:45,840 SPEAKER_01: I'm not sure that's fair, David. 226 00:10:45,919 - > 00:10:49,679 I mean, if you look at the number of clinical categories, 227 00:10:49,919 - > 00:10:53,039 so the the clinical data would suggest that in addition to 228 00:10:53,039 - > 00:10:57,039 weight loss, which is good, out once you hold that outside of 229 00:10:57,039 - > 00:11:01,039 the results, the cardioprotective aspect of this, 230 00:11:01,120 - > 00:11:04,159 with heart disease being the leading killer of Americans, I 231 00:11:04,159 - > 00:11:10,639 believe, still over cancer and accidental death, uh appear to 232 00:11:10,639 - > 00:11:11,919 be very strong. 233 00:11:12,240 - > 00:11:16,480 There appear to be um an anti-addictive element to the 234 00:11:16,480 - > 00:11:21,519 GLP ones, the the use of those the the the the peptides that 235 00:11:21,519 - > 00:11:25,120 may be tied to the to the blood-brain uh sorry, the the 236 00:11:25,360 - > 00:11:28,240 brain-gut connection, but we're not quite sure. 237 00:11:28,399 - > 00:11:31,519 But there appears to be some very early promising research 238 00:11:31,519 - > 00:11:31,679 there. 239 00:11:31,840 - > 00:11:35,759 The most interesting stuff I saw recently was TBI, you know, uh 240 00:11:36,000 - > 00:11:37,440 brain and concussion. 241 00:11:37,519 - > 00:11:39,679 There appears to be some early stuff there. 242 00:11:40,000 - > 00:11:45,200 These drugs uh have a category of potentially better effects 243 00:11:45,200 - > 00:11:49,279 that are that are growing the more we do research on people 244 00:11:49,519 - > 00:11:51,679 who've taken them and can tolerate them. 245 00:11:51,840 - > 00:11:55,759 So I I'm I I'm pretty excited about this category. 246 00:11:56,000 - > 00:12:00,240 Um and you know, I I would be you you sound a little skeptical 247 00:12:00,240 - > 00:12:05,440 of the microdosing, but the uh the the I don't think I've seen 248 00:12:05,440 - > 00:12:10,320 a drug introduced for one thing that has had more one indication 249 00:12:10,559 - > 00:12:16,399 or clinical impact that have had so many other positive clinical 250 00:12:16,639 - > 00:12:19,519 possibilities and indication in such a short period of time. 251 00:12:19,600 - > 00:12:21,519 SPEAKER_00: Aaron Powell John, the way I look at it is there's 252 00:12:21,519 - > 00:12:24,080 all sorts of potential for these products and they're being 253 00:12:24,080 - > 00:12:25,360 studied in those areas. 254 00:12:25,519 - > 00:12:28,879 Um we don't we don't know where they go, and there's a danger of 255 00:12:28,879 - > 00:12:30,240 people just sort of jumping into that. 256 00:12:30,399 - > 00:12:32,559 And so I'll just mention some of the things that, you know, as 257 00:12:32,559 - > 00:12:35,120 you say, there's many positive things and where it's being 258 00:12:35,120 - > 00:12:35,600 looked at. 259 00:12:35,759 - > 00:12:38,399 Some of I'll just mention some of the areas where there's been 260 00:12:38,399 - > 00:12:39,840 some concerns that have come up. 261 00:12:39,919 - > 00:12:42,559 So there's some studies that have flagged some psychiatric 262 00:12:42,559 - > 00:12:46,080 issues in terms of depression, anxiety, suicidal ideation. 263 00:12:46,240 - > 00:12:48,799 There's concern about people who, let's say, have an eating 264 00:12:48,799 - > 00:12:51,120 disorder who may be taking these products. 265 00:12:51,440 - > 00:12:53,360 GI, we know there's GI side effects. 266 00:12:53,440 - > 00:12:55,120 There's some studies from showing some GI risks. 267 00:12:55,519 - > 00:12:57,919 SPEAKER_01: There are a subset of people, a pretty substantial 268 00:12:57,919 - > 00:12:58,320 subset. 269 00:12:58,480 - > 00:13:01,600 I think 50% of the people who try these drugs historically 270 00:13:01,679 - > 00:13:04,879 have dropped them within six months, I believe. 271 00:13:05,120 - > 00:13:08,879 The it's unclear how much of that was tied to the 272 00:13:08,879 - > 00:13:12,799 extraordinary expense or the difficulty in getting access to 273 00:13:12,799 - > 00:13:13,039 it. 274 00:13:13,279 - > 00:13:16,080 But there's a, you know, there's a fair amount of data that would 275 00:13:16,080 - > 00:13:20,399 suggest that for the current chemical formulations of the GLP 276 00:13:20,399 - > 00:13:23,759 ones, compounders included, that there are some people just have 277 00:13:23,840 - > 00:13:27,120 it's just really hard for them to their their gut to kind of 278 00:13:27,120 - > 00:13:29,279 handle that in combination. 279 00:13:29,519 - > 00:13:34,000 But I I I think, gosh, you know, for a the scale of the both on 280 00:13:34,080 - > 00:13:37,360 label and off-label, where people, to your point, are using 281 00:13:37,360 - > 00:13:40,080 it for stuff that may not be initially indicated, morbidly 282 00:13:40,159 - > 00:13:42,399 obese weight loss, cardioprotective. 283 00:13:42,720 - > 00:13:46,639 That, you know, for for the scale of this, you're not, you 284 00:13:46,639 - > 00:13:49,440 know, you're you're not you're not hearing the kinds of things 285 00:13:49,679 - > 00:13:53,120 most other weight loss drugs, miracle weight loss drugs, 286 00:13:53,279 - > 00:13:56,639 fenfen, they they caused, you know, then they they they did 287 00:13:56,639 - > 00:13:59,039 cause weight loss, and they caused a lot of other healthcare 288 00:13:59,039 - > 00:13:59,440 problems. 289 00:13:59,600 - > 00:14:02,720 This is the first one where it's creating weight loss, 290 00:14:02,799 - > 00:14:05,919 substantial and consistent weight loss, but there appear to 291 00:14:05,919 - > 00:14:06,960 be a lot of other positives. 292 00:14:07,039 - > 00:14:11,360 And then the other thing, David, is that there's an entire wave 293 00:14:12,000 - > 00:14:18,000 of GLP ones that are like drugs formulated in different ways to 294 00:14:18,000 - > 00:14:20,799 solve for some of the challenges of the current formulation. 295 00:14:20,960 - > 00:14:22,240 I think it's pretty exciting. 296 00:14:22,320 - > 00:14:25,440 You you you you're sitting there thinking about all the things 297 00:14:25,440 - > 00:14:26,240 that could go wrong. 298 00:14:26,480 - > 00:14:27,039 I don't know. 299 00:14:27,200 - > 00:14:30,639 I I'm I this is one of those things where I think big pharma 300 00:14:30,720 - > 00:14:33,440 may have gotten it right in a bigger way than we even 301 00:14:33,440 - > 00:14:34,000 realized. 302 00:14:34,639 - > 00:14:34,960 SPEAKER_00: I think so. 303 00:14:35,120 - > 00:14:38,159 You see a lot of activity on the business development side from 304 00:14:38,159 - > 00:14:40,080 those companies that have not been involved. 305 00:14:40,240 - > 00:14:43,200 So Lily and Novo have been the first ones in, but everybody 306 00:14:43,200 - > 00:14:45,919 else is looking to get in and look for some improvements and 307 00:14:45,919 - > 00:14:46,159 things. 308 00:14:46,399 - > 00:14:48,240 I I have a lot of optimism about it, John. 309 00:14:48,480 - > 00:14:50,960 I just think it's uh it's prudent to be careful about it. 310 00:14:51,200 - > 00:14:53,759 You know, another area, though, I'll give you on the positive 311 00:14:53,759 - > 00:14:57,039 potential side is a topic that we've actually discussed a lot 312 00:14:57,039 - > 00:15:01,200 uh on the show related to COVID, and in particular long COVID. 313 00:15:01,360 - > 00:15:05,840 Um, as you recall, we've had Zeke Emanuel on really looking 314 00:15:05,840 - > 00:15:08,960 to say, well, there's a lot of people, maybe 20 percent of 315 00:15:08,960 - > 00:15:12,879 people that had COVID that have some sort of long COVID, and 316 00:15:12,879 - > 00:15:16,879 there has not been necessarily that much to do about it. 317 00:15:17,039 - > 00:15:19,840 And we talked about this could actually be the big impact of 318 00:15:19,840 - > 00:15:20,240 COVID. 319 00:15:20,399 - > 00:15:24,080 So it would be interesting about to look at this from a long 320 00:15:24,159 - > 00:15:27,200 COVID standpoint, which hasn't been such an exciting field 321 00:15:27,200 - > 00:15:29,840 clinically, but as it impacts a lot of people. 322 00:15:31,039 - > 00:15:35,600 There is a uh NIH recover initiative, and GLP1s are one of 323 00:15:35,600 - > 00:15:39,039 the initial agents uh that they are moving toward um you know 324 00:15:39,279 - > 00:15:42,639 enrolling in uh in uh trials and starting actually this summer. 325 00:15:43,360 - > 00:15:47,360 SPEAKER_01: And and okay, the the the So are are you are you 326 00:15:47,360 - > 00:15:50,480 really more of an optimist about these drugs than I than I 327 00:15:50,480 - > 00:15:50,960 realized? 328 00:15:51,120 - > 00:15:53,600 Perhaps I've mislabeled you as a skeptic. 329 00:15:54,320 - > 00:15:56,879 SPEAKER_00: What I think that we're qualified to comment on is 330 00:15:56,879 - > 00:16:00,159 the business side of it, which I find fascinating, and then also 331 00:16:00,480 - > 00:16:04,159 the potential that they have for a lot of different indications 332 00:16:04,159 - > 00:16:05,279 and and possibilities. 333 00:16:05,440 - > 00:16:09,120 And yes, I do find it very uh interesting and exciting, but I 334 00:16:09,120 - > 00:16:11,440 don't I don't want to get ahead of the uh the trials. 335 00:16:11,519 - > 00:16:13,440 SPEAKER_01: Aaron Ross Powell I think the the thing that's going 336 00:16:13,440 - > 00:16:16,399 to be tricky is these are expensive drugs even at the 337 00:16:16,399 - > 00:16:20,720 current reduced cost, and the scale of the utilization is 338 00:16:20,720 - > 00:16:22,080 still growing, to your point. 339 00:16:22,240 - > 00:16:26,639 So it's gonna be a challenge unless people can see a long, a 340 00:16:26,639 - > 00:16:28,080 relatively short-term ROI. 341 00:16:28,159 - > 00:16:30,879 But I I think I think you know where you can get dramatic and 342 00:16:30,879 - > 00:16:33,440 sustained weight loss, I think you're gonna see that, Dave. 343 00:16:33,600 - > 00:16:37,360 I mean, I'm I'm I'm uh I'm uh I'm a positive on this one. 344 00:16:37,440 - > 00:16:40,879 I I do think that the the the and the thing that's most 345 00:16:40,879 - > 00:16:46,080 exciting is you're gonna see because of the success, a lot of 346 00:16:46,080 - > 00:16:50,159 research and money go towards seeing whether this similar 347 00:16:50,159 - > 00:16:53,039 formulation can be tuned to solve other problems. 348 00:16:53,600 - > 00:16:55,600 SPEAKER_00: John, let's let's stick for another one more 349 00:16:55,600 - > 00:16:57,679 minute on the weight loss side of it. 350 00:16:57,919 - > 00:17:01,440 And we hear a lot about the GLP1 rebound rate. 351 00:17:01,519 - > 00:17:04,400 Uh there was a study that showed about 60 percent of weight loss 352 00:17:04,400 - > 00:17:07,359 that was gained during treatments was regained within a 353 00:17:07,359 - > 00:17:08,720 year after stopping. 354 00:17:08,880 - > 00:17:10,000 What if what are you seeing there? 355 00:17:10,079 - > 00:17:13,599 SPEAKER_01: Aaron Powell Well, I I again I think that the the the 356 00:17:13,759 - > 00:17:19,119 the the current I think the current approach here has been 357 00:17:19,119 - > 00:17:23,119 very pharma-led, which is okay, you know, we've got a great 358 00:17:23,119 - > 00:17:25,759 drug, we're gonna charge you a lot of money, it's gonna create 359 00:17:25,759 - > 00:17:29,039 a lot of value, be if it's on it forever, not a problem for us, 360 00:17:29,119 - > 00:17:31,920 it's a problem for you as an employer, as a as a patient. 361 00:17:32,160 - > 00:17:37,039 I think you're starting to see employers um work with uh 362 00:17:37,039 - > 00:17:40,000 businesses like my wife's you know food is medicine business, 363 00:17:40,160 - > 00:17:44,160 Nourished RX, where you you combine it with a behavioral 364 00:17:44,160 - > 00:17:48,400 intervention and teaching people how to cook, how to engage in 365 00:17:48,400 - > 00:17:50,000 food in a different way. 366 00:17:50,400 - > 00:17:54,640 And with that, I think you could see if you can get that behavior 367 00:17:54,640 - > 00:17:57,759 change and teach people how to interact with the food system in 368 00:17:57,759 - > 00:18:02,720 their own um the the the I mean the their own urges, that that 369 00:18:02,880 - > 00:18:06,079 that could have a a really uh a dramatic positive effect. 370 00:18:06,160 - > 00:18:10,000 And the great thing about a GLP1 as an integrated therapeutic is 371 00:18:10,000 - > 00:18:13,440 it, you know, you you can you can have an immediate lift often 372 00:18:14,240 - > 00:18:17,119 or reduction in in weight loss. 373 00:18:17,440 - > 00:18:23,519 No, I'm I'm I I think the tricky thing here is and I may be 374 00:18:23,519 - > 00:18:26,400 having a hard time myself, not being too optimistic just 375 00:18:26,400 - > 00:18:29,200 because I mean there's I mean I've I've even read that there 376 00:18:29,200 - > 00:18:32,640 is some potential cancer reduction possible. 377 00:18:33,039 - > 00:18:35,039 SPEAKER_00: Yes, that's been well what's happened has been 378 00:18:35,039 - > 00:18:39,279 noticed that yes, there have been some um you know some real 379 00:18:39,359 - > 00:18:43,680 world data that GLP ones may reduce cancer progression. 380 00:18:43,839 - > 00:18:47,920 There's a uh this is actually very current, the 2026 ASCO 381 00:18:48,240 - > 00:18:51,279 annual meeting showing GLP1s could reduce cancer progression 382 00:18:51,279 - > 00:18:55,200 in lung, breast, colorectol, and liver by a substantial amount, 383 00:18:55,359 - > 00:18:58,319 um, and that it correlates in lower mortality risk. 384 00:18:58,480 - > 00:19:02,960 So there's a lot of there's a lot of interesting and positive 385 00:19:02,960 - > 00:19:04,480 signals uh that are out there. 386 00:19:04,640 - > 00:19:04,960 Yes. 387 00:19:06,319 - > 00:19:09,680 SPEAKER_01: And so where do you land, Dave, as as as a from a 388 00:19:09,680 - > 00:19:11,200 business perspective? 389 00:19:11,440 - > 00:19:15,359 Do you think these GLP ones are gonna continue to go down in 390 00:19:15,359 - > 00:19:17,680 price and become more accessible? 391 00:19:18,559 - > 00:19:20,720 SPEAKER_00: Yeah, I mean I think that the market is gonna grow 392 00:19:20,720 - > 00:19:22,799 overall and that you're gonna see more uses. 393 00:19:22,960 - > 00:19:28,160 You're gonna see some tuning of GLP ones, some connection with 394 00:19:28,160 - > 00:19:29,599 uh their lifestyle programs. 395 00:19:29,680 - > 00:19:32,160 I mean, mentioned we have another guest, a client of ours, 396 00:19:32,319 - > 00:19:36,720 Diasome, there uh have a program to help make GLP ones more 397 00:19:36,720 - > 00:19:39,359 tolerable so that people actually will stay on them and 398 00:19:39,359 - > 00:19:42,400 not have so many, you know, that this is uh early stage. 399 00:19:42,480 - > 00:19:46,079 SPEAKER_01: But the failure rate or or people just quitting it 400 00:19:46,400 - > 00:19:49,839 within a year is not a great answer for something you're 401 00:19:50,000 - > 00:19:50,079 saying. 402 00:19:50,400 - > 00:19:50,559 SPEAKER_00: I know. 403 00:19:50,720 - > 00:19:52,400 SPEAKER_01: But the thing is, John Trevor Burrus That's a 404 00:19:52,400 - > 00:19:53,920 really important investment on their part. 405 00:19:54,000 - > 00:19:54,240 Trevor Burrus, Jr. 406 00:19:54,480 - > 00:19:54,799 SPEAKER_00: No, it is. 407 00:19:54,880 - > 00:19:56,240 But you know what it's also interesting. 408 00:19:56,400 - > 00:19:58,960 So let's look at these two things, like the GLP1 rebound 409 00:19:58,960 - > 00:19:59,119 rate. 410 00:19:59,279 - > 00:20:00,960 So people regain 60 percent of the weight. 411 00:20:01,119 - > 00:20:05,200 But the thing is, for most diets, most people regain all 412 00:20:05,200 - > 00:20:06,480 the weight and sometimes more. 413 00:20:07,279 - > 00:20:09,839 And it's also you know, when people win the lottery, they end 414 00:20:09,839 - > 00:20:10,319 up poorer. 415 00:20:10,480 - > 00:20:14,960 And also, even for drugs like hypertension, uh you know, I 416 00:20:14,960 - > 00:20:16,799 think comparably people go off those. 417 00:20:16,960 - > 00:20:19,599 And even when people are treating like breast cancer and 418 00:20:19,599 - > 00:20:21,920 they have follow-up treatment, people stop taking their drugs. 419 00:20:22,079 - > 00:20:24,880 So I am not sure, I know these numbers are cited. 420 00:20:25,039 - > 00:20:28,079 I'm not sure the drop-off rate is so much more dramatic for GLP 421 00:20:28,079 - > 00:20:28,480 ones than others. 422 00:20:28,559 - > 00:20:29,200 SPEAKER_01: Aaron Powell Interesting. 423 00:20:29,519 - > 00:20:30,240 That's a fair point. 424 00:20:30,400 - > 00:20:34,480 So, David, uh lightning round, where are we on Medicare and 425 00:20:34,480 - > 00:20:34,880 Medicaid? 426 00:20:35,039 - > 00:20:38,960 50 percent of all the dollars in America, so many people, where 427 00:20:38,960 - > 00:20:41,599 are we on the big government programs in terms of coverage? 428 00:20:41,680 - > 00:20:43,759 And then let's talk a little bit about where we're going from 429 00:20:43,759 - > 00:20:43,920 here. 430 00:20:44,559 - > 00:20:47,200 SPEAKER_00: So the on the Medicare and Medicaid side, um, 431 00:20:47,359 - > 00:20:49,279 of course, a lot of the discussion has been around 432 00:20:49,279 - > 00:20:52,559 people that are working age or employed, but most people 433 00:20:52,559 - > 00:20:54,640 actually get their their coverage from Medicare and 434 00:20:54,640 - > 00:20:55,039 Medicaid. 435 00:20:55,200 - > 00:20:57,759 Now, of course, I'll tell you the Biden administration 436 00:20:57,759 - > 00:21:01,039 actually had a proposed rule to cover GLP1s for obesity in 437 00:21:01,039 - > 00:21:01,519 Medicare. 438 00:21:01,680 - > 00:21:07,119 And so, of course, um Trump dumped that and proposed 439 00:21:07,119 - > 00:21:08,160 something similar, uh. 440 00:21:08,319 - > 00:21:11,519 So it basically tried to have some kind of improvement with 441 00:21:11,519 - > 00:21:14,640 this Trump RX program, and now they have- then they came up 442 00:21:14,640 - > 00:21:17,920 with this balance model, which was to expand access and 443 00:21:17,920 - > 00:21:20,880 Medicare Part D and Medicaid, but the the health insurers 444 00:21:20,880 - > 00:21:21,680 didn't go along with it. 445 00:21:21,839 - > 00:21:25,440 So now there's this thing, the Medicare GLP1 bridge, which is 446 00:21:25,440 - > 00:21:27,599 going to cover these drugs starting in July through the end 447 00:21:27,599 - > 00:21:30,480 of 2027, uh, with Medicare footing the bill. 448 00:21:30,720 - > 00:21:35,119 Only 13 states are covering in Medicaid, only 13 states cover 449 00:21:35,119 - > 00:21:38,880 GLP1s for obesity, and that's actually down from 16 a year 450 00:21:38,880 - > 00:21:39,119 ago. 451 00:21:39,279 - > 00:21:43,359 So basically the story is Biden set things out in a direction of 452 00:21:43,359 - > 00:21:47,359 coverage, Trump undid it and is trying to now redo it. 453 00:21:48,640 - > 00:21:51,279 SPEAKER_01: I mean, my my read of the current news, Dave, is 454 00:21:51,279 - > 00:21:54,240 that they're gonna they're gonna find a way to make it work for 455 00:21:54,240 - > 00:21:57,200 Medicare, at least partially because the President keeps 456 00:21:57,200 - > 00:22:00,480 talking about it as a positive, which is, you know, uh generally 457 00:22:00,480 - > 00:22:02,880 what drives things in the administration. 458 00:22:03,119 - > 00:22:04,400 So, Dave, where do we go from here? 459 00:22:04,559 - > 00:22:07,119 I mean, this is a I think we're at the beginning of a really 460 00:22:07,119 - > 00:22:11,279 interesting phase of of this category of drugs. 461 00:22:11,440 - > 00:22:14,240 But but where do you how you're you're the you're the one who 462 00:22:14,240 - > 00:22:16,720 knows a lot more about prescription drugs than I do. 463 00:22:16,799 - > 00:22:16,960 Trevor Burrus, Jr. 464 00:22:17,119 - > 00:22:17,279 SPEAKER_00: All right. 465 00:22:17,519 - > 00:22:20,319 So I'll give the real big picture the real big picture, 466 00:22:20,480 - > 00:22:20,640 John. 467 00:22:20,799 - > 00:22:22,559 And thanks for puffing me up, you know. 468 00:22:22,720 - > 00:22:23,839 But um, low bar. 469 00:22:24,000 - > 00:22:24,559 Low bar. 470 00:22:25,200 - > 00:22:25,839 Big picture, John. 471 00:22:26,079 - > 00:22:28,640 So if if we look at the public health trends over the past 50 472 00:22:28,640 - > 00:22:29,839 years, they've been bad, right? 473 00:22:30,079 - > 00:22:34,319 All the states have gotten worse in terms of the rate of obese 474 00:22:35,039 - > 00:22:36,000 and overweight. 475 00:22:36,160 - > 00:22:38,160 And actually we are starting to see that change a little bit. 476 00:22:38,319 - > 00:22:40,640 So that's actually for the first time, that's that's changing. 477 00:22:40,799 - > 00:22:44,559 Then we have these other things where you've got uh cancer, 478 00:22:44,720 - > 00:22:48,640 heart disease, which have really been pretty difficult to do 479 00:22:48,640 - > 00:22:52,000 anything about, and those may start to have an improvement as 480 00:22:52,000 - > 00:22:52,079 well. 481 00:22:52,240 - > 00:22:54,640 And then even some of these things we talk about, deaths of 482 00:22:54,640 - > 00:22:58,799 despair, psychiatric problems, uh, mental health in general, 483 00:22:58,960 - > 00:23:02,559 and maybe those-maybe there is a chance actually to turn the 484 00:23:02,559 - > 00:23:02,960 ship. 485 00:23:03,119 - > 00:23:06,720 So that's the that's the macro side of it with with GLP ones. 486 00:23:07,039 - > 00:23:09,599 Maybe that will work in terms of public health, and maybe it's 487 00:23:09,599 - > 00:23:13,039 really gonna pay off from a cost standpoint, regardless of what 488 00:23:13,039 - > 00:23:15,279 happens with pricing, which is just one one part of this. 489 00:23:15,599 - > 00:23:16,559 SPEAKER_01: You're the big maybe here. 490 00:23:16,640 - > 00:23:18,079 I'm a more more positive. 491 00:23:18,240 - > 00:23:22,480 I I I'm gonna with less information, I want to be more 492 00:23:22,480 - > 00:23:24,000 positive here, Dave. 493 00:23:24,720 - > 00:23:24,880 SPEAKER_00: All right. 494 00:23:25,039 - > 00:23:26,640 I thought I was being pretty positive, John. 495 00:23:26,720 - > 00:23:28,000 That's about as positive as I get. 496 00:23:28,160 - > 00:23:31,279 Maybe I need to macro dose myself so that I would be uh uh 497 00:23:31,519 - > 00:23:33,440 be able to give something more positive for next time. 498 00:23:33,680 - > 00:23:36,400 Well, what I am gonna say, John, is that that's it for another 499 00:23:36,400 - > 00:23:37,599 episode of CareTalk. 500 00:23:37,680 - > 00:23:40,160 We've been talking about the current state of the GLP1 drug 501 00:23:40,160 - > 00:23:44,559 business, science, policy, and why John is so optimistic, even 502 00:23:44,559 - > 00:23:46,319 when his co-host is less so. 503 00:23:46,480 - > 00:23:49,200 I'm David Williams, president of Health Business Group. 504 00:23:49,519 - > 00:23:51,519 SPEAKER_01: And I'm John Driscoll, the chairman of UConn 505 00:23:51,599 - > 00:23:51,759 Health. 506 00:23:51,920 - > 00:23:55,039 If you like what you heard, or you didn't, or you've got 507 00:23:55,039 - > 00:23:58,160 questions, we'd like you all to subscribe on your favorite 508 00:23:58,160 - > 00:23:58,799 service.