#5SmartReads - March 3, 2023

Hitha on the insulin news, the battle over medication abortion, and the rise of the founder-influencer

March 03, 2023

This is a really, really big deal. And while there is more to do here, it’s an important first step in making insulin affordable and accessible for every resident who needs it.

Here’s what Lilly is actually doing:

  • Reducing the cost of Insulin Lispro to $25/vial (from $82/vial) - this is a biosimilar (aka generic version of a biological drug) of Humalog, whose sales have been declining over the past 2 years. Humalog is the most commonly prescribed insulin, and its price will also get a significant cut (by 70% in Q4 this year)

  • Lilly is about to launch Rezvoglar this year - this is a biosimilar of Lantus, one of Sanofi’s insulin products that also has had declining sales over the past couple of years). A five pack of Rezvoglar injectable pens will cost $92 (about a 78% discount to Lantus)

  • For these drugs, Lilly is capping the out-of-pocket costs to $35 at their participating retail pharmacies, or they can obtain it for $35/month via InsulinAffordability.com.

I fully expect Sanofi and Novo Nordisk - the other two major insulin players - to follow with similar plans on insulin products with declining sales and biosimilar competition.

So what impact will this move actually make for patients?

“This argument that, if they lower the list price that it would change what someone pays out of pocket, is only true if a patient pays something based on the list price,” he [David Kliff] said. “Yes, for some people, it may be cheaper, although I think they have to sit down at the kitchen table and do the math. But it’s a myth to say that there aren’t other options available.”

Despite cutting list prices, Kliff suggested Lilly may be able to compensate for lower net pricing because the company might be able to sell still more insulin to those people who must pay cash or have a high-deductible health plan. “This won’t have a material impact on their bottom line,” he explained. “This is all about volume, and the more volume, the better, which can keep manufacturing costs lower.”

While this is a more modest step, it is still a step in the right direction, and I expect Sanofi and Novo Nordisk (the other big insulin players) to follow.

What I would LOVE to see is the onboarding of independent pharmacies (particularly in underserved areas) into Lilly’s participation program, and materials to let those pharmacists and primary care providers to help them communicate this offer to their communities.

Affordability is only one part of this equation. Accessibility is quite another, and this area requires investment, attention, and resources it rarely receives. I hope we give the latter the same attention that Lilly is getting for this overdue move.

If you’re seeing “for the next 30 days, you and I are…” videos on Instagram and TikTok, you’ve either stumbled upon Monica Grohne’s page or someone influenced by her.

It’s but one example of how founders are expected to become influencers (or why influencers become founders) in this weird time we’re living in.

There are no rules, and as such you see folks doing it well, folks straight up copying content (even down to the script!), and folks finding it hard to find their voice and rhythm. And even if a founder is successful in building an engaging account, it doesn’t necessarily translate into sales or revenue.

A lot of very smart founders and creators shared their perspective in this piece, but I find myself drawn to Sahra Nguyen’s perspective on this subject:

“But she worries about the sustainability of the founder-influencer model, as she wonders how long founders are able to keep up the strict pace of content creation required to grow sales, consistently over the long run. 

“I wonder… will the company become [too] reliant on the founder,” she said. She said she tries to tell herself that “you are not the company, the company is not you” though she acknowledges the irony, given that the company is named after her. 

“I think it’s so important for me as an operator, and also for the company, to really have boundaries and distinction there. “Because for me –- there were points where I felt like that line was blurred,” she said. “If I feel like I’m the company, then I feel like my worth is tied to the company.””

I am a nerd for geopolitics and F1. And while this article may be for the few who live in that Venn Diagram, it is a really well reported, well written piece that offers a perspective on both the sport and the global implications of Putin’s invasion of Ukraine.

The TL;DR - Uralkali, a Russian petrochemical company, invested a significant amount of money to become Haas F1’s title sponsor (Haas is the only American F1 team on the grid). Haas got some much-needed capital, and Dmitry Mazepin, the head of Uralkali, helped clinch his son a seat on the Haas team.

Haas has a troubled history with unreliable and problematic sponsors in the team’s short history (so much that an entire book was published about an infamous Haas sponsor, Rich Energy).

I highly encourage that you give this a read, even if you’re not an F1 fan. And a big thanks to my husband for being my “is this too niche?” litmus test and encouraging me to share it. It is very niche - but it’s also a read that touches on a number of issues and shows how nothing exists in a vacuum, despite the FIA’s best attempts to make things just about racing.

One of my little rituals is watching YouTube clips from talk shows when I’m doing my evening skincare routine. I find it entertaining, and also inspiring (it keeps me connected with my own goal of being on The View or having my own show).

Clips from the Tamron Hall Show have taken over the clips from The View, and I love it. Tamron tackles so many topics with heart, humility, and curiosity, and she makes you feel like you’re a part of something.

The show gives me Oprah vibes, but Tamron’s own voice and perspective is what keeps me coming back. And she’s only just getting started, having published a thriller, hosting a second show on CourtTV, and working on a documentary.

And she’s one of the powerful women who openly talks about her home team - her mother’s visits every other month, friends and loved ones who jump in, and her live-in caregiver.

Come for the inspiration, and stay for Hall’s radical honesty that I think every mother can empathize with:

“She unapologetically admits she brings an iPad to their lunch dates and doesn’t care if anyone judges her for it. “It's a weapon in my arsenal of entertainment,” she says simply.

Hall has long lived by the mantra, “I was a success the day I was born,” and while it’s a good attitude to carry through life, it also helps guide her through the inevitable crises of confidence that every parent has. “It helps me because my son doesn't know the mistakes I'm making,” she says. “He doesn't know that I had to reread the potty training book 17 times and still didn't get it right.””

Hope is a rare thing in the battle for reproductive health rights in the United States. Hope is also what fuels Kiki Freedman, the founder and CEO of Hey Jane (a telemedicine provider of abortion medication).

“There are definitely areas where optimism is warranted. While we’ve seen really dystopian regulations rolled out in some parts of the country, we’ve seen very creative protective regulations rolled out in others. Many states like California, New York, and others are working on or have already implemented shield laws, which essentially say they will protect patients and care providers from interstate lawsuits related to the provision of reproductive and gender-affirming care. We find those to be really compelling as a means of going beyond just the codification of Roe, making sure that patients can continue to have access even if their local governments are not supportive.”

I won’t lie to you - I am very nervous about the upcoming ruling about FDA’s approval of mifepristone, even though the case is weak. The filers of the lawsuit claimed that the expedited approval of the medication 20 years ago was rushed and didn’t provide enough safety data. What they failed to understand or mention is that the expedited pathway allowed FDA to put restrictions on the use of mifepristone - restrictions that are now just being walked back, after 20 years of safety and efficacy data of the drug.

Viagra has more risks to patient safety than mifepristone. And should the suit in Texas be decided in favor with its filers, I would hope that physicians in another state file a similar lawsuit to revoke FDA approval of Viagra.

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