The Cost of Shamelessness in Healthcare

We are witnessing quite a number of battles unfolding and harming innocent people in diverse settings. They range from actual wars to political contests to the lucrative business of healthcare. A common thread in all of these situations is shamelessness in pursuing money, power, or both. That shamelessness is especially troubling when it pops up in healthcare.

Chasing a Windfall in Obesity

Novo Nordisk and Lilly are finding a windfall of profits in meeting the desperate need for better options in obesity care. Novo is now – because of their multi-billion dollar sales of semaglutide for this purpose – the most valuable company in all of Europe. With the benefit of tirzepatide sales for obesity and diabetes, Lilly may become the first ever trillion-dollar drug company.

Through visionary investment in metabolic research, these companies have the foundation for a windfall of profits that may sustain them for many years.

Gross Disparities

Their successes bring us good reason to celebrate. But at the same time, they set up some gross disparities in the care that people can receive for a chronic disease that has profound effects on their health and their lives. For now, only people who are wealthy or very well-insured can afford these medicines.

High prices mean that health plans are terrified of the financial effects that adopting these drugs might bring. So insurers double down on exclusions and abusive pre-authorization procedures. A recent Kaiser Family Foundation survey found that, even at large companies, only one in five have health plans that will cover these medicines.

On top of the problems with pricing and coverage comes the problem of an inadequate supply. Of course, any economist can tell you that supply, demand, and pricing are all related. When demand is high and supply is short, prices go through the roof.

Looking for a Piece of the Action

The shortage sets up an opportunity for even more shamelessness in the pursuit of healthcare profits. Compounding pharmacies have been only too happy to jump into action and do their bit to ease two problems: the high price of these drugs and the short supply. While the prices for semaglutide and tirzpatide can be a thousand dollars per month or more, compounded products are available for $150 to $300 per month. One industry advisor called this a “golden opportunity” offering “substantial profits” to compounding pharmacies.

Earlier this month, FDA shut down the legal option for compounded versions of tirzepatide by declaring that the shortage was over. Then, compounding pharmacies sued the agency and now, FDA seems to be reversing itself.

Make no mistake. A lot of money is in play and everyone wants a piece of it.

Patients and Health Come Up Short

This shameless pursuit of profits is leaving patients and their health at the back of the line. In Stat, Elaine Chen recently described the dilemmas this creates for patients and health professionals. Dr. Beverly Tchang told her about the risks that compounded and counterfeit drugs can introduce. At the same time, she also noted that losing access to an affordable supply of these medicines is a real problem:

“There’s a whole cohort of individuals who are finding success in using compounded tirzepatide to treat obesity, and those are the individuals who are at highest risk of losing those health benefits with the end of this shortage and the enforcement of the patent form of the medication.”

None of this is easy. But we naïvely hope for a reordering of priorities to put human health ahead of the shameless pursuit of profits. Many millions of lives are in play here.

Click here for Chen’s article and here for a reflection on pervasive shamelessness.

Hell, from Visions of the Hereafter, by Hieronymus Bosch, photographed by Didier Descouens, licensed under CC BY-SA 4.0

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October 13, 2024