Pharma

Scary Charts (Prescription Drug edition) – 08.02.26

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Today, three PBMs, CVS Caremark (34% market share), Express Scripts (23%, owned by Cigna’s Evernorth), and Optum Rx (22%, owned by UnitedHealth Group), control nearly 80% of all U.S. prescription claims. In exchange for placing a manufacturer’s drug on the formulary, or giving it preferred status over competing therapies, the PBM negotiates rebates, administrative fees, and performance payments from the manufacturer. A portion of those payments flows back to the health plan, while the PBM retains part of the negotiated revenue.

One feature of today’s market that surprises many people is how vertically integrated it has become. The largest PBMs are no longer independent middlemen. They sit inside healthcare conglomerates that also own insurers, pharmacies, physician groups, specialty pharmacies, and mail-order pharmacies. For example, CVS Health owns Aetna, CVS Caremark, CVS Pharmacy, MinuteClinic, and Signify Health. UnitedHealth Group owns UnitedHealthcare, Optum Rx, and Optum Health. Cigna owns Express Scripts through Evernorth. This consolidation has fueled ongoing debate about whether these organizations can optimize each part of the supply chain independently or whether incentives increasingly favor the parent company as a whole. Mark Cuban on Breaking the Drug Pricing Cartel: Inside Cost Plus Drugs – https://pearhealthcareplaybook.substack.com/p/mark-cuban-on-breaking-the-drug-pricing

Hat Tip – https://ritholtz.com/2026/08/10-sunday-reads-239/

Yikes.

GLP-1’s – Anti-Aging Drug?

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Enjoy. But please read the entire article before you go online, buy a GLP-1 and start injecting yourself.

The Anti-Aging Drug We Keep Calling a Weight-Loss Shot

https://afshine.substack.com/p/the-anti-aging-drug-we-keep-calling?r=22fro&utm_campaign=post&utm_medium=web&triedRedirect=true

GLP-1 Just $50 a Month!!!

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Starting July 1, 2026 Medicare covers certain GLP-1 drugs under the Medicare GLP-1 Bridge program. This temporary program is available nationwide (including all states and U.S. territories) to certain people with Medicare drug coverage (Part D). https://www.medicare.gov/coverage/weight-loss-drugs

You must be 18 or older and meet one of these requirements when you start GLP-1 therapy:


You have a body mass index (BMI) of 35 or more.


You have a BMI between 30-34.99 and have at least one of these conditions:
Diastolic heart failure (also called heart failure with preserved ejection fraction)
Uncontrolled high blood pressure (also called hypertension)
Chronic kidney disease at stage 3a or higher
Prediabetes
A previous heart attack (also called myocardial infarction) or stroke
Blocked arteries in your legs or arms (also called peripheral artery disease) with symptoms


You have a BMI between 27-29.99 and have at least one of these conditions:
Prediabetes
A previous heart attack (also called myocardial infarction) or stroke
Blocked arteries in your legs or arms (also called peripheral artery disease) with symptoms

Yes, I loved writing the click bait title to this post.

The Dangers of Self-Diagnosis and AUD (Alcohol Use Disorder)

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Using naltrexone to cut back on drinking isn’t new, says Sarah Wakeman, a senior medical director for substance use disorder at Mass General Brigham. The approach dates back to the 1980s with the Sinclair method, which pairs drinking with naltrexone to blunt alcohol’s pleasurable effects. In parts of Europe, Wakeman adds, people have long used a “pill-in-the-pocket” strategy, taking the medication only when they anticipate drinking. A decades-old drug is helping people drink less alcohol—without giving it up completely – https://www.nationalgeographic.com/health/article/naltrexone-drink-less-alcohol? (Paywall article)

The Provider Individual who is not a doctor will see you after you answer the questionnaire (this is the self-diagnosis part).

Oar Health is an online service offering naltrexone subscriptions to those with alcohol use disorder (AUD). Users can fill out a brief assessment which is reviewed by a medical professional, then be given a naltrexone prescription if appropriate. After a one-time $50 fee, subscriptions cost $297 for three months of medication, which comes out to $99 monthly. It’s currently available in 42 US states. Beyond the naltrexone prescription, Oar Health offers ongoing access to the support of a medication prescriber, a health coach, a Facebook group for community support, and extras like educational articles and guided reflections.Oar Health Review: Pros & Cons, Cost, & My Experience – https://www.choosingtherapy.com/oar-health-review/

Health coaches who are “naltrexone experts”! And The Sinclair Method might not work for everyone. https://drugfree.org/article/sinclair-method/

Depending upon the online service you choose you may get naltrexone prescribed when trying to get your doctor prescribed GLP-1 filled out even when you don’t have alcohol use disorder.

Telehealth companies such as Vida Health and its rivals offer lifestyle support so people taking drugs like Wegovy and Zepbound can have the most success on the drugs. But the companies often have another job: limiting obesity drug costs for employers.

The Vida Health nurse said he was a good candidate for Zepbound but insisted he try two generic drugs first: naltrexone, a drug used to curb alcohol and opioid use, and bupropion, an antidepressant. Neither drug is approved for obstructive sleep apnea. Primary care doctors raise alarm as telehealth companies get involved in obesity drugs – https://www.npr.org/2026/06/14/nx-s1-5805984/glp1-telehealth-weight-loss-drugs

Yikes.

GLP-1s (it’s kind of a mess)

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“But the real question is what is the quality of the weight regain and what is the shift in people’s metabolism, and it seems to be very bad,” she said. “Ongoing studies that haven’t been published yet suggest that hypertension comes back. All the inflammatory markers come back, and lipids go up. And if you have diabetes, it gets worse. Overall, it’s kind of a mess…As these studies and others showed, most people regain the weight. Whether or not they regain all the weight depends in part on diabetes and insulin and many other factors, but people will likely regain most of their weight.”

“But the message isn’t that you regain the weight. The message is that you may be less healthy when you regain the weight. That’s why we need to couple the drugs with lifestyle interventions. And it’s why people who just want to lose 5 or 10 pounds really need to consider that lifestyle change, hard as it is, is the better way to do it.”

Anne Peters, MD, professor Keck School of Medicine of the University of Southern California

Less Weight Regain, More Health Loss after Stopping GLP-1s? – Medscape – March 05, 2026 – https://www.medscape.com/viewarticle/less-weight-regain-more-health-loss-after-stopping-glp-1s-2026a10006rv?

I never envisioned developing an obsession with pharmaceuticals. And after many years of endless blogging into the void I learned I could link to previous posts like this: https://lifeunderwriter.net/tag/glp-1-receptor-agonist/

The learning never stops.

My Statin Comes From India

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According to the USP, the bulk of the APIs come from India. That country is responsible for 50% of the active pharmaceutic ingredients. China is not far behind at 32%. The European Union supplies 10%. That’s a big change since 2000. Back then, European countries like France, Germany, Switzerland and Denmark supplied 42% of the APIs. Drug Recalls From India – Can You Trust Foreign-Made Generics? – https://www.peoplespharmacy.com/articles/more-drug-recalls-from-india-do-you-trust-foreign-made-generics

Dozens of companies received approval from the FDA over the years to sell metoprolol and bupropion in the U.S. Yet from 2018 to 2024, the agency reported running only 2 tests on metoprolol and 7 on bupropion through its quality surveillance program — in each case, by pulling a sample from a single drug maker. In many of those years, the drugs weren’t tested at all, FDA records show. Those that were assessed received passing results. The FDA Often Doesn’t Test Generic Drugs for Quality Concerns, So ProPublica Did – https://www.propublica.org/article/fda-generic-drug-testing

ClinCalc DrugStats Database – https://clincalc.com/DrugStats/

Both articles are long reads but worth your time.

Yikes.

Antidepressant Prescriptions Increase 130% for Teenage Girls

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The increasing rate of mental health disorders among children and adolescents is a concerning trend that has been observed for several decades, with survey studies revealing dramatic increases in anxiety, depression, and suicidal ideation.1 In the United States, suicide ranks as the second leading cause of death for those aged 10 to 19 years and the third leading cause of death for those aged 15 to 24 years.2 Antidepressant Prescriptions and Mental Health – https://publications.aap.org/pediatrics/article/153/3/e2023064677/196661/Antidepressant-Prescriptions-and-Mental-Health

Between January 2016 and December 2022, the monthly antidepressant dispensing rate increased 66.3%, from 2575.9 to 4284.8. Before March 2020, this rate increased by 17.0 per month (95% confidence interval: 15.2 to 18.8). The COVID-19 outbreak was not associated with a level change but was associated with a slope increase of 10.8 per month (95% confidence interval: 4.9 to 16.7). The monthly antidepressant dispensing rate increased 63.5% faster from March 2020 onwards compared with beforehand. In subgroup analyses, this rate increased 129.6% and 56.5% faster from March 2020 onwards compared with beforehand among females aged 12 to 17 years and 18 to 25 years, respectively. In contrast, the outbreak was associated with a level decrease among males aged 12 to 17 years and was not associated with a level or slope change among males aged 18 to 25 years. Antidepressant Dispensing to US Adolescents and Young Adults: 2016–2022 – https://publications.aap.org/pediatrics/article/153/3/e2023064245/196655/Antidepressant-Dispensing-to-US-Adolescents-and?autologincheck=redirected

Between 2020 and 2022, antidepressant prescriptions for girls aged 12-17 skyrocketed by 130%. Antidepressants Increase 130% for Teen Girls, Drop 7% For Boys – https://brownstone.org/articles/antidepressants-increase-130-for-teen-girls-drop-7-for-boys/

Yikes.

Not Just For Allergic Rhinitis Anymore

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A common hay fever nasal spray was found to cut COVID-19 infections by two-thirds in a clinical trial, while also reducing rhinovirus cases. Researchers believe it could serve as an easy, low-cost preventive measure, pending further studies. Saarland University. “Common allergy spray slashes COVID-19 risk in surprising trial.” ScienceDaily. http://www.sciencedaily.com/releases/2025/09/250907024535.htm (accessed September 7, 2025).

For Robert Bals, the results suggest practical applications: ‘Azelastine nasal spray could provide an additional easily accessible prophylactic to complement existing protective measures, especially for vulnerable groups, during periods of high infection rates, or before travelling.’ But Professor Bals also stressed the importance of further research: ‘Our results highlight the need for larger, multicentre trials to continue exploring the use of azelastine nasal sprays as an on-demand preventive treatment, and to examine its potential effectiveness against other respiratory pathogens.’

Link to the Jama article – https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2838335 Azelastine Nasal Spray for Prevention of SARS-CoV-2 Infections