Tuesday, January 10, 2023

Podcast Episode Recommendation: Politico Pulse Check - Can Mark Cuban disrupt prescription drugs?

Next up on my podcast episode recommendations is a podcast that comes from Politico, a media outlet that runs a podcast called "Pulse Check". Politico describes its Pulse Check podcast this way: "Politico Pulse Check delivers the latest news in healthcare with sharp policy analysis and a dose of real-world perspective". In other words, "Pulse Check" is about healthcare and healthcare policy emanating from Washington, DC.

On December 20, 2022, Politico Plus Check interviewed Mark Cuban about his cash-pay Cost Plus Drug Company. Before I get to the episode itself, I must acknowledge that Mark Cuban Cost Plus Drug Company is not unique. 

Indeed, other prescription drug retailers, including the giant warehouse retailer Costco Wholesale's Pharmacy business, was really an earlier version of the "Cost Plus" model which does the same thing (although Costco is not strictly cash-only pharmacy, it also accepts some insurance payments; someday I aim to write about Costco's Pharmacy business, because it's a bit of an odd hybrid retail pharmacy model which I've had trouble trying to figure out, but that's not on the agenda for today).

In the Politico Pulse Check podcast episode entitled "Can Mark Cuban disrupt prescription drugs?", Mark Cuban does acknowledge how his recent deal with Roche Diabetes Care for Accu-Chek test strips and meters as the company's first branded supplier, but he says he doesn't believe it will be his last. He elaborates a bit about how the contract negotiations with branded drug companies is extremely time-consuming because the pharmaceutical industry includes provisions such as "most favored nation status" which he says makes contract negotiations extremely time-consuming to execute. Mr. Cuban also talks a bit about the Cost Plus insulin trial with Eli Lilly and Company via its ImClone Systems business unit which commercializes Lilly Insulin Lispro Injection U-100. Lilly has been cutting prices on its unbranded version of Humalog (the manufacturer coupons can be found at https://www.insulinaffordability.com/, perhaps in anticipation of biosimilars coming in the near future). However, on that, my assessment is that Lilly's unbranded version of Humalog which is an "authorized generic" designed to bypass the PBM rebate problem and list price growth which plagues prescription drug pricing in the U.S. as an indirect result, will not necessarily be an exclusive insulin supplier for Mark Cuban Cost Plus Drug Company. They are agnostic to drug suppliers.

For example, rival Novo Nordisk Pharma, Inc. now offers an unbranded version of Novolog which it calls Novo Nordisk Insulin Aspart Injection U-100. As I covered in September 2022, Novo Nordisk also introduced an unbranded version of its newer basal insulin analogue Tresiba which is calls simply Novo Nordisk Insulin Degludec Injection U-100. Finally, it took rival Sanofi two years longer to do it, but as I covered in a previous blog post, today Sanofi (via the company's Winthrop US business) finally now offers a Lantus U-100 "authorized generic" version called Winthrop Insulin Glargine Injection U-100 as well. Sanofi also introduced a manufacturer coupon program, effectively matching Lilly Insulin Lispro's reduced price of $35/vial. I doubt we'll see Sanofi do anything with its proprietary prandial insulin analogue known as Apidra since patents on that product are due to expire, but with a manufacturer coupon from Sanofi, that insulin has become vastly more affordable.

However, "authorized generics" are by no means the only way to bypass PBM rebate-driven market failure driven by legally exempted cash kickbacks amounting to hundreds of billions of dollars annually. True biosimilar insulins made by companies other than the innovators are coming, which I have blogged about previously. We know that public companies including Sandoz, Lannett, Amphastar and Civica all have insulin biosimilars now in development. We should see the first of those coming starting in 2024.

Have a listen below, or by visiting https://politicos-pulse-check.simplecast.com/episodes/can-mark-cuban-disrupt-prescription-drugs-xd6r_5Hi

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