366：维京减肥药失败，“从药厂到餐桌”的药物销售

欢迎收听本周的《Read Out Loud》，这是来自STAT的每周生物技术播客。我是Alison DeAngeles。

Welcome to this week's episode of the Read Out Loud, a weekly biotech podcast from STAT. I'm Alison DeAngeles.

我是Adam Forrestein，度假回来了。

I'm Adam Forrestein, back from vacation.

我是Elaine Chen。今天是8月21日，星期四。Adam度假回来了，下面是我们本周要聊的内容。

And I'm Elaine Chen. It's Thursday, August 21. Adam is back from vacation, and here's what we're gonna talk about this week.

我们要聊的是Vikings。不，我们说的不是10世纪航海的北欧人，也不是明尼苏达的美式足球队。我们指的是肥胖药开发商Viking Therapeutics，以及追捧它的投资者“邪教”。本周两者都来了个痛苦的肚皮拍水式大跌。

We're gonna talk about Vikings. No. We're not gonna talk about the seafaring Norse people of the tenth century or the Minnesota football team. What we are referring to is, the obesity drug developer Viking Therapeutics and the investor cult that embraces it. Both performed a painful belly flop this week.

我们还要聊“farm to table”，拼写是p-h而不是f。这是大药企内部人士爱用的聪明口号，用来推广直接向消费者卖药的计划，据说价格更低，会让特朗普总统高兴。不过，正如我本周报道的那样，由礼来、诺和诺德、百时美施贵宝等力推的这些直销计划，不太可 能让药品更便宜。我们会深入细节。

Also, we're gonna talk about farm to table. That's with a p h and not an f. It's the clever buzz phrase bandied around by big pharma insiders to promote plans that sell drugs directly to consumers, supposedly at lower costs that will make President Trump happy. Except, as I reported this week, these direct to consumer plans championed by Lilly, Novo Nordisk, Bristol Myers Squibb, and others are unlikely to make drugs more affordable. We'll dig into the details.

广告之后，这些内容马上回来。

All that's coming after a word from our sponsor.

Samsung Bioepis是一家生物制药公司，拥有快速增长的优质生物类似药组合。今天，我邀请到Samsung Bioepis全球商业部门执行副总裁兼负责人Linda Choi MacDonald，来了解生物类似药为何对医疗体系至关重要。

Samsung Bioepis is a biopharmaceutical company with a rapidly growing portfolio of high quality biosimilars. Today, I'm joined by Linda Choi MacDonald, EVP and Global Head of Commercial Division at Samsung Bioepis, to learn more about why biosimilars are so crucial to health care systems.

生物类似药在疗效、安全性和高质量方面与原研参照药相当，基于同样的科学，由同样的FDA专家审评，遵循同样严格的标准。它们通过降低成本让患者更早获得治疗，从而改变生命。但问题是，未来十年失去专利保护的大多数生物药都没有对应的生物类似药在开发。要填补这一缺口，我们需要削减过于严苛的监管壁垒，并让更多生物类似药进入优先报销目录。

Biosimilars are just as effective and safe with the same high quality comparable with their reference products, but built on the same science, reviewed by the same FDA experts, and held to the same rigorous standards. They're changing lives by allowing earlier access to treatment through lower costs. But here's the problem. Most biologics losing exclusivity over the next decade have no biosimilars in development. To close this gap, we need to cut overly restrictive regulatory barriers and have more biosimilars placed on preferred formulary status.

Linda，大家怎样才能了解更多信息？

Linda, how can people find out more?

只需访问samsungbioepis.com。

Simply go to samsungbioepis.com.

好了，各位，咱们先来聊聊“维京神教”。这家肥胖症初创公司在推特（也就是X）上拥有无数粉丝，大家几个月来一直在猜测它会成为极具吸引力的并购标的。有人信誓旦旦说“明天肯定被收购”，结果并没有。

Okay. Let's kick it off with the cult of Viking, folks. This is the obesity startup that has, many, many fans on Twitter, aka x, people who have been speculating for months and months that it is going to be a very attractive m and a target. It's certainly it's getting bought up tomorrow. No.

又说“下周一定被拿下”，还是没有。还有人喊“马上就会爆出几十亿美元的大交易”。所有这些议论，在维京公布二期数据后有点变调。Elaine，你来详细说说？

It's getting bought up next week. No. It's gonna go out in this multibillion dollar deal. Well, all of that chatter, you know, got a little bit of a shift this week after Viking released some phase two data. Elaine, can you tell us more about it?

好的，这是他们主要候选药物的口服版本，一种GLP-1/GIP双激动剂。数据发布前市场预期极高。这是二期试验，13周后最高剂量组体重下降了12%，但耐受性看起来并不理想。

Yeah, so, this is the oral version of their lead candidate. It's a GLP-oneGIP dual agonist And expectations were really high going into this readout. It's a phase two readout. And ultimately, over thirteen weeks, the pill led to 12% weight loss at the highest dose. But the tolerability didn't look amazing.

停药比例相当高：整个治疗组有28%的受试者退出，而安慰剂组只有18%。消息一出，股价单日暴跌42%，反应非常剧烈。一方面，此前预期确实过高，可能需要回调；但另一方面，13周减重12%依旧算很有效。

There were quite a high number of discontinuations, and when we're looking at the entire treated population in the study, twenty eight percent of treated participants discontinued compared to eighteen percent of those taking placebo. And the stock dropped 42% in one day. So really dramatic reaction. And on the one hand, expectations were really high going into this readout, and probably not warranted. So maybe there is some kind of adjustment that needed of expectations.

而且这只是二期，公司还没完全摸索出最佳的滴定方案，仍有空间去优化，争取更好的耐受性表现。

But at the same time, 12% weight loss over thirteen weeks is still very efficacious and it's a phase two study so I think the company hasn't fully, you know, figured out the right titration schedule so there's still room to moderate that and maybe, you know, try to get a better tolerability profile.

哎哟Elaine，你这口气听起来就像维京神教的铁杆信徒啊。

Man, Elaine, you sound like one of those Viking cult members. I

没错，就是我，本人。

that's me. That's exactly.

你是不是……你是不是戴着那啥？

Are you wearing? Are you

戴着牛角头盔呢？嗯哼。

wearing you're wearing horns? Uh-huh.

你正戴着呢。

You're wearing

就像你头上戴着一个带角的头盔。我能看到

like a helmet with horns on your head right now. I can I can see it

是的？对吧

Yes? Right

我们要把所有维京人的梗都先说完。所以我们先把这些

We're going to get all the Viking jokes out of the way. So we'll get those

搞定。绝对没问题。

done. Absolutely.

嗯。不，我觉得你说的确实有道理，对吧，Elaine？我的意思是，如果纯粹从减重的角度来看，这个结果并不算差。但我认为大家原本期望很高，觉得这不仅会看到显著的减重效果，而且还会看到非常有利的安全性表现，尤其是在我们已知的这些GLP药物或这次的GLP-GIP药物所带来的胃肠道副作用方面。但事实并非如此，对吧？

Yeah. No, I think, what you say is it rings true, right, Elaine? I mean, this is the weight loss when you look at it just purely from the weight loss perspective, it's not it wasn't a bad result. But I think there was a high expectation that this was going to be not only you're going to you were not only going to see great weight loss, but you were going to see a really favorable safety profile, particularly when it comes to all the gastrointestinal side effects that we know that these GLP drugs or these GLPGIP drugs in this case cause. And that just wasn't the case, right?

我的意思是，我们看到其实停药率相当高。然后公司方面和药物的支持者会说，他们在这里用了非常激进的滴定方案，也就是药物剂量随时间递增的方式。但归根结底，这是公司自己选择的试验设计。他们这么做是有原因的，因为他们显然觉得可以靠这种方式展现出同类最佳的效果。结果适得其反。

I mean, we saw there was it was actually really high rates of discontinuation. And then the defenders of the company and of the drug say, well, they were using a very aggressive titration schedule here, meaning how sort of in terms of how they were escalating the doses of the drug over time. But ultimately, that's the study that the company chose to run. And they did that for a reason because clearly they thought that they could get away with that and show kind of a best in class profile. And that backfired on them.

所以我的意思是，这是他们自己的问题，不能怪别人。

So I don't mean, that's their fault and not anyone else's fault.

支持者还会提到，要知道，这个口服版本——因为Viking有这款药物的注射版本，我们现在说的是口服版本——公布了数据。支持者说，这款口服药并不是要让患者单独长期使用，而是作为一种维持疗法。也就是说，患者先用注射剂大幅减重，然后可以转成低剂量的口服药来维持体重，Viking在这次研究中也发布了一个探索性队列数据，显示出维持体重的潜力。我是个记者，所以我觉得市场反应过于负面，但同时我也搞不懂为什么还有那么多正面声音，因为它毕竟是一个口服肽。

Defenders also talk about how you know, this oral version because again, Viking has an injectable version of this drug, and this is the oral version we're talking about, that released data. The defenders say this oral version is not really meant to be the sole drug that patients take. It's meant to be a maintenance therapy. So, say patients first lose a lot of weight on the injection, then they can transition to maybe a low dose of the pill to maintain the weight loss, and Viking did release kind of an exploratory cohort data, that they did in this study that did show potential for weight maintenance. I'm such a journalist because I like feel like the reaction was, too much, there was too much negativity but at the same time I also don't understand all the positivity because it is an oral peptide.

所以它并不是小分子，生产时需要大量原料药。Viking是一家初创公司，我不知道他们会不会找合作伙伴，但生产难度会非常大。所以我对这款口服候选药为何仍被热捧也感到困惑。

So it's not a small molecule, it's going to require a lot of API to manufacture. Viking is a startup, I don't know if they're going to partner, but like it's going to be really difficult to manufacture. So that also confuses me on why there's still so much enthusiasm for this oral candidate.

整体来看，可以说大约去年这个时候，整个药物行业对开发口服GLP-1疗法或口服GLP-1/GIP疗法的热情，确实遭遇了很多挑战。于是Viking支持者的声音就与临床试验结果形成了鲜明对比——Viking的口服药二期结果令人失望；礼来首次尝试的口服药物也未达预期；辉瑞则直接终止了开发。我们现在是不是该对口服药物的期望进行一次更大范围的重新校准？

Well, at large, it seems excitement that was kind of permeating the drug industry, let's say, know, like, this time last year about developing oral GLP-one treatments or oral, you know, GLP-one GIP treatments has really been met with a lot of challenges and so then the Viking defenders stand out in very stark opposition to the clinical trial results, which is, you know, Viking's, you know, phase two oral drug result disappointed. Eli Lilly's, like, first stab at an oral, you know, drug didn't really meet expectations. Pfizer's discontinued development. Do we need to have like a larger, you know, level setting for our expectations for oral medicines at this point in time?

是的，我觉得这很合理。我们确实看到这样一个趋势：口服候选药物的表现远不及注射药物，也许我们正身处这样一种境地——我们睿智的Adam Forrestein曾在推特上说过，也许我们已经达到了目前市面上减肥疗法的最佳状态。

Yeah, I think that's fair. It is a trend that we're seeing that really the oral candidates are not living up to the injectables and maybe we are in a situation where our wise Adam Forrestein once tweeted that maybe we're just at the best that we already are with the obesity treatments on the market right now.

我确实说过，对吧？那是挺久以前了，我当时说，嗯。

I did say that, didn't I? Was a while ago where I said, yeah.

谢谢你，Elaine。

Thank you, Elaine.

Elaine，你知道别引用Adam的话。我们可不能让他再膨胀了。

Elaine, you know not to quote Adam. We can't let his ego get any more inflated.

Elaine，你太Elaine了，你引用我真是太睿智了。

Elaine, you're so Elaine, you are so wise to quote me.

没错，我也很睿智。

Exactly, I'm wise too.

也许最好的减肥药已经在市场上了。

That just maybe the best obesity drugs are already on the market.

嗯，这种新思路，再加上Viking把它定位为维持治疗，有点……

Well, new kind of thinking plus Vikings positioning of this as a maintenance treatment kind of

让我觉得他们现在在肥胖领域的产品线上简直是在抓救命稻草。我觉得，老实说，任何在Novo和Lilly之后想挤进来的公司，都像是……他们必须找到切入口，不管是说‘我们要做维持治疗’还是‘我们要做辅助疗法’。你知道，它们可能永远比不上我们现在这些单独使用、需求巨大的疗法。

makes me feel like they're grasping at straws at this point in time with, you know, their pipeline in the obesity space. I think like honestly any of the companies that are coming after now after Novo and Lilly are all just like, I mean they kind of have to find a way in whether it's like, oh we're going to be maintenance or we're going to be an adjunct therapy. You know, it's never going to be perhaps as big as just like the therapies that we have now that are just, you know, taken on their own and just have huge demand for them.

我们聊过Viking的投资者粉丝团，那主要是由散户推动的。但Elaine，你觉得Lilly也有类似的粉丝团吗？

So we talked about the Viking investor cult, which is kind of retail driven. But Elaine, you think there is a Lilly cult out there?

是的，有点。因为当Orfagliptron的数据公布时，也就是礼来的小分子GLP-1，几周前数据发布时，投资者反应也非常负面。礼来的股价当天大跌。结果是72周减重11%。这比我们在Wegovy或Zepbound上看到的效果差很多。

Yeah. A little bit because I mean so when the Orfagliptron data came out, Lilly's small molecule GLP one, when that data came out a few weeks ago, the I mean, to be fair, investors also reacted really negatively. The stock dropped a ton that day, Lilly stock. The result was 11 weight loss over seventy two weeks. So that's significantly less weight loss than what we see with, Wegovy or Zepbound.

我看到很多分析师为礼来辩护，这很有趣，因为我觉得大家对礼来的数据解读似乎比对诺和诺德更宽容。比如诺和诺德的Calgary Summit数据公布时，减重效果非常显著，大约20%，但大家都说这对诺和诺德的管线是灾难等等。而礼来的数据出来后，很多人还在为它辩护，说这会是一个重磅药物，可能不如预期那么强，但数据中仍有很多积极因素。我有点困惑。

And I saw a lot of analysts defending Lilly and it was just interesting because I feel like there's perhaps maybe like what appears like a little bit more favorable interpretation of Lilly's data compared to say Novo, Like when Nova's Calgary Summit data came out, know, very substantial weight loss, like 20%, but everyone was saying how this is terrible for Novo's pipeline, etcetera, etcetera. And then when Lilly's data came out, a lot of people were still defending it. They were saying this is still going to be a blockbuster drug. Maybe not as much as we thought, but like there's still so much like positives that we see in the data. And I was kind of confused by that.

我理解它是小分子，可以到处运输。

Like I get that it's a small molecule, you can ship it everywhere.

得了吧，我们点名吧，Jared Holtz，瑞穗证券的。他就是那个大

Come on. But let's name names, Jared Holtz Mizuho. Right? He's like the big

他爱死礼来了。礼来在肥胖领域做什么都对。嗨，Jared，最近怎么样？

he loves Lilly. Everything Lilly can do no wrong when it comes to obesity. Hey, Jared. How are you?

是啊，这有点反直觉，我们说Kagri SEMA减重20%或略多还不够，但又说Glupon减重11%太棒了，仍然会是

Yeah. It's just a little counterintuitive when we're, like, saying, you know, Kagri SEMA 20% weight loss or or whatever, like a little bit more than 20% weight loss. It's not enough. But then we're saying, like, or for Glupon 11% weight loss Is amazing. Is still going to right.

再说一次，我知道它是小分子，不一样。但我还是觉得可能存在区别对待。

Again, I get that it's a small molecule. It's different. But still, I feel like there is maybe some differential treatment going on.

我觉得在肥胖药物上有一种淘金热心态，显然市场巨大。礼来就像Levi Strauss，给所有矿工卖最好的牛仔裤，赚得盆满钵满。

I think there is this gold rush mentality when it comes to obesity drugs where obviously it's a huge market. And you got Eli Lilly out there. Eli Lilly is like the Levi Strauss. They're selling the best genes to all the miners out there. And they're making tons of money.

然后一堆小公司像Viking冒出来，卖便宜的JCPenney牛仔裤。礼来确实值得肯定，他们有巨大的先发优势。诺和诺德当然也是。

And you've got all these little companies coming along like Viking. And they're selling their cut rate JCPenney jeans. Lilly deserves credit for it. They have this huge head start. I mean, obviously, does Novo.

所以追赶会很难。这也是我们长期讨论肥胖领域的一个主题：在这样一个大市场里，是否以及如何才能追上，即便市场很大，蛋糕够分。但当有公司像礼来这样早早布局、投入巨资——比如制造环节，他们已经砸了几十亿美元——追赶确实不易。

And it's going be tough. And I think that's kind of one of the themes we've talked about for a long time when it comes to obesity is how if and how anybody can catch up, even in a big market. Because obviously, the argument is that there's a lot to go around. There's a big pie here. But it's tough when you've got companies that have such a head start and have invested so much like in Elaine, you talked about manufacturing and they've invested billions and billions of dollars in manufacturing already.

而且公司要追上这一点会很困难。我想我是在为莉莉辩护。

And it's going be difficult for companies to catch up to that. I guess I'm being a Lily defender.

贾德把你洗脑了，亚当。你进了莉莉的邪教。

Jared's gotten to you, Adam. You're in the Lily cult.

没错。对对。对。

Exactly. Yeah. Yeah. Right. Yeah.

对。没错。

Yeah. Exactly.

在我们结束spiking环节之前，我想指出的一点是，SoStat每年都会发布一份医疗行业CEO薪酬报告，我们会按薪酬高低给医疗行业的CEO排名。让我非常惊讶的是，Viking的CEO布莱恩·连恩在总薪酬包方面位列薪酬最高的CEO之一，甚至超过了艾伯维的CEO。其中很大一部分是已兑现的股票，所以你知道，这是主要组成部分。但我仍然觉得很震惊，一家还没有任何产品上市的小型生物科技公司Viking的CEO，薪酬竟然和艾伯维、赛默飞、再生元这些大公司处于同一水平。

Before we finish the spiking segment, one thing I wanted to point out was SoStat every year does an annual health care CEO compensation report where we kind of rank the CEOs that made the most in the healthcare industry. What was really surprising to me was that the CEO of Viking, Brian Lien, was among the top compensated CEOs, if we're looking at total pay package, even more than AbbVie's CEO last year. And a lot of it was in realized stocks, so, you know, that was a big component of it. But I think it's still just so surprising that, you know, the CEO of Viking, a small biotech that doesn't have any products on the market yet, up in, you know, the same pay range as like, AbbVie and Thermo Fisher and Regeneron.

这在很多方面说明了生物科技和制药行业的薪酬状况以及激励机制。但这又是一个更大的话题了。

That says so much about biotech and pharma compensation in so many ways and the incentives Yeah. At But that's a whole larger conversation.

所以，伊莲，我喜欢“从农场到餐桌”这个说法。再次强调，是P H A R M。这个说法很棒。给我们讲讲这些直接面向消费者的事情到底是怎么回事。

So, Elaine, I love the phrase farm to table. And again, P H A R M. It was great. Great phrase. Explain to us what is going on with all this direct to consumer stuff.

因为看起来每家大制药公司都在说，想要直接向人们、向消费者卖药。

Because yeah, it seems like every big pharma company is talking up, you know, wanting to sell drugs, directly to people, to consumers.

你喜欢这个说法真有趣，因为我们的编辑其实讨厌这个说法。我想如果我在文章里多说一次的话，

It's funny that you love the phrase because our editor actually hates the phrase. And I think if I said it more than once in my story,

他懂什么？他什么都不懂。我

does he know? He knows nothing. I

我也很喜欢这句话。对不起，Jason，你被否决了。

also love the phrase. I'm sorry, Jason, you're overruled.

我不喜欢。因为我脑子里会浮现一家制药公司像服务员一样给你端盘子的画面。我明白这很聪明，但我不喜欢制药公司给你上菜这个想法，不过我想这就是背后的创意。总之，我们聊过特朗普总统的计划，要把美国药价压到与其他国家持平的“最惠国”方案。作为该计划的一部分，他要求制药公司对畅销药实行直接面向消费者的模式。

I don't love it. Because I have the idea of like a pharma company kind of like, serving you. I mean, I get it's clever, but like, I don't like the idea of just like a pharma company like kind of serving you food but I guess that's, you know, the idea behind it. Anyways, yeah, so, you know, we've talked about how President Trump has his plan to lower US drug prices in line with what other countries pay this most favored nation's plan. As part of that plan, he's demanding pharma companies implement direct to consumer models for popular drugs.

思路就是制药公司绕过PBM和保险公司，直接把药卖给患者。显然，特朗普还提了其他要求，比如这些公司必须给政府机构和商业支付方提供与其他国家持平的更低价格。但制药公司真正公开支持的，只有这个DTC要求。他们长期把这一招当作进一步对抗PBM的手段，声称我们可以绕过PBM，变得更透明，降低患者成本，这就是他们一贯的说辞。

And the idea is, you know, the pharma companies bypass PBMs and insurers and just sell directly to patients. Obviously, Trump has also made other demands, like these companies have to offer government agencies and commercial payers lower prices that are in line with what other countries pay. But really, the only demand that the pharma companies have really vocally supported is this DTC one. Pharma companies have kind of used this as a way to further antagonize PBMs, something they've long done. They say, you know, we can go we can bypass PBMs, we can be more transparent, we can lower costs for consumers and that's kind of the the spiel that they've embraced.

那咱们再深入聊聊，因为礼来、诺和以及其他药企已经做了很多姿态，说这一举动是在顺应特朗普的要求，想借此安抚他，好让他别再推进其他会伤害制药业的举措，比如最惠国定价。

Well okay, let's get into that a little bit further because there's already been a lot of positioning about this this move from Lilly, from Novo, from other drug companies that it's, you know, kind of part of acquiescing to Trump's demands and and, you know, trying to appease him in a way to maybe, you know, steer him away from, you know, other initiatives that would hurt the pharma industry, like, you know, most favored nations pricing.

这种做法被广泛宣传为让药更便宜、解决药价问题的办法，但你采访的人说这其实并不太可能真正改变美国人自掏腰包的药品支出。为什么？目前现金支付的选择并不多，已公布的一些现金价确实比标价低，但每月仍要好几百美元。专家认为这大概跟保险市场的净价差不多。

And this is like, extensively been like, in some areas, like targeted as a way to make drugs more affordable to for patients, kind of address the drug pricing issue, but you spoke to people who said that this isn't actually likely to really change how much Americans are paying out of pocket for drugs. Why is that? You know, we don't have a ton of cash offerings, cash pay offerings right now. There are some that companies have announced currently the ones that we see, yes, they're lower than the list price, but the cash prices are still several $100 per month. I think experts think that's probably similar to whatever the net prices are that are happening in the insurance market.

可不管怎么说，这些现金价每月几百块，对需要长期吃多种药的患者来说根本负担不起。而且如果你能掏得起这笔钱，大概率已经有一份不错的保险了。此外，所有这些DTC药费都不计入保险计划里的免赔额或自付上限，而这些机制本来是用来帮患者控费的。所以很多人觉得这并不能系统性地降低患者的药费。

But anyways, these cash prices are several $100 a month. That's really not feasible for patients to pay out of pocket, especially if they're taking multiple drugs chronically, then that adds up really quickly. And if you can pay for the drugs, then you're probably already, you probably already have good insurance. And then on top of that, all of that spending on DTC drugs, none of that goes towards a deductible or an out of pocket maximum that is built into insurance plans to help limit costs for patients. And so that's why I think the overall picture is a lot of people think, you know, this is not going to help lower drug costs for patients.

需要说明，这些计划面向的是没有保险或保险不足的人，对吧？比如处方药福利很差或者干脆没有。

And to be clear, plans are aimed at people who don't have insurance or maybe who are sort of underinsured, right? Maybe they don't have a very good prescription drug benefit or none at all.

对，是的。我想这也是很多

Right, yeah. I think like and I think that's why a lot

专家感到困惑的地方。比如BMS给广泛覆盖的Eliquis宣布了现金价；诺和最近也给糖尿病药Ozempic做了同样的事，而Ozempic的覆盖也不错。既然保险已经报得很好，为什么还要现金价？再说，如果你保险不足或没有保险，更可能是低收入人群，照样付不起那几百块的现金价。

of experts are confused. For example, BMS announced a cash pay price for Eliquis, which is very widely used, has good coverage. Novo recently also announced a similar thing for Ozempic, a diabetes treatment that again is also pretty widely covered. I mean for those it's very confusing because you already have good coverage for this so why do we need a cash pay price? And again if you are under insured or not insured, you're more likely to be lower income, and you wouldn't be able to afford to pay the cash pay prices anyways.

不过减肥药物可能是个例外。我们知道礼来早在特朗普上任前就开始给Zepbound提供现金价。减肥药情况特殊，保险覆盖很零散，目前很难走保险报销，而需求又极高，所以有人愿意掏现金。这确实给礼来带来了可观销量，但问题是，这算是一种系统性降低患者药价的好办法吗？

Now, an exception perhaps is the obesity treatments. We know that Lilly started offering a cash pay price for Zepbound last year before Trump took office. Obesity drugs are in a unique position because there's actually spotty insurance coverage, so it's not very easy to get it through insurance currently, and there's such high demand. So people, there are people willing to pay, you know, the cash pay price. I think the question is like, you know, that has led to a good amount of sales for Lilly, but is that actually like a good way of systematically lowering drug costs for patients?

我的意思是，很多我聊过的医生都说这仍然只是短期的事。让患者每月花500美元买ZAP BAND并不现实，而一些更持怀疑态度的专家说，这看起来更像是抢占复方制剂市场，而不是真正扩大可及性，尤其是对那些根本负担不起任何治疗手段的人。

I mean, lot of doctors I talk to say it's still just a, you know, short term thing. It's not feasible for a lot of patients to pay $500 for ZAP BAND every month, and some of the more skeptical experts were saying that this seems more so to capture the compounding market rather than to really expand access, especially to people who, you know, can't don't have the means to really afford any kind of treatment.

嗯，好，我想插一句。这就是我的质疑观点：我完全同意，我认为这种DTC模式确实是被肥胖治疗推动的。礼来和诺和一直在跟复方药房打架，去年大部分时间他们都在打击那些做Zepbound和Wegovy“山寨版”的复方药房，低价抢生意。我真觉得这是礼来和诺和想砍断复方药房腿的办法。我很怀疑DTC模式会走出这些非常特定的场景，比如目前保险几乎不报的肥胖药。

Yeah, okay, I want to jump in. Here is my like, skeptical take, which I completely agree that I think that this was really driven, this DTC model is really linked so closely to obesity treatments. And these fights that Lily and Novo have had with compounding pharmacies, which was I mean, they spent most of last year battling, you know, these compounding pharmacies that were creating kind of knockoff versions of Zepbound and Wegovy, and selling them and undercutting their business. And I like I really see this as a way for Lilly and Novo to try to undercut those compounding pharmacies or kind of cut them off at the legs. I'm really skeptical that we see the DTC model of like go much further than some of these very specific use cases like the obesity drugs that are not really covered well by insurance, if at all, at this point in time.

Elaine，你怎么看？

Elaine, what do you think?

嗯，我觉得

Yeah, I think it

确实很难。再说，就算在肥胖领域，我也不清楚按现在的现金价能扩大多少可及性。问题是，他们会真心把现金价大幅降下去吗？我采访的人对此有点怀疑，因为大家猜现在的现金价可能跟净价差不多。要是他们公开卖得更便宜，支付方就会喊：‘嘿，你们给现金市场这么低，那我们也要更低。’

is really hard. And again, even with obesity, I don't know how far they could expand access with the cash pay prices that currently exist. And the question is like, okay, well, are they going to meaningfully lower the cash pay prices? And I think the people I talked to, they're a little skeptical of that because the assumption is maybe it's probably the cash pay prices we have now are similar to the net prices. Because if they offer much lower cash pay prices, that's public information that payers will be like, Hey, why are you offering such a low price on the cash pay market?

支付方要么狠砍价，要么干脆不包了，让患者自己去买。可要是支付方越来越不想覆盖药，患者就得自费；一旦要同时买好几种药，自费还是比走保险贵。有人指出，这其实对药企也不是理想局面：他们虽然老抱怨PBM和保险体系，但其实正需要这层‘缓冲’。出现可及性问题时，他们可以甩锅给保险和PBM。

We want a lower price. And so payers could either negotiate aggressively down the net price or payers could be like, Okay, we're just going to stop covering it because patients can just get it, you know, on their own. But obviously that's not a good situation if we see that continuing to happen. Payers are incentivized to cover fewer and fewer drugs, then patients will be on the hook because ultimately, again, still if they have to pay for multiple drugs cash pay that's still going to be more than what they can get through insurance. Then you know someone made the point that this is actually not an ideal situation either for the pharma companies if everything goes to cash pay because the pharma companies as much as they like to complain about PBMs and the insurance system, they still benefit from essentially kind of being shielded from like there's a medium between the patients and so like whenever there's like affordability or access issues, the pharma companies blame insurance companies and PBMs.

如果全走DTC，价格完全公开，患者对价格又极其敏感，药企任何调价都会直接砸到患者身上，届时所有关于可及性的骂声也会直接对准药企自己。

And if everything goes DTC, then the prices are out there fully for patients to see and, like, patients are extremely price sensitive. So, like, any changes that the pharma companies make in their prices will directly impact patients, and then pharma companies themselves will be directly on the hook for complaints about, you know, accessibility and access issues.

对，我读你文章时也是这条思路：这样药企反而更容易被个人的花钱习惯和价格承受力影响。大家都说医疗是‘抗衰退’的，因为人会一直生病；我生病了去看医生，医生开药，保险基本全报，经济好坏对我没差。但如果Zepbound、Wegovy，甚至你文章提到的那个抗生素——是百时美施贵宝在做DTC吗？

Yeah, I had the exact same line of thinking when I was reading your piece, Elaine, that I feel like this would make pharma companies actually much more susceptible to people's spending habits and, you know, kind of their their personal price constraints. I mean, like, they always say that health care is, like, essentially recession proof because, you know, people always get sick. If, you know, I get sick, I go to the doctor, they prescribe me medicine, my insurance covers most, if not all of it. If it's a recession or it's boom times, doesn't really matter anything for me. If I'm a patient that's taking Zepbound or Wegovy or even like you mentioned in your piece, there's a I think there's an antibiotic that was it Bristol Myers Squibb is offering DTC?

GSK在琢磨哪些药可以DTC，其中就包括他们治尿路感染的抗生素。

GSK was talking about potentially like what are different drugs we could offer DTC and one of them was their antibiotic for UTIs.

对，所以如果让我完全自费买这些药，而经济又突然下行，我的消费行为就会变，我是否还愿意自掏腰包买这些药，就成了问题。

Yeah, exactly. So if I'm the consumer, and I then need to pay completely out of pocket for those things, and like, let's say that, you know, the economy hits the skids, that then changes my spending habits. Might, you know, it raises a question as to whether I would actually purchase these medicines myself.

是啊，我的意思是，研究已经表明，患者对价格非常敏感，哪怕只是自付额发生变化。所以如果你想想，如果完全变成自费支付，我们可能会看到更高的价格和更大的价格波动，那么患者对价格就会更加敏感。因此，我并不认为那是制药公司理想的情况。

Yeah, I mean, and I was going say research already shows I think that patients are really price sensitive even when their copay changes. And so if you think about if it's like completely cash pay, we'll probably see like higher prices and greater changes in price then patients would be even more price sensitive. So I don't, there is an argument there that like that's not an ideal situation for the pharma companies.

本期《Read Out Loud》就到这里。

That does it for another episode of the Read Out Loud.

感谢Hyacinth Empanato制作本期节目。

Thank you to Hyacinth Empanato for producing this week's episode.

我们的高级制作人是Teresa Gaffney，执行制作人是Rick Burke，主题音乐由Brian Joel创作。

Our senior producer is Teresa Gaffney. Our executive producer is Rick Burke, and our theme music is by Brian Joel.

我们很想听到你的反馈。告诉我们你喜欢本期节目的哪些地方，不喜欢哪些地方，以及你最喜欢的生物制药“邪教股”是哪只？你可以通过邮件readoutloud@statnews.com联系我们。

And we'd love to hear from you. Tell us what you like about this week's episode, what you didn't like, and what's your favorite pharma biotech cult stock? You can do all that by sending us an email at readoutloud@statnews.com.

如果你喜欢我们的节目，请在Apple Podcasts或你使用的任何播客平台上留下评价或评分。

And if you like what we do, leave a review or rating on Apple Podcasts or whichever platform you use to get your podcasts.

下周见。

See you next week.