Generics of old GLP-1s could make new versions cheaper

Two of the oldest GLP-1 drugs have gone generic, and that could help Medicare bargain for lower prices on Ozempic and other brand-name versions of semaglutide, right as the public health insurance program considers covering them for weight loss.

It's confusing to keep track of the developments related to GLP-1s and how generics could impact the price of the current blockbusters.

GLP-1 drugs like Wegovy and Zepbound grew in popularity as obesity treatments, but Medicare doesn't cover drugs for weight loss – at least not yet.

Drugs that work similarly are often sold under multiple brand names, at different prices, depending on the condition they treat and the way they're taken, and their patents expire years apart. The GLP-1s that have gone generic don't work as well as Ozempic and Wegovy, but they could still help Medicare drive a harder bargain.

If you seek clarity, read my story.

insurance

Record ACA coverage sets up Trump for a fall

President-elect Trump will inherit lower Medicare drug costs for seniors thanks to the Biden administration and congressional Democrats, but he'll be stuck with a quandary also of Democrats' making: whether to buck his party and spend big to renew ACA premium subsidies or face major insurance coverage losses.

Nearly 24 million people have signed up for ACA insurance with one week left to enroll for 2025, and the Biden administration is using the record coverage numbers to urge Republicans to renew the enhanced subsidies that made it possible.

The enhanced ACA premium tax credits – the government already subsidized ACA insurance to some extent – expire at the end of this year. There will no doubt be a fight over whether to extend them.

Republicans have so far refused to extend the subsidies, though Sen. Lisa Murkowski (Alaska) is the rare Republican to say she would like to renew them.

drug middlemen

PBM reform is still on the agenda

The newly confirmed Senate Finance Committee Chair Mike Crapo (R-Idaho) has outlined his health care agenda, and it includes "much-needed PBM reform" as well as changes to how Medicare compensates physicians.

Robert F. Kennedy Jr.'s Make America Health Again movement focuses on chronic disease, and Crapo tied Medicare doctor payment reforms to chronic disease reforms. He said he wants to provide long-term doctor payment reform, encourage alternative payment models, improve primary care, and support chronic-care benefits.

Crapo also made vaguely critical statements about the Inflation Reduction Act, and he promised to shore up Medicare telehealth services, expand mental health care resources, and keep the doors open at rural health care facilities.

trump transition

Long Capitol hill to climb

HHS Secretary-nominee RFK Jr. has been on the hill again this week ahead of an expected confirmation hearing by the end of the month. The vaccine critic faces less pushback from Republicans than some of Trump's more controversial cabinet picks, but the outcome of his nomination is still not clear.

Kennedy's opponents are out in force this week. The progressive nonprofit group 314 Action aired an ad on Fox News in Washington Tuesday morning that blames Kennedy for a measles outbreak in Samoa that killed 83 people, mostly kids.

When CNN's Manu Raju asked Senate health committee Chair Bill Cassidy how his meeting with Kennedy went, the Louisiana Republican wouldn't say whether he'd vote to confirm Kennedy. Cassidy, a doctor, said they had a frank conversation about "every permutation of vaccines."

FDA

Califf's warning

While the attention is understandably on the incoming administration, it's useful to hear from leaders who are on the way out. In an exclusive interview with Matthew Herper, departing FDA Commissioner Robert Califf offered some wisdom to future commissioners.

FDA is nearing a potentially volatile period if RFK Jr. is confirmed to run HHS, and President-elect Trump has vowed to replace career staff with loyalists, though it's not clear that he has designs on the FDA specifically. Califf warned that FDA commissioners should set policy and let career staff do their jobs without interference.

"I shouldn't be involved in the interpretation of an individual case unless there's an appeal that comes up the chain from the civil servants…," he said. "If a political appointee starts doing that, where does it stop?"

cdc

Protecting CDC's reputation

Outgoing CDC Director Mandy Cohen is continuing her efforts to shore up the agency's reputation as Washington readies for the arrival of an administration that appears skeptical of its value, according to my colleague Hellen Branswell. In a discussion at the Center for Strategic and International Studies, Cohen stressed how critical CDC's work is to the country's national security.

"We're not going to walk back from our commitments on the defense side, the military defense side. We should not be walking back our defense on the biologic side, on the public health side," she told former Republican Senator Richard Burr and CSIS Director Stephen Morrison.

Cohen spoke at length about the CDC's international work helping countries develop their laboratory and epidemiological expertise, saying that the importance of that relationship building was evident in this fall's Marburg outbreak in Rwanda.

It was the country's first experience with a viral hemorrhagic fever, and initially the illnesses were thought to be malaria — until a CDC-trained epidemiologist raised the possibility of Marburg, and the country asked CDC for help.

"You can't separate out our ability to protect people at home without doing the work globally. Because the most cost-effective way to protect us here is to actually extinguish something before it gets to our shores," Cohen said.

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