Eli Lilly recently announced a new direct-to-consumer pricing schedule for Zepbound, which is tirzepatide labeled for the treatment of obesity. Previously, Eli Lilly had been selling Zepbound in pens for administration to those without insurance for $549 a month. Lilly announced that the two starting doses of the drug, 2.5 mg and 5 mg, would now be available in vials for $399 a month (2.5 mg) and $549 a month (5 mg). These require patients to use an insulin syringe to give themselves an injection weekly. Simultaneously, Lilly increased the prices of Zepbound 7.5 mg and higher to $649 a month, although this wasn’t stated in the press release. The price changes apply to consumers who purchase Zepbound through Lilly Direct and don’t affect prices adjudicated through insurance.
Zepbound is generally started at 2.5 mg a week, and the dose is increased monthly until side effects aren’t tolerated or the desired cadence of weight loss is achieved. Therefore, most people will be on the 2.5mg dose for the first month, the 5-mg dose for the second month and will be on a dose of 7.5 mg or more each week starting in the third month.
Many press outlets heralded this as a challenge to telemedicine firms using compounded GLP-1 medications, although this actually represents an increase in cost. Here are some examples: (1) (2) (3) (4). Some quoted the Obesity Action Coalition, an advocacy group that obtains much of its funding from pharmaceutical companies.
The Food and Drug Administration (FDA) recently approved the updated Moderna and Pfizer 2024 COVID-19 vaccines. These vaccines were designed to be effective against the KP.2 variant, a close relation to the KP.3.1.1 variant, which is now predominant. The FDA is expected to also approve the Novavax COVID-19 vaccine soon. That vaccine is targeted at an earlier variant, JN.1, although some believe it will cause fewer adverse reactions.
People who got COVID this summer can wait three months from when they got it to get vaccinated. This could mean they will be more protected during the likely winter wave. However, current COVID-19 infection rates are still high across the country. So, vaccination in September is a good way to protect people who didn’t get a recent infection. I’m scheduled to get my COVID vaccination in early September.
Here’s a great guide to fall vaccines from Katlyn Jetelina, PhD, who writes Your Local Epidemiologist.
Researchers at the CDC published an economic analysis of pediatric vaccines showing that on average each dollar spent on vaccination saved over $3 in medical costs, and over $11 in total societal costs. Pediatric vaccinations prevented 508 million illnesses (four per child), 32 million hospitalizations and 1.1 million deaths over the cohort of children born over the two decades from 1994 to 2023.
The researchers evaluated vaccination costs (both direct, including the cost of vaccinations, and indirect, including time for parents to go to get their children vaccinated) and illnesses prevented based on projections if vaccinations hadn’t been available. They evaluated costs and benefits for vaccinations for childhood diseases including diphtheria, tetanus, pertussis, Hib, poliomyelitis, measles, mumps, rubella, varicella, hepatitis A, rotavirus, pneumococcus and hepatitis B.
Vaccinations shaved $540 billion from medical costs. Considering additional societal costs (including death and productivity), vaccinations were responsible for $2.7 trillion in savings compared to these vaccines not being available.
This research comes out even as nationwide polling shows fewer parents regard vaccination as extremely important. This polling shows the public health challenge of maintaining the high vaccination rates necessary for health and productivity.
The FDA approved a new blood test for colon cancer screening (Shield from Guardant) in late July. The test detects cell-free DNA from colorectal cancers (CRC) and has been approved for use in those ages 45 and older. This new test has been covered widely in the media (1) (2) (3), and I’ve heard from several companies wondering whether and how to cover this test.
The New England Journal published results of a validation study with over 7,800 participants with stage I – III colorectal cancer and found that the test has an 83% sensitivity (meaning that 83 out of 100 with colorectal cancer will be positive on the test) and a 90% specificity (meaning that 90 out of 100 who don’t have colorectal cancer will have a negative test). The test has only a 13% sensitivity in detecting colonic polyps that are precursors to cancer.
With an 83% sensitivity, we’d expect to find five out of six true cases of new CRC. With a 90% specificity, we’d expect to see 1,000 false positives out of 10,000 members. This means that negative tests are highly accurate (only one case of cancer among 9,000 negative test results). However, 99.5% of the positive tests (1,000 out of 1,005) will be false positives.
The cost of this test is $895. If all 10,000 members were evaluated with this test, the cost would be about $9 million, or $1.8 million per cancer found. This represents just the cost of this blood test, not the cost of colonoscopies or other CRC tests.
We often talk about the high cost of pharmaceuticals in the U.S. Costs of brand-name drugs in the U.S. are over four times higher than in other high-resource countries. However, the U.S. often has lower-priced generic drugs than other high-resource countries.
Research published in JAMA Health Forum used drug pricing data from eight high-resource countries (Australia, Canada, France, Germany, Japan, Switzerland, U.K. and U.S.) to simulate whether ignoring the lower prices of drugs when they become available as biosimilars or generics leads to an underestimation of the value of pharmaceutical products in pharmacoeconomic research. They found that for drugs that have years left on their patents, future price drops had little impact on cost effectiveness. However, considering future generic prices helped increase the calculated cost effectiveness of medications for drugs that were close to the end of their patent exclusivity.
Generic medications are an extremely “good deal” in the U.S., based on the much higher prices paid here for brand-name medications. Eleven states have laws that encourage pharmacists to dispense generic medications, and generic use is higher in these states.
Jeff is an internal medicine physician and has led WTW’s clinical response to COVID-19 and other health-related topics. He has served in leadership roles in provider organizations and a health plan and is an Assistant Professor at Harvard Chan School of Public Health.
