Taking Chances with Health Care

By SAM URETSKY

Accidents happen – sometimes for the best. In 1928, Alexander Fleming went on vacation without cleaning his laboratory. When he got back, he discovered penicillin, which is still the basis for many of the antibiotics used today.

In the 1950s, a team studying N,N-diallylmelamine (DAM), found that the patients in their study were growing hair, and that was the discovery of minoxidil, now sold over the counter for male pattern baldness.

The most recent accidental discovery are the glucagon like peptide -1 (GLP-1) agonists used to control blood sugar in patients with type 2 diabetes (maturity onset diabetes). GLP-1 causes the pancreas to produce more insulin after eating and helps keep blood glucose levels within the normal range. These drugs mimic the action of GLP-1 made by the body and can affect glucose control through several mechanisms including increase of glucose-dependent insulin secretin, slowed gastric emptying, and reduction of postprandial glucagon and food intake.

There are a number of drugs in this class. The Washington State Health Authority made a list:
• Dulaglutide (Trulicity)
• Exenatide (Byetta)
• Exenatide Extended Release
• (Bydureon BCise)
• Liraglutide (Victoza)
• Lixisenatide (Adlyxin)
• Semaglutide subcutaneous. The version of semaglutide for weight loss is sold under the name of Wegovy and is a 2.4 milligram dose administered weekly as subcutaneous self-injection
• (Ozempic, Rybelsus)
• Tirzepatide (Mounjaro)

Some are a daily tablet, some are given by weekly injection, but they work the same way. By virtue of a great advertising budget and a less than great jingle (Oh Oh Oh Ozempic to the tune of Oh Oh Oh It’s Magic) the brand name is commonly used to refer to the entire group. All of these drugs work the same way and have the same possible untoward effects;
• Nausea
• Vomiting
• Diarrhea
• Constipation
• Stomach pain
• Loss of appetite
• Headaches
• Dizziness
• Mild tachycardia (increased heart rate)
• Indigestion (upset stomach)

The big one is loss of appetite – weight loss. The goal of weight loss without diet and exercise has been the el dorado of quacks for well over a century – and this one works. The Food and Drug Administration released a notice: “The FDA approved semaglutide, also known by the brand name Wegovy, in June 2021 as the first new drug for chronic weight management since 2014. It’s the same drug as Ozempic, but in a slightly higher dose for a different use. Wegovy is. most effective when combined with a healthy diet and exercise.” The approval for weight loss is intended to help people whose obesity is great enough to jeopardize heart function, and not for cosmetic purposes, although it will undoubtedly be used for that purpose.

The GLP-1 agonists have one serious problem – the price, and the infamous donut hole. Medicare Part D has a limit to what insurance will pay. Medicare.gov puts it this way: “Most Medicare drug plans have a coverage gap (also called the ‘donut hole’). This means there’s a temporary limit on what the drug plan will cover for drugs. Not everyone will enter the coverage gap. The coverage gap begins after you and your drug plan have spent a certain amount for covered drugs. Once you and your plan have spent $5,030 on covered drugs in 2024, you’re in the coverage gap. This amount may change each year. Also, people with Medicare who get Extra Help paying Part D costs won’t enter the coverage gap.”

The numbers are rough, but paying for the drug can get rougher, since the price of the GLP-1 drugs run to about $1,000 for a month’s supply, so that in five months, insurance takes a vacation, and the patient has to pay full price. This lasts until the patient has paid $8,000 for the drug, and then insurance kicks in again. That’s expensive.

Senator Bernie Sanders has issued a press release. “WASHINGTON, March 27 – Sen. Bernie Sanders (I-Vt.), Chairman of the Senate Health, Education, Labor, and Pensions (HELP) Committee, on Wednesday called on Novo Nordisk to lower the list price of Ozempic and issued the following statement after the release of a new study, which found that the diabetes and weight-loss drug could be profitably produced for less than $5 a month.”

Sanders said: “Today, a new Yale study found that Ozempic costs less than $5 a month to manufacture. And yet, Novo Nordisk charges Americans nearly $1,000 a month for this drug, while the same exact product can be purchased for just $155 a month in Canada and just $59 in Germany.” Novo Nordisk has claimed that, while the drug is inexpensive to produce, it costs billions of dollars in research and development, which has to be compensated for, and critics just don’t understand.

Donald Trump, the Republican candidate for President, has been all over the lot in his plans for Medicare and Medicaid, but he has been open to cutting the entitlement programs: Medicare, Medicaid, and Social Security. The Republican Party seems to want to turn these programs into fixed grants to the states, to develop their own programs. Their own programs – like they managed to do with abortion., leave it to the states.

Sam Uretsky is a writer and pharmacist living in Louisville, Ky. Email sam.uretsky@gmail.com

From The Progressive Populist, September 1, 2024

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