Hot seat for PBMs

PBM execs testified before the House Com­mit­tee on Over­sight and Ac­count­abil­i­ty that they’re the good guys — they keep costs down when those evil pharma companies raise prices so high. Plus they rescue bunnies and orphans and they help little old ladies cross the street. Mm hmm.

They blamed “patent abuses” by drug manufacturers that delay launches of cheaper generic and biosimilar medicines for the heightened costs to consumers. The launch price of new drugs was also an issue, they said.

They apparently spent a lot of their testimony talking about the wholesale prices, rather than their role in the process. Regardless, the DC fire department was on hand in case the fire on the execs’ pants spread to the rest of the room.

Fertility — and life — extension

Rapamycin might extend women’s fertility by up to five years and make them healthier to boot. Columbia University researchers are studying that very possibility, and they’ve completed the first step: Proving the drug is safe. (Which isn’t a high bar, as rapamycin has been FDA approved, at least for transplant patients, since the ’90s.)

Rapamycin has gotten press before as a potential anti-aging drug that might reduce a long list of age-related conditions, but it hasn’t been tested on something like fertility. Even though it’s still only approved for transplant patients, rapamycin has been prescribed off-label for other aging issues — this could be a huge new indication for it, on- or off-label.

And counting

There have been six straight quarters (metric: 18 months) of drug shortages in the US according to data from the American Society of Health-System Pharmacists. That is all.

A better morphine than morphine

Opioids, as you know, work by binding to pain-suppressing receptors, and we all know the problems they can cause. So what if there was a drug that also binds to that receptor, but in a slightly different place? That might also relieve pain, but maybe not come with opioids’ baggage.

That was the thinking of researchers at Washington University School of Medicine and Stanford. In fact, they knew of a molecule called C6 guano that binds to just such a different spot. Unfortunately, it was too big to pass the blood-brain barrier.

They needed something smaller … and they found it. It’s called RO76 and it was derived from fentanyl of all things. It binds to the anti-pain receptor in a different way than opioids do, and in tests with mice they found it “appeared to suppress pain as effectively as morphine” but without slowing the mice’s breathing the way opioids do.

Oh, and it also has fewer withdrawal symptoms and works when taken by mouth or by injection. A few decades from now, it could actually be a new medication.

Short takes

Let’s go with vitamin B₁

Vitamin B₁ can reduce constipation, according to a Chinese study that used five years of survey data from 10,371 adults.

Constipation prevalence was 7.69% in the group with the highest B1 intake, 10.7% in the middle group, and 14.09% in the group with the lowest intake.

Caveat: As is often the case, this showed correlation, not causation.

GLP-1s: A different supply shortage

The battle for the GLP-1 market is heating up not just in the lab or even the market, but on the factory floor. With demand high and supply low, existing and upcoming GLP-1 makers are racing to secure manufacturing facilities — either by buying existing plants or building new ones — and paying a premium for it as demand goes up and up.

Cranberry’s OK

Researchers at University, Bond University have confirmed (they say) that cranberry juice can prevent urinary tract infections^*. They base that on “a network meta-analysis that amalgamated the results of 20 studies involving 3,091 participants worldwide.”

^* When used orally, not topically

A 100% HIV preventative?

A large clinical trial in Africa found that lenacapavir, an injected fusion capside inhibitor, was 100% effective in preventing HIV in young women. One hundred percent. That compares to 98.5% of women who took Truvada and 98.2% of those who took Descovy.

98.5% and 98.2% might seem like really good numbers, unless you’re one of the 1.5% or so where it wasn’t effective.

While both Truvada and Descovy are daily oral medications, Lenacapavir is injected twice a year. You might think a pill would be a better option, but in fact taking one daily is “challenging to maintain, for a number of social and structural reasons.” A six-month injection will actually be a better option for a lot of those women.

The Long Read/Elsewhere: Drug pricing boards pick up steam

State price-control boards for prescriptions are gaining traction, as more states hear from angry consumers about the cost of drugs. Today, 11 states already have some sort of prescription drug affordability board, and 14 more have bills in the legislature to do so.

The boards won’t simply set lower prices for drugs. Their real power is in forcing transparency in the system by requiring drug makers to justify their prices. As the chair of Minnesota’s board put it:

“We want [these businesses] to be successful, but this marketplace is not transparent enough for people to feel like they’re getting a fair shake. Free market forces really only work when there is equal information on both sides of the equation. When there’s so much that is not transparent, it takes a public actor to bring about transparency.”