[elamje]

The situation is basically this -

Novo and Lilly spent billions making Semaglutide, Tirzepatide, and future formulations/modalities.

They are going to monetize this heavily while they have IP coverage. There is no world they will let HIMS or any compounding pharmacy of scale undercut them.

On the insurance front - expect your insurance to decline this forever unless you are at serious risk of diabetes. It would make you cost them $3-6k/yr more. Insurance premiums would rise for everyone if insurance was subsidizing this - no free lunch.

Fortunately, the prices are coming down. Amazon pharmacy has Wegovy in an auto-injector starting at $199 without insurance. And that’s delivered to your door in under 24 hrs in most major cities.

I highly recommend checking out the terms of trumprx.gov - not endorsing the entire government here, but it is actually working and quite cleverly written to ensure Americans are getting the lowest cost drugs in the world now. Historically, we subsidized R&D globally by allowing pharma to make most profits on Americans then have cheaper prices abroad. That is changing and hopefully that’s a net positive.

[calvano915]

> I highly recommend checking out the terms of trumprx.gov - not endorsing the entire government here, but it is actually working and quite cleverly written to ensure Americans are getting the lowest cost drugs in the world now.

Brief research indicates otherwise unless you're talking about a handful of Brand name Rx. For generics, CostPlus and other options are still better pricing.

https://www.healthcompiler.com/cost-plus-drugs-vs-trumprx-ho...

[bonsai_spool]

> I highly recommend checking out the terms of trumprx.gov

The website is very good marketing for people who don't typically follow drug pricing. Here is more about why the only folks who will benefit are those without insurance—but those people will find better prices in several places, sometimes significantly better prices [1]. Further, it's likely that they're already finding those prices, since the website prices are no better than what you can get today outside fertility medication; and fertility medications are neither new, nor the most expensive part of that process.

This site has nothing to do with the effective subsidies that Americans provide to the world, and it will change nothing about that. The major thing that would help all Americans, negotiating for drug prices, has been neutered by the current administration. In fact, an executive order has specifically lengthened the amount of time that new drugs will be able to charge higher prices to Americans [2].

We should all be very careful in parsing news items that are not in our field of expertise.

1. https://www.nytimes.com/2026/02/05/health/trumprx-online-dru...

2. https://www.kff.org/medicare/the-effect-of-delaying-the-sele...

[elamje]

Can you explain from first principles how the US market gaining MFN pricing does not benefit Americans? Open to changing my mind

[bonsai_spool]

I think 'MFN' is almost propaganda (not a term that existed before 2016-2020 administration) so let's leave that aside.

Are you claiming that the new website is offering lower prices than patients are paying after their co-pay? That is not the case outside the example I presented; moreover, the way the website is organized, there will be no pressure for prices to remain competitive after the initial media attention dies away.

I agree that a hypothetical case where we were paying lower prices would be better for us—but this remains an unrealized hypothetical. One way for us to pay lower prices would be to allow our government to negotiate prices for Medicare/Medicaid recipients, and that is exactly the thing that has been hampered.

[elamje]

Not arguing on broken internal pricing dynamics that are skewed by all sorts of gov programs and payors.

It’s about external, global pricing dynamics. The site clearly isn’t going to be able to give clean payor/pbm/gov subsidized pricing tables - that is almost an impossible exercise in our system.

What the agreement does accomplish is saying Americans will not pay $1150/mo while EU pays $400/mo while Argentina pays $120/mo.

It guarantees drugs will be greater than or equal to US pricing abroad which effectively forces pharma to find deeper profits outside of the US, or lower prices for all countries to acquire demand.

That is extremely effective. Now it’s up to a really complex group of people to figure out what that means inside our weird system of pharma/pbm/rebates/insurance/medicare.

But that’s not what trumprx is aiming to solve for right?

[bonsai_spool]

> But that’s not what trumprx is aiming to solve for right?

Correct

> What the agreement does [...]

This is hypothetical and does not exist. It also is not going to happen, politically, because drug companies are currently expecting to charge US prices in the US, while charging lower, non-US prices outside the US.

> That is extremely effective

This is hypothetical—and, as I've said, the attempt that the Inflation Reduction Act made toward this was watered down by an executive order. To be fair, the negotiation mechanism is still in place, and its existence must be influencing drug pricing already.

[mhb]

Drug companies produce drugs to make money. There is a huge investment. They maximize revenue by price discrimination to recover the cost of the good drug and all the drugs that didn't work. The US is a rich country. People in other countries can't pay as much for the drug. To maximize revenue the drug company sells the drug at a lower price to those people.

More generally, price controls lead to less supply. Drug price controls will result in fewer new drugs. Minimum wage laws result in no workers doing work that is worth less than minimum wage. Anti- price gouging laws result in less bottled water and fewer generators after a hurricane. The principle is universal despite promises of delightful state run grocery stores.

Praise for price-gouging: https://www.grumpy-economist.com/p/praise-for-price-gouging

[mullingitover]

> unless you are at serious risk of diabetes

The US obesity rate is in the 40% range.

The most effective use of public funds would be to simply buy out the patent and give it out for free. It will save so much in future medical costs it's a no-brainer.

[LadyCailin]

It’s a no brainer for reasonable people, but a very substantial portion of US voters would rather shoot themselves in the foot so long as there was a chance some shrapnel grazed a liberal.

[mhb]

> hopefully that’s a net positive

It can't possibly be a net positive. The first pill costs $1B and subsequent ones costs 50 cents. Yes, the U.S. pays more, but the result can only be some combination of 1) other countries also paying more and 2) fewer new drugs.

[loeg]

And 3) US consumers pay less for pharmaceuticals. Together this might be a net positive for US consumers (even if they get fewer new drugs out of the bargain).

[mhb]

Well that's the choice. Allow drug companies to price discriminate so that poorer people can also buy the drugs or don't allow it and get more new drugs. It's not clear that drug companies are even going to retain low prices in other countries if it means that the US consumers will pay less.

Which drugs that haven't been invented yet do you think we should forego?

[loeg]

I'm not taking a side here.

[direwolf20]

Why are you so sure that isn't a net positive? Maybe we're spending too much money on inventing drugs that would be better spent on building houses or feeding the poor.

[mhb]

Anyone who's buying GLP-1 drugs can choose to give that money to the poor instead. What particular drug do you think shouldn't have been invented?

[botro]

>On the insurance front - expect your insurance to decline this forever unless you are at serious risk of diabetes.

I'm not understanding this part. If these drugs have solved obesity and the whole host of associated diseases, including the number one killer; heart disease, shouldn't the insurance companies be clambering over each other to cover these drugs and heavily encouraging their use considering the cost reduction on the overall health system.

And if the incentives are misaligned with insurance companies why are governments not handing out GLP-1s to anyone who asks?

[phil21]

For chronic diseases that tend to be caused by obesity, the expensive bits tend to be towards retirement aged people - or are so disabling that people drop out of the workforce early.

In either case the vast majority of those costs will be incurred by either Medicare or Medicaid. Or at least the next insurer in line as the typical worker doesn’t spend an entire career at the same firm with the same insurance provider.

By the time any cost savings benefits have been realized (call it a decade later), chances are that insured patient is long gone and all they were was an additional expense.

By the time government gets involved you have someone who has been obese all their life and the damage is largely already done. Even if you paid for the meds now, the savings are limited.

Given the market already though - these drugs will be affordable to the average working person within a few years

[CincinnatiMan]

Your employer (large employers usually dictate what is covered by their insurance benefit offerings) may not care much about whether you end up with obesity-related diseases in your 60s and above.

[derektank]

>why are governments not handing out GLP-1s to anyone who asks?

Governments require consensus, which makes them slow. It took decades to phase out leaded gasoline.

[YokoZar]

> On the insurance front - expect your insurance to decline this forever unless you are at serious risk of diabetes. It would make you cost them $3-6k/yr more. Insurance premiums would rise for everyone if insurance was subsidizing this - no free lunch.

It's often up to the employer whether these meds are covered - many insurers just offer it as an option to check or not check.

That said, even at 3-6k/year, it wouldn't surprise me if these drugs were net savings to cover for a lot of patients due to their extremely positive effects as preventative care.

[tombert]

Yeah, my employer changed insurance a few months ago from UHC to Cigna.

Cigna is terrible, even worse than UHC, I'm not happy that we have them but that's a whole separate rant I don't care to get into right now, but one thing I was really annoyed by was that UHC covered Zepbound, but then Cigna didn't. They actually wouldn't cover any GLP-1s unless you are already diabetic, so my wife had to stop.

I initially blamed Cigna for this, but eventually I found out that my employer deliberately opted out of it, so now I'm mad at my employer and Cigna.

We've had to use a compounding pharmacy for my wife to continue her terzepazide, which has worked fine and at least thus far hasn't been an issue, but I knew that these things were on borrowed time due to their kind of gray legality.

[cowsandmilk]

Novo will also sell you the auto-injector Wegovy directly starting at $199/month. And the pill starting at $149/month.

[terminalshort]

Good. Now we just need to cut out the doctors. No reason this medications shouldn't be over the counter.

[alephnerd]

The major Indian generics manufacturers have all signed branding and IP agreements with Lilly and Novo as well, so the only people that are hurt are consumers I guess.

India wins (because Indian pharma gets IP and branding transfers). The Trump admin wins (the right strategic lobbying was done). The GOP wins (strategic tariffs on Iowa, North Dakota, and Montana lentil and soybean oil exports were about to kick off in India after they were hit by similar tariffs from China). The American consumer (who voted for Trump) loses.

Welcome to a trade war.