The Pound of Cure Weight Loss Podcast
Hosted by obesity specialist Matthew Weiner, MD and dietitian Zoe Schroeder, RD, The Pound of Cure Weight Loss Podcast provides a comprehensive approach to weight loss. We cover nutrition, the new GLP-1 medications, and Bariatric Surgery in depth and answer tons of questions from our audience every week. Check out our website for video versions of the podcast: www.poundofcureweightloss.com/podcast
The Pound of Cure Weight Loss Podcast
Novo Nordisk’s Weekend at Bernie’s
In Episode 49 of the Pound of Cure Weight Loss Podcast, Dr. Weiner and Zoe examine the steep costs of obesity medications like Wegovy, the influence of pharmacy benefit managers (PBMs), and the role of big pharmaceutical companies in shaping healthcare. Highlighting recent Senate hearings led by Bernie Sanders with Novo Nordisk’s CEO Lars Fruergaard Jørgensen, this episode sheds light on how the current system prioritizes profit, often at the expense of patients’ access to care.
Wegovy Cost: Breaking Down High Prices in the U.S.
Wegovy, a GLP-1 medication, costs around $1,349 per month in the U.S., while in other countries like the U.K., prices are as low as $92. Dr. Weiner explains that this discrepancy illustrates a broken healthcare model, where the U.S. market fuels corporate profit but leaves millions unable to afford essential treatments. With 72% of Novo Nordisk’s revenue coming from U.S. sales, the company’s pricing strategy relies on American consumers, who are left paying significantly more for the same medications.
Big Pharma’s Influence on Policy and Profits
This episode delves into Big Pharma’s control over drug pricing, particularly the stark contrast between their research and development costs and their profits. For example, while Novo Nordisk spent $21 billion on R&D, they spent twice as much—$44 billion—on stock buybacks and dividends. Dr. Weiner highlights how political influence plays a crucial role, with both major parties receiving substantial donations from pharmaceutical companies, leading to stalled efforts in drug price regulation and patient access.
Pharmacy Benefit Managers (PBMs): Hidden Gatekeepers Driving Up Costs
PBMs, the intermediaries between insurers and pharmacies, are supposed to negotiate better prices, but Dr. Weiner and Zoe point out that they often drive costs higher through hidden fees. In many cases, PBMs have financial incentives to push higher-priced drugs, creating a “pay-to-play” system that limits patient access. For example, PBMs profit by taking a percentage of negotiated drug price savings, meaning higher drug list prices generate greater profits for them. Dr. Weiner underscores how PBMs complicate and inflate pricing, making it even harder for patients to get GLP-1 medications through insurance.
Do We Need Health Insurance Companies and PBMs?
Dr. Weiner questions the necessity of insurance companies and PBMs in the healthcare system, arguing that they don’t provide direct patient care yet extract billions from the system. He suggests that healthcare can function without these financial middlemen, allowing for a more transparent, patient-centered system where costs are lower and patients have better access to needed treatments.
The Morality of Obesity Treatment Costs
The episode closes with Dr. Weiner and Zoe discussing the stigma surrounding obesity and the moral implications of restricting access to life-changing medications like Wegovy. They emphasize that obesity is a complex, chronic disease requiring comprehensive treatment, not simply a “lifestyle” issue. Dr. Weiner advocates for recognizing obesity treatment as essential, which could lead to a shift in how these medications are accessed and covered.
Final Takeaways
While the healthcare landscape remains challenging, Dr. Weiner believes patient advocacy, legislative changes, and innovation can improve access to these life-saving treatments. This episode offers insights into navigating the current system while emphasizing the need for systemic change to prioritize patient health over profits.
These prices are really the symptom of a broken system, as opposed to a single act or a single bad person kind of taking advantage of our healthcare system.
Zoe:Hello and welcome back to the Pound of Cure Weight Loss Podcast. Today's episode is Nova Nordisk's Weekend at Bernie's.
Dr. Weiner:Yes, so this is a little bit of a different show than we've ever done. I've been following this.
Dr. Weiner:We've been talking about Bernie Sanders, you know bringing Lars Jorgensen, the CEO of Nova Nordisk, in front of a Senate hearing, and so it finally happened at the end of September. And you know I watched the whole thing. It was like two and a half hours long. I watched the whole thing. I pulled out some clips that I thought would be interesting and I was going to go through because I think it. You know as much as we look at policy and how laws are made and how all this stuff happens, it is very understandable. Anybody can kind of understand what's happening and where they're going, and I think you can really just see how much bureaucracy there is in getting anything done, anything done, and our political situation, where neither party can stand the other party, doesn't make for us able to kind of come to the middle and find some good policies, which is how historically this country has worked.
Dr. Weiner:So, anyway, I thought it was interesting. There was a lot to learn, but in the end there is of you know, they all kind of there is a group think and they all kind of come to a fairly similar conclusion. So this was the Senate Health Committee and they are made up. It's a bipartisan group and there's kind of two leaders of it. The first leader is Senator Bernie Sanders and I think he's like the main head, but then there's also Senator Cassidy. He's a Republican constituent and so they were both kind of the heads. It actually is Dr Cassidy, he's from Louisiana, and so the two of them kind of headed up this. But then they had different members of the committee and each one of them was given a chance to kind of ask questions and go through a line of reasoning and it's partly showboating and it's partly trying to get to the bottom of the problem.
Dr. Weiner:So the big issue is and we're going to hear from Bernie in a second that these medications are far more expensive in our country than they are in any other country, and so you know, there's a lot of background facts that brought on these hearings. The first is that Novo Nordisk's sale price, and I'll show you right here, zoe, just a shot of Novo's sale price. Zoe, just a shot of Novo's sale price, novo's stock let's see, we're going to go through this In 2022, the stock was somewhere in the high 50s and they've reached a high of like 140. So they're running like 120, 140. So in the last few years, novo's stock has more than doubled. So in the last few years, novo's stock has more than doubled.
Dr. Weiner:So clearly this company has done very very well as a result of Ozempic Wegovi and I think over five years it's up 368%. So I saw this coming years ago. I knew these drugs were going to be amazing and I didn't buy stock in it. That kind of kills me, yeah, but it's a side point. So 72% of the revenue from Novo Nordisk comes from US sales, so they make way more money from us than any other country.
Zoe:Right.
Dr. Weiner:That's the first point, right? That's the first point. These drugs are anywhere from four to ten times more expensive in our country than in any other country. We also spend twice as much on health care as any other country in the world, and yet 85 million Americans are either uninsured or underinsured. We still have to pay a tremendous amount of out of pocket um, and 65 000 people a year die from lack of insurance coverage and we're still sicker yes, and we are less healthy than most other countries.
Dr. Weiner:Our infant mortality rate is in line with some third world countries. I mean mean there's a lot going on with our healthcare system. And so when you see this happening and Novo Nordisk is making record breaking, profits you're going to get brought into it. So let's start by kind of looking at what Bernie's introduction to this was. And he kind of outlines why we're doing this. Here's the video.
Bernie Sanders:Which shows that Novo Nordisk's diabetes drug, nozempic, is sold in Canada for $155, in Denmark for $122, in France for $71, and in Germany for $59. For $71, and in Germany for $59. In the United States, novo Nordisk charges us $969, over 15 times more than they sell that product in Germany. Regovi, novo Nordisk weight loss drug, is even more expensive, as the chart behind me also shows. Wegovy is sold for $265 in Canada, $186 in Denmark, $137 in Germany and $92 in the United Kingdom. In the US, the list price for Vigovy is $1,349 a month, nearly 15 times as much as it cost in the United Kingdom. What we are dealing with today is not just an issue of economics. It is not just an issue of corporate greed. It is a profound moral issue.
Dr. Weiner:What do you think about that Zoe?
Zoe:I mean, obviously we've talked about it before on the podcast. It's just disgusting. It's kind of a sad state of affairs. Yeah, I just like. I, I feel like it everything's in so many ways I mean, I think the health care system is.
Dr. Weiner:It is starting to get a little bit to a tipping point.
Zoe:It's insane. This is like something has to change. This is not okay. It's not okay.
Dr. Weiner:So I'm going to bring up a second image here and I'm going to explain why I don't really see it changing much over the next five years. So this is a chart of the top 15 political candidates who have received funding from the healthcare industry. This is just 2024. Of course, the top two people are our current presidential candidates, with Kamala receiving over $5 million in funding from the healthcare industry in 2024. Over $5 million in funding from the healthcare industry in 2024. Trump is substantially lower at about $860,000, but still a lot of money for Trump. Some interesting things on there. Nikki Haley is also on there and Bill Cassidy, who we're going to hear from, is on there. He's one of the people on the Senate committee.
Zoe:That'll be interesting.
Dr. Weiner:He's one of the people on the Senate committee. That'll be interesting. Yeah, so you know, we just have the politicians are bought and sold by the health care industry. And if you look also at that graph, it's not Democrats, it's not Republicans, it's like a 50-50 split. This is really not a partisan issue. The winner of this election it's not going to neither of the candidates.
Dr. Weiner:Whether we're talking about flipping the Senate or the House or the presidential candidate, no matter what it's still, they're still going to be heavily influenced by the healthcare industry.
Dr. Weiner:And so I, you know, I think that I think that's really the state of affairs. So when we look at something that's happening, and in many ways I think what we're going to see is that these prices are really the symptom of a broken system, as opposed to a single act or a single bad person kind of taking advantage of our healthcare system. It really is. It's because and we've talked about that in the past with our creative dosing strategies, how you know when the system's screwed up, there's sometimes there's a little chink in the armor and you can kind of take advantage and save some money, and you have to do things a little bit unusually, but it can save a tremendous amount of money and give you access to a drug that you couldn't otherwise afford. And so there's something in our healthcare system the pricing that doesn't make any sense, and you can leverage that to your advantage, and we do that every day in our practice.
Zoe:And it's kind of like this problem has probably been here for a really, really, really long time, but now, with the widespread use and like this life-changing class of medication and all these these drugs, it's now just really having a spotlight on the it's. It's utilizing the glp1s as kind of this on the pedestal look at this problem. But there are probably so many other drugs that this is happening with as well, this is happening with chemotherapeutics, this is happening with radiation treatment after cancer.
Dr. Weiner:The problem is it's happening on these little one-off situations. It's this one case here, one case there rare cancer, this drug, that drug. Millions and millions of people we have millions and millions of people who want the same drug and they really want it, really really want it, and they can't get it because of it. So these GOP ones are really putting a spotlight, like you said, on our healthcare system and kind of focusing it around a single issue, which is this drug.
Zoe:But, like you, said yeah, it's a systemic issue.
Dr. Weiner:I think you put it exactly right that way. So let's see what Lars Jorgensen has to say in his initial response, and I'm interested to hear what you think about this.
Lars Jorgensen:Hard at work in making sure that patients have access via the insurance schemes, and today 80% of all Americans with insurance have access to these medicines at $25 or less for a month's supply. So it's a price point at the pharmacy counter we have to talk about.
Bernie Sanders:Let me just interrupt you, if I might. Okay, you're correct that many people pay $25 a month for Zympic, but what you're forgetting to mention is that many of those people are paying outrageously high prices for the insurance that covers Ozempic and other drugs. So, simply, this is a pass-through to the insurance companies. Bottom line is you are charging the American people substantially more for the same exact drug than you are charging people in other countries, and my question is why?
Zoe:I love how he just got straight to the point and asked the question. I mean that's. I mean First of all.
Dr. Weiner:I don't see people get this for $125 on average. I don't see 80% of our patients get it. No way, I mean. I don't think people get this for 25 bucks on average. I don't see 80 of our patients getting no way. I mean I don't think 80 of our patients get it for 100 bucks or less right um, I have seen lots of patients paying two, three hundred dollars, uh, and so I don't know where he gets that number, but I I call bs on that and then second I think bern Bernie's response was exactly right.
Dr. Weiner:Yeah, health insurance is just. It's a way to spread out the cost over time and so if it costs more, health insurance is going to be more. That's why anybody, if you have a cheap car, your car insurance is less expensive than if you have an expensive car, because you're going to break it at some point and it's going to be more expensive to break, and so they're basically charging you for the future cost of repair yeah, it's almost forced savings to to some degree, um and so.
Dr. Weiner:So anyway, there's 190 million people do not have access to we go, so that, wherever he's coming from that, most people can get it for 25 bucks. That's not true. And again, we pay. Whether if you're on a state funded plan like Medicaid or access or Medicare plan, it's paid for taxes. Who pays our taxes? We pay our taxes. We pay our health insurance premium. You work for our practice. You get a health insurance premium paid for you by the practice. If our health insurance was cheaper, you would get a higher salary. So the idea that either your employer or your insurance company is paying for a drug, that's not how it works.
Zoe:We're paying for it. It's going to come from somewhere.
Dr. Weiner:You pay for it. You pay for it in lieu of wages or in taxes, or somehow you are paying for these drugs, okay. So yeah, bernie has some other interesting points here, and I think this is also some good stuff.
Bernie Sanders:This year, dr Alison Galvani, an epidemiologist at Yale University, conducted a study on Wigovie and what she found and I hope Mr Jorgensen pays attention to this is that over 40,000 lives a year could be saved if Wigovie were made widely available at an affordable price to Americans who need the drug 40,000 lives I ask unanimous consent to insert that study into the record.
Bernie Sanders:A few months ago, dr Melissa Barber, a health care economist at Yale University, conducted a study on the cost the cost of manufacturing Ozempic and what she found is that Ozempic can be profitably manufactured for less than $5 a month. We all know the cost of production is not the only expense by far for a drug company. Pharmaceutical companies spend great sums of money on research and development to find new treatments, with many of these products not coming to market. We all understand that new treatments, with many of these products not coming to market. We all understand that. But it is important to know that this drug can be manufactured profitably for a few dollars a month. We may hear from Mr Jorgensen that Novo Nordisk spent $21 billion on research and development since 2018, and I take his word on that. What he may not tell you is that Novo Nordisk spent $44 billion on stock buybacks and dividends over that same time period.
Dr. Weiner:So I think that's another great point, which is, whatever they're spending on research and development, they're spending twice that much on buybacks and other things that are going to increase their salary, their profit and and um. So clearly, if you're buying back stock, it means you have lots of extra money and and again. So so we're novo nora's stock is up 360 percent over the last five years. They're the price is five times as high as what it is in the US, and they're able to do buybacks that are twice $20, $44 billion buybacks twice what they're spending on R&D. So clearly, this company is cleaning up and, at the same time, 40,000 people are dying. And maybe if they made a little less money I mean, as much as I hate to sound like a socialist and I've God knows, I'm not a socialist but maybe if they made a little less money.
Zoe:I mean, if we think about it, 1 billion last dollars, they'd still have their $43 billion to do their stock buyback with $1 billion to make that. I mean, I remember we did the math on a previous podcast, where I can't remember exactly which one it was, but where it was like if we took this small amount.
Dr. Weiner:If we could buy it, for what Canada can buy it for?
Dr. Weiner:I think we put like 5 million people or something I said, could get the medication. Yeah, just by getting rid of the PBM spend and paying what we pay in Canada, so which is Canada is the second most expensive country to get this right. Yeah, and I, and to me there's something like, you know, as a doctor and we I run my own private practice here and, and you know, you're certainly involved in how we make decisions and the money and all of that stuff and you understand there's, there's a business and you have to make money because that's how businesses survive. But at the same time, we also have core values, like putting our patients first and always making sure that the decisions we make are in the best interest of the patients coming to us, because we chose healthcare as a profession and that comes with a set of ethical guidelines that you have to follow, and so the truth is, most doctors think that way, most nurses think that way, most healthcare professionals think that way.
Dr. Weiner:The problem is health insurance companies and pharma companies don't, and somehow the health insurance companies, because the doctors have been asleep at the wheel just working and treating patients, but somehow we basically said, oh, you can't trust the doctors to make these decisions that are best for your health, even though we are the ones who took an oath. We're the ones who see you, who feel with you, who see your suffering firsthand. We can't be trusted to make financial decisions because we'll make biased decisions about your health care. Instead, we've basically given that control to the health insurance company and the pharma company.
Zoe:Who don't care?
Dr. Weiner:They don't care, they don't see your suffering, they don't sit with you at the bedside. They don't see the pain. They don't hear your stories of discomfort or, if they do, they outsource it to someone in another country to answer the phone on their customer support line. And so we've given this control, we've given them the financial leverage to make all your decisions on health care, and they have not been doing a very good job. You know it's illegal for physicians to start a hospital in the United States.
Zoe:That's so stupid.
Dr. Weiner:Isn't it stupid?
Zoe:I was just thinking like I wonder how different things could be if they had doctors running like at least on the board of Okay.
Dr. Weiner:So here's the problem Doctors aren't immune either. This is a very you know, this is a complex issue. With every complex issue, there's going to be both sides of it, Of course. So let's hear from Dr Senator Cassidy.
Zoe:Why shouldn't a doctor be able to start a hospital?
Dr. Weiner:Because we might be biased.
Zoe:And help patients.
Dr. Weiner:And do too many surgeries that people don't need. That's the thinking. But, anyway.
Dr. Weiner:So this is Dr Senator Cassidy, I believe. Yeah, he's from Louisiana and he is going to talk a little bit about this. He has received $258,000 from Farm and Healthcare in 2024. He's the 11th highest recipient on the list and he also voted against the Inflation Reduction Act, which was a very big and broad act. It was Biden's Build Back Better whatever act.
Dr. Weiner:But that was also in. That act was where Medicare can now negotiate with the pharma company. We talked about that too on the podcast. Medicare can negotiate for up to 10 drugs, and talked about that too on the podcast. Medicare can negotiate for up to 10 drugs, and every year they get to add 10 new drugs that they can negotiate with. I think another important part of this whole hearing is that you can pretty much count on that when they release the next set of medications, which should be coming out fairly soon and I think it's either 2026 or 2027 when the negotiations could begin, because they announced it and then two years later it happens you can guess that Ozepic is going to be on the list. I think that's pretty much a foregone conclusion at this point, but anyway. So let's hear from Dr Cassidy.
Dr./Senator Cassidey:But let me say, without a profit motive, without something in return, it's unclear that these drugs, or any drug, is going to be developed.
Dr./Senator Cassidey:There is a tension, a tension between the need to incentivize innovation and the ability to afford that innovation. And we are here struggling with that balance. Now, if anyone thinks going after big pharma is the silver bullet, that if you do that boom, health care costs or drug costs go down, they don't understand what happens with pricing a drug. There is no silver bullet, but, as my friend Angus King says, there is silver buckshot. You do a little bit here and a little bit there and it adds up so the drugs become more affordable. You do a little bit here and a little bit there and it adds up so the drugs become more affordable. Given that, we still have to preserve the profit incentive for the creativity, for drug companies to invest in order to develop the drugs that are going to positively affect the burden of disease in our society. So, as this committee examines the affordability of GOPs, we have to also examine how do we preserve that incentive for the innovation?
Zoe:I agree.
Senator Hassan:Yeah.
Zoe:And it's very, very well put, because if there wasn't that incentive, we wouldn't have any new drugs.
Dr. Weiner:Absolutely the problem is, and I think this is something that we're getting wrong as a country is that there is this pendulum right, it's either favoring the pharma company, favoring the big industry, versus favoring the people. Right? So in a perfect world, we would just give Ozempic out for free to everybody, because that's what's best for the people, but of course that would reduce the innovation, as Senator Dr Cassidy has put. When you're putting $21 billion in research and $44 billion in buybacks, that pendulum has shifted too far. It's shifted too much in favor of innovation. That pendulum has shifted too far. It's shifted too much in favor of innovation. Right, right, on one hand, once you discover a drug, it's yours for life and you're the only one who, for the rest of the history of the world, can produce that drug.
Dr. Weiner:That's not good either, because that drug's never going to make it out to market, it's not going to get to the people, and so there has to be this balance, and in my mind the balance has shifted too far in favor of the pharma industry, in favor of the patent holder, and we have to shift it back. So I agree with him that there has to be this tension, but I think what we're seeing is that that tension is pulled too far to one.
Zoe:We're snapping. It's like a rubber band and we're on that end, about to let go.
Dr. Weiner:Yes, exactly, and one of the rubber bands is laxed and the other one is pulling it all the way. Yeah, so we need to move it back to the center not to the point where Ozempic is free and screw the patents and that's all over, right. But so I hear what he's saying, where he's coming from with this, but I think that there's more to this story, so let's hear from Dr Marshall. So there's a couple of docs on this committee. I do like there are physicians in the government.
Zoe:Is that going to be in your future?
Dr. Weiner:It's like my total secret little fantasy.
Zoe:Yeah, oh, my God, yes.
Dr. Weiner:Like once I'm done with surgery like you know, mid-60s, to run for Congress or something like that. I would love that, Honestly, my God. Yes, Like once I'm done with surgery.
Zoe:Like you know, mid 60s to run for Congress or something like that.
Bernie Sanders:I would love that.
Dr. Weiner:Honestly, I would love that I would create so much trouble. Ok, so here we have Senator Dr Marshall, and this is where, really, the hearing starts to take a turn and, I'll be honest, I don't necessarily disagree with it. So let's hear what Dr Marshall has to say. Again, he's the senator, dr Marshall is from Kansas and he's a Republican. So here we go.
Dr./Senator Marshall:Novo Nordisk is not the villain in this story. Novo Nordisk is not the villain in this story. They're a hero. We should be here celebrating this miracle innovation that's responding to this diabetic epidemic we have in this country. It's a miracle drug. Now we all agree on this committee, across the Senate, that the cost of health care is too much and that prescription drugs are too high, especially the out-of-pocket expenses. But we need to figure out who the villain is. Who is the real culprit here? Who's making the money? So on this particular poster you've said it once, you've said it twice, everybody up here said the same thing Whatever the cost is, whichever number we want to use, novodortis keeps 24% of it and the PBMs extract 76, 74%, 26 and 74%. So really the PBMs are making the bank here. So let's talk about PBMs for a second here. The real culprit in this room, in this story? So these three big parent companies, the three big PBMs, control 80, 85% of the industry. Their gross revenue last year was $800 billion. Their parent companies gross revenue $800 billion.
Dr. Weiner:So this is where it all shifts toward blaming the PBM.
Zoe:Well, I'm glad.
Dr. Weiner:Yeah. So I think a little bit of history too is that this committee also put out the pbm reform act, and we've covered this also in past episodes. It really asks for more transparency. So pbms and and we're going to hear a little bit more about this make their money by saying the role of the PBM is these pharma companies are screwing you and we're going to negotiate with them and we're going to bring the price down, which clearly they're doing an absolutely terrible job at, if the drug costs four times more here than in any other country. So immediately, this whole, the premise of this entire hearing, really brings the necessity or need for PBMs into question, because they're clearly not doing as good of a job as anyone else in the world.
Zoe:So it makes me think, like if the drug company was in charge of setting the price or you know, instead of the PBM middleman, and we know that X drug could be, you know, manufactured with a profit margin at $5 a month without that PBM middleman, like what would they? Oh yeah, like what? If we do $10 a month, we'll still make buckets of money and so we'll help so many people.
Dr. Weiner:Right, and I think that's a little overly optimistic at $10 a month, but maybe it'd be $150.
Zoe:Well, yeah.
Dr. Weiner:And that would be a game changer for so many people out there, but anyway. So I think, another really important thing. So back to the PBM Reform Act. It hasn't gotten passed yet. They're hoping that it's going to get passed early next year. Gotten passed yet, they're hoping that it's going to get passed early next year. But you know, all of the political machine is just kind of grinding on this thing and again, it's because these health insurance companies and these numbers that I put up there, with Kamala taking, you know, 5.8 million and Trump with 800 something thousand of donations this year, that's not just pharma, that's all health care fields. So probably the majority of it is from these $800 billion revenue companies of Cigna, aetna and United.
Zoe:A drop in the bucket.
Dr. Weiner:Right, and so which is also that's such a good point it's $800 billion and they're paying $8 million to influence, right, so that's 10,000 times. They're making 10,000 times as much in revenue. One, 10,000 is what they're using. They're using such a small amount of money to get the influence that they need to takes a relatively small amount of 250 000 to a senator and you're going to influence the way he or she is going to vote, so, um, so anyway. So there's some frustration in this committee that this act has not been passed too, and and so we're going to really take a um, a shift.
Dr. Weiner:But I think one last thing on the pbms. They make their money on that spread. So what happens is nova nordic says, oh, we go, these 1300, and then the pbms negotiate it down to 600 bucks, and so then they go back to the employer and that well, the health insurance company which owns them. But eventually this money gets passed to the employer where they, hey, we saved you 700 bucks, we get to keep 25% of it. So the higher the starting price, the more money they make off of every prescription, and we'll hear more about that in these coming videos.
Senator Hassan:CVS said lower list prices would open up access for obesity treatment in particular. Unitedhealth Group Optumx said, given the significant price differential for these products across borders, a decision by Novo Nordisk to align US pricing more closely with those in other countries would meaningfully increase access for US patients. So, with that in mind, would you please commit to lowering the list price of these drugs.
Lars Jorgensen:So, senator, allow me to share a few points before I answer your question. Is that okay? So the experience we have is one of losing access when we lower price. I know you can always find specific plans that did include insulin with a lower price, but the broad totality is that less patients have access to our medicines when we have lowered the price. I understand that perhaps the PBMs have changed their mind and I'd be happy to collaborate with them on this, because anything that helps patients to get access and affordability we are supportive of don't, I don't really understand it's the spread pricing.
Dr. Weiner:So when he lowers the price, pbms make less money.
Dr. Weiner:We've talked about that yeah before where the pbms will say, oh you, you need to go through our pharmacy for the 90 days, um, and? And what they'll end up doing is they will tell you, oh, we don't cover this cheap medicine, we only cover the more expensive medicine because the PBM profits more on that medicine, because they get that spread pricing difference, and the cheap medicine they don't make any money on because it's cheap to begin with. And so that's what he's saying and the problem is he's right. He's right that that is like lowering the price of a medication you may limit access to patients.
Dr. Weiner:Wow, which is when that is a true statement. That is so paradoxical. It really shows you that whatever is going on with the way drugs are bought, sold, distributed and authorized for insurance payment, it's so totally broken. Now what Bernie did and I don't think I have a video of it, but he had secured from the PBMs in writing a statement that said that if you lower the price, we will continue to cover and provide access to Ozempic. So he did secure this, which his goal, I think, is to get them to lower the price. But the truth is he's just kind of warming them up for the Medicare negotiations coming down the pipe. But you know the fact that that's the explanation is, and it's right, he's's not being, he's not being untrue, it's not a lie yeah to me that's, that's a kind of a crazy, it's a crazy state reality crazy
Senator Budd:reality exactly, yeah um, uh, okay, so let's go to the next video are there ways to reduce these perversions and, as we're asking for suggestions here, perhaps this will come in ongoing discussions with the committee, but in your time here. Do you have some suggestions to reduce these perverse incentives to deliver savings and value to the patients in need?
Lars Jorgensen:Thank you, senator.
Lars Jorgensen:We should really unite around what helps patients. And if you have the industry making big risks in R&D, making big commitments into manufacturing, and then we have to negotiate against PBMs and their insurance companies, not taking much risk and yet benefiting from a significant fee linked to the list price, I think that's absurd. So if we could stop linking their income to a list price, I think that would create an incentive that is not as absurd as it is today. I would prefer doing business on the net price, where I compete against competitors based on what is the real price for our medicine and what is the value of the medicine. And these are medicines that are addressing societal challenges that are paramount. And we talk about the cost of the medicine, but it's really the cost of the diseases that's breaking the system and we have to find a way where we transact in a way where it becomes much more transparent, what is the real price of the medicine, to really adopt the medicine and mitigate the societal course that diabetes and obesity is putting on the US healthcare system and economy.
Dr. Weiner:You know, I think this is where they really talk about the PBMs. I think you know, I think this is where they really talk about the PBMs. I think one of his points, though, which I think is a total BS point, is that, well, if they just, we have to talk about the cost of the disease. And so these medicines, even though they're expensive, the disease is so much more expensive. That, to me, is like if I'm on ER call and a patient shows up with appendicitis and I say, oh well, it's going to be $100,000 for me to take out this person's appendix, and they'll be like that's crazy, it's a 45-minute surgery. Why would I ever pay you $100,000? Well, because if I don't do the surgery, then the patient is going to end up in the ICU with sepsis and it's going to cost $100,000 to take care of them, and that's a BS answer right.
Dr. Weiner:And so when you say these drugs reduce the burden of cost of diabetes, that ignores our responsibility to our patients. That is a very financial decision and the problem is with health care is that it cannot solely be a financial decision. There is an obligation to patients and you cannot look at every opportunity in health care as a mechanism to extract as much money as you can out of the system.
Zoe:Well, and I mean we can look at the cost of disease in all of those other countries that are delivering this medication to their patients.
Dr. Weiner:They're not paying the full cost of the disease. Yeah, that's a great point, I think kind of my final thoughts on that and the cost and the perverse incentives is if you really think about health care and let's look at every piece of this, can we provide health care without pharma, without the pharma industry? We can't right how care without pharma, without the pharma? Industry we can't right. How about without doctors? Of course not nurses. How about speech therapists, audiologists, durable medical equipment, hospice? Can you provide health care without all those people?
Zoe:it's a it's a ecosystem that requires everybody you require require everything.
Dr. Weiner:Can you provide healthcare without health insurance, without PBMs?
Zoe:Without PBMs.
Dr. Weiner:No problem. Without health insurance, you can still provide healthcare.
Zoe:Yeah, yeah.
Dr. Weiner:And yet $800 billion of revenue is going into the companies that aren't actually involved in providing the healthcare they don't actually provide. In providing the health care, they don't actually provide anything of value or use no service, and so they really have just figured out a way to insert themselves into the equation, into the payment equation, and have it come up with ways, through political means and business means, and and, uh and and kind of controlling the market, to extract a huge amount of money out of the healthcare system without actually contributing anything. And so, in all honesty, I think, as much as you start watching this and you want to be like the pharma industry, they're screwing us. This is a total ripoff. Nova nordis, they should be thrown in jail. I don't know that.
Dr. Weiner:I really think that that's the true problem here right I think they are a symptom of a broken system and they're just pricing it. You know they're, they're leveraging it, just like our patients are leveraging our creative dosing strategies, taking advantage of a little chink in the armor, and that the ultimate problem is with the companies who we've put in charge of controlling our healthcare expense, and they really have been derelict in that duty. So let's move on to video eight.
Senator Braun:Making a profit on your Ozempic product when you're selling it to Australia for $87 and you're selling it to the US for $9.36? Are you making a profit at $87?
Lars Jorgensen:Yes, we are, and the price you mentioned in the US is not what we get. That's the list price.
Senator Braun:So what are you getting in the US? What price?
Senator Braun:So I mentioned that on average for our products we give 74% in rebates to PBMs and that was a chart that Senator Marshall held up that PBMs are making 74% and you're getting 26%, so you've got a screwed up industry Number one. When I've talked to other pharma folks, they regret that PVMs ever came into it. It would seem like, since you make the product, that you could disassemble them or do something that would go around it if, in fact, this place won't do something about it. Have you ever thought of that?
Lars Jorgensen:It's very difficult, senator, because they control what insurance is put in front of patients. So they have integrated themselves with insurance companies and we negotiate against the PBMs, but they're owned by the insurance companies, so no matter what we do, they decide what products patients use mean a lot there, right?
Dr. Weiner:so much there 85 bucks, and they're making a profit. Imagine that these drugs for 85 bucks, what a difference that would make. Um, and and so even novo nordisk, this gigantic pharma in company that has the blockbuster drug of all blockbuster drugs, is powerless when it comes to fighting against the pbms right and he's like, yeah, I'm only making 26 percent of that.
Dr. Weiner:Yeah, yeah, which I mean, which means 74 percent of that cost and it's probably not the full 74 percent is going to to the pbms and to the healthcare industry. I mean, unitedhealthcare is the 11th or 12th biggest company in the world, and they're just US healthcare, you know. So, anyway, a lot. There a lot to learn from this. So let's do our final video and we'll wrap this episode up.
Dr./Senator Marshall:Disappointed in your company. All Big Pharma is the marketing that they do. I think that the marketing is very influential. I really think that Congress needs to go back and revisit that as well. I think that the marketing is so good. There's people on this drug that shouldn't be on it and are being taken advantage of, and so I do think we need to go back and look at that Again. Advantage of, and so I do think we need to go back and look at that Again. Instead of coming after the hero of this story, we need to look in a mirror. America needs to look in a mirror that nutrition is a big problem in this country and lack of activity.
Zoe:Amen.
Dr./Senator Marshall:Yeah.
Zoe:Amen yeah.
Dr. Weiner:So I think so he's basically acknowledging that healthcare marketing is a problem. And I think so he's basically acknowledging that health care marketing is a problem.
Zoe:And I think it is. It's all reactive, it's not preventative and it's not going from the root of the nutrition and the movement and just our kind of overall culture and what's being prioritized because it's not making money.
Dr. Weiner:Yeah, I mean, even think about your childhood. You're younger than me. When you were a kid, what kind of commercials were there that were on TV? It was Coca-Cola, mcdonald's. It was, you know, jordache jeans that's probably before your time, but it was, you know, clothing and very retail type items.
Zoe:Yeah, like um different, like toys, like there was, like you know, the Barbie dream house that I want Right, um, but, but anyway, now it's all pharma. Yeah.
Dr. Weiner:All pharma. I mean, go on and watch pharma. Ads are what you see, and so that's another issue, and so I think you know. The last thing I would say to Senator Marshall's comment, though, is, if you, if we're going to look in the mirror at our nutrition and our exercise which, again, absolutely needs to happen, we also need to look in the mirror at our political system.
Zoe:Well, I thought that's where he was going with it. I thought he was going to say we need to look in the mirror to say let's fix something with this PBM insurance, big pharma situation and fix it. I was, you know. Yes, we do again need to look in the mirror and look at the nutrition and movement. But like, can we look in the mirror on those other like kind of bigger items?
Dr. Weiner:The thing that kind of struck me here too, is that we've got the US Senate, we've got a huge mega pharma company, and they both feel powerless when they're battling against the health insurance industry.
Zoe:Can they not have representatives? I mean, they don't need that insurance, people don't need to. Why would we?
Dr. Weiner:They've got all of the politicians bought and sold. They figured this all out. They've got lawyers up the wazoo, and that really, to me, is when I watched this, that was kind of a take home message, was like even these guys, who really should be kind of captains of the universe, are unable to penetrate this crazy health insurance thing we've got going on. And the problem is is this is we're looking at. To some degree, it almost feels to me very much like what I saw with the housing market like 2005, 2006, where it was like craziness, crazy, crazy prices, crazy profits, people making crazy money and it was this you know system that was just about to break.
Dr. Weiner:And then it did, and the problem is is, if they're making $800 billion and they want to get to $900 and a trillion dollars, and they want to get to $900 and a trillion dollars, at some point this will all come crumbling down, and the problem is, you know, and it's going to be bad just like the recession was our homes, this is going to be our healthcare. And so what happens? People are still going to get sick, they're still going to need hospitals, they're still going to need doctors, and when this whole thing comes crashing down, what happens? The people lose. The people lose, and so I'm really hopeful that at least we get this PBM Reform Act passed. I think that's a really important first step.
Dr. Weiner:And then, you know, as much as we're seeing the government kind of going after some of the monopolies from Google and Facebook and looking at them, I think it's just as important probably more so that they start looking at these health insurance and maybe they're not monopolies, because there's, you know, three or four big companies, but they really are. They're duopolies. They're controlling the market with their size at the detriment of the US consumer, the US patients, and so I'm hopeful that we start to see some activity there. And you know, I don't know that this is all going to come crashing down in a weekend like it did with the recession.
Dr. Weiner:It's going to fall apart, kind of brick by brick, and there's going to be an opportunity for us to step in, and I really just hope our political system is strong enough to do it, because we're counting on them.
Zoe:Yeah.
Dr. Weiner:All right, A lot, a big episode, a lot to unpack and I think, for those of you who stuck with us and listened, I appreciate you hearing this and you know we're coming into an election cycle and please make sure that you do your research and you look at at people's voting records when it comes to pharma and when it comes to health insurance, when it comes to your healthcare access. All right, We'll see you next time.
