February 27, 2025

[00:00:00] Speaker A: ProactiveMD. [00:00:05] Speaker B: From Makorx and ProactiveMD. This is healthcare Explained. I'm Jeremy Vanderck. Knife. [00:00:10] Speaker A: I'm Vinay Patel. [00:00:12] Speaker B: All right, well, thanks for hanging on with us. Our last couple episodes have been interviews with some industry experts. This week we're going to be back talking about some recent news and updates and what's going on in the country and the world in the exciting healthcare space. I'm going to do my very best here, Vinay. As you know, coming off of about two weeks of travel, culminating in the flu. So hopefully my voice will hold for that. If not, I think these things have AI tools or something. We'll just, we'll just dub me over with someone else. But how are you these days, Vinay? [00:00:43] Speaker A: Doing great, just like you, Jeremy. Running 100 miles an hour. And we're trying to tackle the new healthcare challenges that we expect to be facing this year with the same figure that we did last year. And I think that we got some exciting times and exciting opportunities and exciting challenges that we're. We're only going to be able to see as the year unfolds, doing well, staying healthy otherwise. And we'll be making sure that we get you recovered super fast so that we can continue these sessions. [00:01:12] Speaker B: That's right. All right, so what we've got on tap today, we're going to talk about some recent healthcare news. We're going to continue our recurring segment of what's killing us this week. For me, it's obviously flu. And then this being, you know, we're only a month and change into 2025 at the time of recording. So there's still 11 more months of, of healthcare in front of us. So let's do some predictions and end this show thinking about what we expect to see change in the world of healthcare in, in 2025. Before we dive into our first topic, Vinay, that I know you'll be talking us through, I did just want to provide a very important update to our listeners who have been with us since our pilot episode. They have announced that all of the monkeys have been recaptured. All of the monkeys that escaped from the South Carolina lab have been recaptured. They're all found. They're all safe and accounted for. [00:02:04] Speaker A: Wow. [00:02:05] Speaker B: So that's bringing it full circle. We at least don't need to worry about random rhesus monkeys running around that may or may not be infected with some kind of experimental. Experimental drug or disease. [00:02:17] Speaker A: That's right. Oh, that's great to hear. Excellent. They're all still on the island. They made it back into the institution. [00:02:24] Speaker B: And hopefully they, they enjoy their time away you had as a vacation. That's all right, Vinay. So what's our first topic today? [00:02:32] Speaker A: So we're, we're going to talk about our first health care healthcare news related item is about Aetna. Aetna sues drug makers claiming the insurer, consumers and the federal government was overcharged for generic drugs. These are the drugs that are the most commonly available and the lowest cost medications. People that may know these medications as blood pressure medications or antidepressant medications and birth control medications. So Aetna, which again other insurers have already done this previously, they are sort of a little late to the game, but they're suing Aetna suing 20 drug makers alleging they and others colluded as far back as 2012 to determine the market, the market share and prices of more than 100 generic drugs. Novartis, Pfizer and Teva are among the top pharmaceutical companies named as defendants. And Aetna alleges the company's predetermined market share, fixed prices and rigged bids on listed generic drugs. The Department of Justice filed a lawsuit against generic drug companies in 2016 and there have been several multimillion dollar settlements by Teva and Glenmark Pharmaceuticals to states and federal government. The big question is why now Aetna maybe because it had a bad year in 2024 and needs to find some new revenue unknown. But here we are with another insurance company suing generic drug manufacturers. Gener Jeremy, any thoughts? Comments? [00:04:09] Speaker B: I mean I think it's fascinating and just, you know, a few weeks ago Vinay Goodrx was being sued. That's right, by pharmacies, if I recall. [00:04:18] Speaker A: That's correct. [00:04:20] Speaker B: Around price fixing and things like that, collusion. I guess my number one question is how is it that there is so much ability allegedly for these companies to collude in this space, particularly for generic drugs which are manufactured all over the world. How is it that there continue to be kind of these lawsuits with these allegations coming out? And if we were to assume, which we should not, but let's say for the sake of argument that these allegations are true or that the ones against Goodrx are true. [00:04:49] Speaker A: How does that work? [00:04:50] Speaker B: How are these companies able to create an environment in which there is a sufficient lack of oversight to enable them to do a price fixing at this scale? Any thoughts there? [00:05:02] Speaker A: The I've done some research recently in the last six months around the drug supply chain and it's really opened my eyes to a lot of the inner workings of the drug supply chain, particularly the generic drug supply chain. And I don't know if it's related or not, but here's what we know about where we've come to in the, in the drug supply chain. And there was actually a report published by the Department of Health and Human Services around this very topic of generic drug supply and shortages, drug shortages, particularly on the fragileness of drug supply that we have in the country since, since we had the boom of generic drugs in the early 2000s up until probably 2015. So generic drug manufacturers don't get, don't have any idea what kind of volume that they'll get in terms of, if they decide to create a manufacturing line for generic drug. They will have group purchasing organizations or wholesalers reach out to them and tell them here's the drug that we need. And they have very one sided agreement contract terms in those agreements that say if for some reason we find a lower price, we're going to go to a different manufacturer or if you don't meet, you know, certain conditions that are outside of their control, they're going to be able to pull the contract and cut pricing. And so they're operating on razor thin margins and unpredictable market share, market volume. And so I think that environment and that condition has led to the drug company, generic drug company, saying okay, well if we're going to figure this thing out, if we're going to survive, we're going to have to divide and conquer this market to really be able to serve the world's need for these medications. And again, this is not a direct correlation. I don't have any insider knowledge, but I'm just describing. And this, this book by Katherine Eben called Bottle of Lies was really insightful. It was published a while ago now, but it talks about the generic drug supply chain and how the international community became the place to go get drugs manufactured. India is a big source. All the primary ingredients, the key starting ingredients for these medications come from China. And so we have geopolitical ramifications here. And we also have this stability and viability. And there's been suggestions by the federal government to bring to have some sort of stockpile of drugs in case something happens to the supply or have some manufacturing continue to happen here in the States. And ironically those same factories are the same ones that the big drug companies use like Pfizer and Novartis to manufacture brand name trucks. And then they switch and become the generic manufacturer. And the qualities is not as closely monitored as it is in stateside where they can do random inspections there, they have to schedule them and tell them that they're coming to get inspected by the fda. So a lot of different factors. [00:08:06] Speaker B: Yeah, a lot of different factors. It's just a tough regulatory, political, legal environment right now. It does seem that, I mean, probably if you asked people their 10 most admired companies, let's be realistic, insurance companies and pharmacy, you know, big pharma is probably not going to top the list for most Americans. But it's definitely been really eye opening these last few weeks and months just to see as our environment is changing, as people are becoming more aware of spread pricing, of kind of the complicated supply chain of getting the drug to the bottle, the pharmacist hands to you and all the different hands that are in that bottle. Hot. As people have become more familiar of what's going on and maybe not so happy about it, it definitely seems like there's an increase in litigious behavior as the finger pointing goes on between the different parties who are involved, whether it's the pharmacies, you know, going against Goodrx for colluding with insurance companies, insurance companies doing pharmaceutical companies and manufacturers for price fixing. I'd like to say that at the end of whatever scorched earth legal battles is going to be an environment in which we've got transparent pricing and the consumers are going to come out ahead. Maybe this gets into my, maybe this gets into my, my predictions for this year a little bit too early, but I'm not convinced that that'll be the case. If history serves as any model for. [00:09:29] Speaker A: The future, I'm with you. I have hope that if anyone's going to do it, it's going to be the federal government demanding this or breaking up the company. So, you know, either way, the regulatory compliance issue, compliance legislation or breaking up these large insurance companies will lead to that, lead to more transparency. But I'm with you. Let's see what happens. Maybe this year we have a better chance than any other year. But still hopeful but, but cautious about what's about to come. I liken this to. I've been thinking about this. I don't know why quite a bit over the last month is healthcare seems to be a Mexican standoff and it seems like patients are caught in the middle. It's like on the drug side, you got pharmacy benefit companies, drug manufacturers and employers all pointing a gun at each other saying who's going to flinch, who's going to move? And then they all just slowly keep backing away because they have to work with each other. They have to continue the model. If they stop, if someone sort of falls off this triangle, then everything falls apart. And it's so, you know, sort of very loosely held together. And we got, on the, on the other side, you know, you got pharmacies and wholesalers and pharma, and they're all sort of like at a standoff, like, come on, we need to change something. But then we all just sort of wait and years go by and it just keeps getting worse while everyone's just sort of like, come on. [00:10:55] Speaker B: Yeah, no, I think you're right. And it is just very interesting that I think, you know, the course of the way of solving this and. Right. If we think about a capitalist, free market society, for a free market to operate effectively, there needs to be transparency and price signals to the consumers, to the individual buyers. And I think that maybe what we're seeing with so much litigation around this issue is a direct result of the intentional lack of transparency that the entire environment has created. Because at the end of the day, you know, I could understand the position of an Aetna or any, any pharmacy benefits manager being upset around price fixing. If positive supply and demand would be a lower price, then so be it. But as a consumer, I also know, okay, so you're upset that you got charged $2 for a 90 day supply as the pharmacy benefits manager and it should have been a buck fifty. Meanwhile, you will turn around and sell it to the consumer for a, you know, a $20 generic copay plus, you know, a $30 bill to the insurance. It's, you know, so it's just a, it's a, it's an interesting, it's just a very interesting dynamic. Well put. [00:12:04] Speaker A: All right, Jeremy, I think that you need to enlighten us on what's killing us this week. What do we got on tap? [00:12:11] Speaker B: Well, in the last couple weeks, the first recorded death from bird flu, avian flu, was reported in the United States. There have been, as of about mid January or so, there have been a few dozen cases that were reported. This was the first death though, from it. It was an elderly, elder, elderly patient, as I understand, who had come into contact with backyard poultry. And so it was a, a bird to human transmission on this one. But you know, bird flu is something, we've been talking about it for probably 15 years as, as one of those things that like many communicable, zoonotic or animal based diseases, has always been floating around on the periphery and has, has certainly raised concerns before. I think what we're seeing though is now people within the US have, are, are catching it. And of course with the first death. Some of the things that, you know, scientists have noticed about this particular strain of the avian flu is that it appears to mutate very quickly. So it was able to make the leap. Usually it goes through several different animals before finally it mutates to be able to, to reach humans. And I, I think I, I heard or read something recently that it was one of the, the dominant strains right now made the jump to humans. It was like bird to pig to human and a kind of a quick or bird to cow to human. And so a number of animals, mammals have been infected with it very easily. Is mutating quickly. It is an area of public health concern. But I'll, I'll tell you one of the really interesting things that, that we're going to be faced with in the environment right now. And Vinaya, you and I talk. We want this to be a nonpartisan, non political podcast and I think it's important to our listeners who probably are all across the political spectrum to do that. Certainly we might have some, some feelings on, you know, health care and the insurance industry or primary care, but it tends to be non political. One thing that is important to note though that came up recently is as a result of President Trump's executive orders, one of those executive orders directed Health and Human Services and the CDC to pause all communication with the public. Right. And I understand there are reasons behind that executive order, etc. But what it means from a public health standpoint is one of the most exciting. By exciting, I mean it's a lot of tables and graphs. But every week the CDC has a report they put out called the mmwr. It's the Morbidity and Mortality Weekly Report. So CDC is putting out statistics of essentially it's the original what's killing us this week or last week. Right. And so they're able to take in data from all the individual public health surveillance laboratories in the country, communicate, you know, until recently with the World Health Organization, the WHO to receive data. And so I think one of the things coming out of this is the MMWRs have been paused. So from a national standpoint, as far as being able to communicate from a federal level with public health agencies in states and local communities, with universities and researchers, other kind of public health allied workforce is going to be somewhat limited at least as long as this, this executive order is in place or until the CDC receives new leadership and order is lifted. So I guess my advice would be that if you're one of those people who's interested in understanding, you know, what is the latest with, you know, some of these communicable diseases would be looking to independent researchers, universities, or retrieving the data yourself from state, individual state health departments or local health departments. But MMWR has always been a good source of understanding how is this particular disease increasing in prevalence and what do we expect to see over the coming weeks and months? So just something for our listeners to be aware of. If you're keeping an eye on avian flu and wondering what it's going to mean for you or your employee population, is this something you need to be worried about right now? Flu A and B are the ones that are going around and really infecting people right now. Not, not bird flu, but it's certainly something that's worth keeping an eye on. But you may need to look for for some different sources than you would previously just as a result of some of these regulations. And Vinay, any, any thoughts on, I guess, bird flu or kind of public health communication? [00:16:22] Speaker A: So, yeah, you know, my, my daughter actually asked me this question this week when I mentioned to her about this bird flu death and she was like, how do you get it? And I was like, I don't know. Is it, you know, is it only by interaction, physical touch to the animals that it's communicable or can it be communicated after a human gets infected through respiratory secretions? You know, it, it. [00:16:46] Speaker B: So the current strain of bird flu that's going around can be passed from human to animal contact? Of course, animal to animal contact. That's how it, you know, is able to make the jump from birds in the first place. But you know, some of the earlier strains that we had seen in months and years past, it was, you would typically hear about it was poultry farmers typically overseas somewhere that were dealing with large, you know, herds or flocks of chickens, ducks, you know, in some cases, if it does make the leap into mammals, then, you know, I think it could be communicated or it could be passed from, for example, a cow to a human. But it can be passed human to human. I don't believe it is currently airborne right now, but they are warning that it could be spread from person to person contact. So as with anything, I think. Wash your hands. [00:17:38] Speaker A: Exactly. That's right. [00:17:41] Speaker B: Particularly if you're handling livestock, you know, animals, if you keep chickens as pets, as even I have some friends who do for those eggs, just make sure you're washing your hands. If you start to show Symptoms again, keep yourself out of contact from, from other people as well. [00:17:56] Speaker A: That's right. Have separate clothing where you handle the animals. Then make sure they go to the wash immediately after that. Change out your clothes after you've handled pets. [00:18:05] Speaker B: I have to ask Vinay, you're somebody who has worked in a clinical environment. Are you a germaphobe? [00:18:11] Speaker A: I personally am not. I can tell you that when I was doing clinical rotations, every time I stepped into the hospital, it wouldn't matter if it was the ICU or if it was the general ward, I would come home with a fever literally within a week of starting in a healthcare setting. I've washed my hands regularly, but I'm not overly or particularly concerned about germs to that, to that extent. I'll just, I'm not a surgeon. You know, surgeons will, will be meticulous about how they wash their hands and, and for, you know, right reason they're opening up a body cavity. But yeah, no, not a, not a germaphobe. How about you, Jeremy? [00:18:44] Speaker B: I, I am a compulsive hand washer. I mean I'm not, I'm not like if you ever remember that TV show Punk with Tony Saloob, you know, not to that extent, anything like that. But I love my dog dearly. I pet her and I wash my hands. And I'll tell you, becoming a father, you know, 10 years past now is you just have to put that away because there's no, no amount of soap or water in the world. [00:19:11] Speaker A: That's right. [00:19:12] Speaker B: Will keep your kids from getting you sick. [00:19:14] Speaker A: That's right. [00:19:14] Speaker B: I dream one day of when they become compulsive hand washers. Maybe I won't get sick quite so often, but yeah. [00:19:21] Speaker A: Okay, let's move on. To close out this episode of Healthcare explained on predictions for 2025. You know, healthcare specifically predictions for 2025. I got a couple I'll rattle off and then Jeremy, share your predictions and we can chat about it real quick. So first one up and I think this is going to be a non shocker for everyone. Increased GLP1 utilization. So that's drugs like Ozempic and Zepbound and Mounjaro. We're just going to see more of this drug being utilized in the general public and then we have employers pushing back due to costs. I think we saw a couple of eyes widen this past year with several employer groups that we interface with due to just runaway costs that they've seen and they may want to redecide decisions. We have compounded Pharmacy options, but they're likely going away in light of the FDA determining there's no longer a shortage of specifically the active ingredient in Mounjaro called Tirzepatide. And, and most doses of the active ingredient, Ozempic, which is semiglutide, until probably, there's probably another week or two left of obtaining these drugs from compounding pharmacies with an individual prescription. And then we have bulk compounders, they have the notice to stop manufacturing this in bulk and sometime in March. But there's, there's also some legal activity around that decision and we'll see how that plays out. For now, this is the information we've gotten from the fda. [00:20:51] Speaker B: Well, hold on, hold on. I can't let you go, Vinay. Okay, predictions. Which way do you think it's going to go? [00:20:58] Speaker A: I think there's too much money in GLP1s across the board for there not to be a good fight. I think these pharmacy compounders will have a really good fight fight in the courts about this to the point that they may not win, but they'll delay it to hopefully get, you know, maybe another six months, maybe another year out of this before it truly gets shut down. We've already seen the drug companies, Lilly, I think Lilly, and Novo Nordisk sue Medispas over labeling of these drugs. And so we may see some litigation against big compounders as well. But I think that there's going to be a good fight and that the compounders will at least extend it, the ability for them to manufacture it. [00:21:38] Speaker B: All right, that, my friend, is a prediction. [00:21:40] Speaker A: There we go. Thank you. Thank you for holding me accountable. [00:21:43] Speaker B: We gotta, we gotta have the crystal ball. All right, what else, what are some other predictions you have? [00:21:50] Speaker A: There's gonna be more biosimilars released to market in 2025. But the prediction here is that they probably won't get widespread adoption unless it's the insurance company or the PBM that owns the manufacturer. And so we saw this recently with Stellara, Stellar went biosimilar this year, this, this, this past month actually. And we were about to see, you know, a manufacturer release it to market and have some good competition instead. I can't remember the name of the insurer owned drug manufacturer. They're going to be releasing it exclusively through this particularly insurance owned manufacturer. And in that, in that product line and product vein with two different versions, there'll be a high rebate, I'm sorry, high cost, high rebate product release and the same product released as a low cost, low, no rebate product. So employers get to decide if, if they're not steered in any particular direction, which, which version of this new biosimilar for stelara they'd like to see. Hopefully we'll see more biosimilars, but I don't think there'll be great adoption unless we see this competition really heat up and employers start pushing back on wanting the ones that are value added. What do you got, Jeremy? Why don't we go with an example, a prediction you have for 2025. [00:23:04] Speaker B: I honestly, I think this is going to be the year that we start seeing some legislative and federal changes that are going to encourage more value based care models. You know, I think one example is I think we'll see an increase in Medicare Advantage. That's something that President Trump had indicated support for. And with the selection, assuming, um, Dr. Oz is confirmed as the head of Centers for Medicare and Medicaid Services. Now the, the other interesting choice for one of the deputies was Dr. Marty McCary for head of the FDA. And Dr. Oz has indicated, I think previously support for Medicare Advantage. And that, you know, what's really interesting about Medicare Advantage is that it is a good example of where public private partnership can work effectively, at least with certain markets and certain products. I've demonstrated the idea that, hey, you can drive better outcomes for patients by disbursing this money rather directly from the federal government to the provider who's providing services on behalf of the patient through a Medicare Advantage program. You're going to see it where these programs are subsidized from the federal government to health insurance carriers who have launched value based care products like your Blue Cross Blue Shield or your Humana. And then those groups then are able to leverage the power of their networks and their contracts to be able to provide preferred reimbursement for providers who are able to achieve certain quality metrics within the population. And what's that seen is that when that system works effectively and those products are effective, it's able to drive down the cost of care. So I do think that under this new administration we will see more of a push for that. Medicare is probably the biggest landmine in all of politics because it is something, the concept among older, you know, of Medicare is very valued among older adults who tend to, you know, be one of the largest voting, voting blocs in America. So both parties tend to approach discussions around changes to Medicare very carefully. But I do think we'll see more of a push for Medicare Advantage and other value based care products coming out of some of the some of the leaders that President Trump has nominated for these cabinet or deputy cabinet positions along those lines also coming out of the primary care space, one of the pieces of legislation that has never quite made it over the finish line, I'm not sure if it's made it out of committee is can patients members who have a high deductible health insurance plan with a health savings account, an hsa, can they use that HSA to actually purchase a primary care membership with a DPC doctor? And currently that's not allowable under the IRS and the rules for hsa, you're allowed to, to pay for as much fee for service medicine as you want. But the idea of getting that care more in a more cost effective, value based manner is, is not allowed. I do think with, you know, Dr. Makary has been one of the louder voices and most prominent voices the last few years around healthcare transparency and the value of direct primary care. And I do think that, that this might be the time that we see that legislation advance again. It tends to be a nonpartisan or a bipartisan sort of piece of legislation. It's just that there haven't necessarily been loud enough voices. Many people who are lobbying, doing a great job trying to raise awareness around the value of direct primary care, you know, but those folks are also coming into conflict with larger health systems and larger insurance companies and all the rules that just come with changing anything in the federal code. But I will predict this year that I think that bill will make it out of committee and I, I think it will actually have bipartisan support and, and be passed. That's, that's what I'm going to put up my money on this year. [00:26:47] Speaker A: Okay, well, stay tuned with us to see what happens in healthcare in 2025. We'll have lots of, lots of upcoming episodes covering all the changes in healthcare and have some more guests to interview. So we're really excited for 2025. And Jeremy, do you have any closing thoughts for us to wrap up this first episode of 2025? [00:27:13] Speaker B: I just hope we, we don't look back on this episode by December 31st and say, man, we were so off. That's, that's it. It's just a prayer for the future. [00:27:22] Speaker A: There we go. Yeah, either way, we'll be here and we'll continue. Even if we fail and we get we, even if we bat a zero, we'll be at it again and continue our predictions for the following year and see how we can get better for next year. [00:27:38] Speaker B: Sounds good. All righty. Well, Vinay, Always a pleasure talking to you from ProActive MD and Makorx. Once again, this is Healthcare Explained. I'm Jeremy vaynerknife. [00:27:48] Speaker A: And I'm Vinay Patel. [00:27:49] Speaker B: And we'll see you next time. [00:27:56] Speaker A: ProactiveMD.