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Here’s Why Cutting Insulin Prices Will Actually Save Big Pharma Money



Increase / This photo illustration shows insulin pens manufactured by Novo Nordisk on March 14, 2023 in Miami, Florida.

Insulin giant Novo Nordisk said Tuesday it will cut list prices on some of its insulin products by up to 75 percent by the end of the year, following in the footsteps of Eli Lilly, which made a similar announcement earlier this month. . Experts expect the third largest US insulin maker, Sanofi, to follow suit.

The price cuts come after years of escalating public backlash against the company’s sharp price hikes on insulin, which many advocates described as price gouging. A 2018 analysis found that list prices for insulin were set five to ten times higher in the US than in other high-income countries, with the average standardized unit of insulin costing nearly $100. The cost of producing products, even new insulins, usually does not exceed $10.

In a statement on TuesdayNovo Nordisk said it will cut prices on several products, including Levemir, Novolin, NovoLog and NovoLog Mix 70/30. At a 75% contraction, the 10 ml vial of Novolog falls out of the $289.36 to $72.34. NovoLog Mix 70/30 FlexPen will drop in price from $558.83 to $139.71.

Amid public outrage over prices, lawmakers are also working on ways to lower them. Voluntary price cuts by companies are closely linked to the federal price cap that went into effect this year under the Inflation Reduction Act of 2022. The law limits out-of-pocket insulin costs to $35 a month for Medicare Part D recipients. When Eli Lilly lowered its prices earlier this month, it also announced programs that cap the monthly cost of insulin to $35 for people with commercial insurance, and also for the uninsured. Novo Nordisk did not propose such a limit in its statement today, although it noted a hodgepodge of deals and programs.

But while the price cuts may appear to be related to last year’s Inflation Reduction Act, health policy experts and lawmakers note that the slightly older legislation, the 2021 American Bailout Plan, may be the real impetus for the drastic cuts. The law contained a number of provisions aimed at improving access to health care and affordability, including removing the cap on discounts that drug companies are required to pay to Medicaid. If the cap were lifted and list prices for insulin were set as they are now, insulin manufacturers might have to pay Medicaid. more than the price of their insulin products each time Medicaid had to cover one, which likely amounted to tens of millions of dollars of Medicaid payments. But with lower list prices, Eli Lilly and Novo Nordisk will be able to avoid these extra charges. The discount restriction should be lifted on January 1, 2024, when price reductions by companies will fully take effect.

The rebate program limitation is a little tricky, so here’s a description of how it works. All of this stems from the Medicaid Drug Rebate Program (MDRP), enacted by Congress under the Consolidated Budget Act of 1990. The immediate purpose of the MDRP was to make sure Medicaid paid the lowest or best possible price for prescription drugs. Thus, drug makers who want their drugs covered by Medicaid must enter into a rebate agreement whereby Medicaid agrees to cover and buy their products as long as the drug makers give them back the rebate to keep costs as low as possible. The cost of the rebate is based on a set of formulas that take into account things like the type of drug—brand or generic—and market prices.

Cold calculations

For a brand-name drug, the base discount that the drug manufacturer will pay to Medicaid is 23.1 percent of the manufacturer’s average price. or the difference between the average price and the best (lowest) price ever higher. IN example outlined Federal Commission for Payment and Access to Medicaid and CHIP (MACPAC)If the brand-name drug manufacturer’s average price is $100 and the best market price is $88, the drug manufacturer will pay a standard percentage of $23.10 for the base rebate. But if the average price is $100 and the best price is $70, the base discount is $30.

However, there is another key element in the discount calculation: inflation. If the drug manufacturer raises prices faster than inflation, then the drug manufacturer must also pay the difference between the current average price and the price of the drug, if the price increase were simply in line with inflation. This is calculated from the manufacturer’s “base” average price, which is the drug’s average price just before the start of the rebate program or, for new drugs, the drug’s initial manufacturer’s average price. Using this base price, Medicaid programs calculate the current price based on general inflation, which is the consumer price index for all urban consumers (CPI-U). Medicaid then subtracts the base price from the current average price, and the drug manufacturers pay the difference on top of the base discount, but only up to a certain point.

Under current law, the discount was limited to the current average price. That is, drug manufacturers would not be required to pay a discount in excess of 100 percent of the average manufacturer’s price for their drugs. But with drug prices skyrocketing far beyond inflation, that meant a lot of money was at stake. A federal analysis of drug rebates in 2012, for example, found that 54 percent of brand drug rebates had an inflation component. And in 2019, capping discounts allowed drug manufacturers to avoid paying. a whopping $3 billion in rebatesaccording to the Congressional Budget Office.

Based on current insulin prices, Eli Lilly and Novo Nordisk will easily end up paying out Medicaid rebates that are above the average manufacturer price of their drugs, thanks to the company’s price surge that has outpaced inflation over the years. For example, Sean Dixon, drug price expert at the nonprofit Center for Western Health Policy, Politico said that Medicaid would eventually generate roughly $150 in revenue for each vial of Humalog she covered, which equates to about $140 million in annual Medicaid payments from Eli Lilly.

Now that list prices have dropped, Medicaid may end up paying more than before for insulin products, though it’s not clear by how much.

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New evidence links pandemic origin to raccoon dogs at a market in Wuhan



An international panel of virus experts said on Thursday they had found genetic data at a market in Wuhan, China that linked the coronavirus to raccoon dogs for sale there, adding evidence that the worst pandemic in a century could have been caused by the virus. an infected animal that has been sold through the illegal wildlife trade.

The genetic data was taken from swabs taken in and around the Huanan Seafood Wholesale Market starting in January 2020, shortly after Chinese authorities closed the market over suspicions that it was linked to a novel virus outbreak. By that time, the animals had already been removed, but the researchers were smearing walls, floors, metal cages and carts that were often used to transport animal cages.

In samples that tested positive for the coronavirus, an international research team found animal genetic material, including a large amount that matched a raccoon dog, three scientists involved in the analysis said.

Mixing the genetic material of the virus and the animal does not prove that the raccoon dog itself was infected. And even if a raccoon dog were infected, it would not be clear that the animal transmitted the virus to humans. Another animal could have transmitted the virus to humans, or someone infected with the virus could have passed the virus to a raccoon dog.

But the analysis did establish that raccoon dogs — furry animals that are related to foxes and known to be able to transmit the coronavirus — deposited genetic signatures in the same place where the genetic material from the virus was left, the three scientists said. This evidence, they say, is consistent with a scenario in which the virus entered humans from a wild animal.

A full report on the findings of the international research team has not yet been published. Their analysis was first reported Atlantic Ocean.

The new data is sure to revive the debate about the origin of the pandemic, even if it does not address the question of how it began.

In recent weeks, the so-called lab leak theory, which claims the coronavirus originated from a research lab in Wuhan, has gained traction thanks to a new intelligence assessment by the U.S. Department of Energy and hearings led by new Republican Chamber leadership.

But genetic data from the market offers some of the most tangible evidence of how the virus could have entered humans from wild animals outside the lab. It also suggests that Chinese scientists have given an incomplete account of the evidence that could fill in the details about how the virus spread in the Huanan market. .

Jeremy Kamil, a virologist at the Louisiana State University Health Sciences Center at Shreveport, who was not involved in the study, said the results showed “samples from the market that had early Covid lines were contaminated with wild animal DNA reads.”

Dr Kamil said he lacked conclusive evidence that an infected animal caused the pandemic. But, he says, “it really brings out the illegal animal trade in a personal way.”

Chinese scientists released study considering the same market samples in February 2022. This study reported that the samples were positive for coronavirus, but it was assumed that the virus came from infected people who shopped or worked at the market, and not from the animals that were sold there.

At some point, the same researchers, including those affiliated with the Chinese Centers for Disease Control and Prevention, posted raw swab data from the market to GISAID, the international repository for viral genetic sequences. (Attempts to contact Chinese scientists by phone on Thursday were unsuccessful.)

On March 4, Florence Debarre, an evolutionary biologist at the French National Center for Scientific Research, accidentally searched the database for information related to the Huanan market when, she said in an interview, she noticed that more sequences than usual were showing up. first about whether they contained new data, dr. DeBarr put them aside, only to log back in last week to find they had a lot of raw data stored in them.

Virus experts have been waiting for this raw sequence data from the market since they learned of its existence in a February 2022 Chinese report. Debarre said she alerted other scientists, including the leaders of a group that published a number of studies last year pointing to the market as the source.

An international team that included Michael Sparrow, an evolutionary biologist at the University of Arizona; Christian Andersen, virologist at the Scripps Research Institute in California; and Edward Holmes, a biologist at the University of Sydney, began collecting new genetic data last week.

One specimen in particular caught their attention. It was taken from a cart tied to a specific stall in the Huanan Market where Dr. S. Holmes visited in 2014, according to scientists involved in the analysis. This tent, doctor. Holmes found that raccoon dogs were kept in a cage on top of a separate cage with birds, and this is precisely the environment that facilitates the transmission of new viruses.

The research team found that a swab taken from a cart in early 2020 contained virus and raccoon dog genetic material.

“We were able to figure out relatively quickly that at least one of those samples had a lot of raccoon dog nucleic acid, along with virus nucleic acid,” said Steven Goldstein, a virologist at the University of Utah who worked on the study. new analysis. (Nucleic acids are the chemical building blocks that carry genetic information.)

After the international team stumbled upon the new data, they approached the Chinese researchers who uploaded the files to collaborate while respecting the rules of the online repository, the scientists involved in the new analysis said. After that, the sequences disappeared from GISAID.

It is not clear who removed them or why they were removed.

Dr. Debarre said the research team was looking for more data, including some of the market samples that have never been released to the public. “The important thing is that there is even more data,” she said.

Scientists involved in the analysis said some of the samples also contained genetic material from other animals and humans. Angela Rasmussen, a virologist with the Organization for Vaccines and Infectious Diseases at the University of Saskatchewan in Canada who worked on the analysis, said the human genetic material was to be expected given that people shopped and worked there and cases of Covid in humans were reported. were connected to the market.

Dr. Goldstein also warned that “we don’t have an infected animal, and we can’t prove for sure that there was an infected animal in that stall.” The genetic material of the virus is quite stable, he said, so it is not clear exactly when it entered the market. He said the team was still analyzing the data and that it had no intention of releasing its analysis prior to releasing the report.

“But,” he said, “given that the animals that were on the market were not selected at the time, this is the best we can hope for.”

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Rare, dusty dying star shown in new JWST image



Giant stars can be a prime example of the “live fast, die young” principle. Unlike our own Sun, which will shine for billions of years, more massive stars can burn off their fusion fuel in just a few million years before shedding their outer layers and exploding in supernovae.

NASA this week presented a rare image from the James Webb Space Telescope (JWST) of one of these stellar giants, Wolf-Rayet stars in the last, fleeting stages of their lives. Named WR 124, it lies in the constellation Sagittarius and lies about 15,000 light-years from Earth. The dying star has at least 30 times the mass of our Sun, but it is rapidly contracting, expelling hot gas into the cold vacuum of space.

“We caught it before,” explains Anthony Moffat, a retired astrophysicist who previously observed WR 124 with the Hubble Space Telescope and was not involved in the recent JWST measurements. Moffat has been studying Wolf-Rayet stars for decades. “This is the youngest person I know,” he says. The colorful cloud in the image, somewhat erroneously called a planetary nebula, is only a few thousand years old. Now, “the nebula is hugging the star,” he says. But as time passes, it will bloom outward in the form of expanding shells or rings of gas and dust.

Stars are natural fusion reactors, glowing with the energy released when hydrogen is fused to form helium atoms. Once massive stars burn off all their hydrogen, they begin to convert helium into heavier elements through a more energetic fusion reaction, causing powerful stellar winds. Rushing at speeds of more than 150,000 kilometers per hour, these winds carry the outer layers of the star with them, throwing huge volumes of gas and dust into space.

This gas glows with infrared radiation, the same type of light that JWST detects. Astrophysicists have created an impressive image by combining data from two JWST instruments, a near-infrared camera (NIRCam) and a mid-infrared (MIRI) instrument. The Hubble Space Telescope, which predominantly collects light in the optical range, has taken pictures of WR 124 before, but the JWST observations show the star’s growing nebula in stunning new detail.

“Personally, the most exciting part of this image is that we are capturing a rare phenomenon, i.e. a Wolf-Rayet star, at a level of detail that can only be achieved with JWST,” says Macarena Garcia Marin, an astrophysicist. The European Space Agency, which works with MIRI.

Only massive stars can go through the Wolf-Rayet phase, and not all of them. Astronomers have calculated that there are only 1,000 Wolf-Rayet stars in our galaxy—about one in every 100 million. The nearest one is about 1,000 light-years away in the star system Gamma Velorum, visible from the Southern Hemisphere. According to Moffat, Wolf-Rayet stars could be a million times brighter than the Sun. “What they lack in numbers, they make up for in light,” he adds.

“This dust is spreading into space and will eventually create planets. And that’s how we got here, really,” NASA astrophysicist Amber Strone said during a panel discussion at the 2023 South by Southwest conference in Austin, Texas, where the image was first unveiled. “I think this is one of the most beautiful concepts in all of astronomy.”

But while we are all made of stardust, there seems to be a lot more to the universe than scientists can explain with a simple cataloging of obvious sources. “It’s always exciting to be in science when our theories don’t match up with our observations — and that’s where we are right now with the dust,” Strawn says. These detailed pictures of the decoupling of a dying star as it forges heavy elements and produces copious amounts of dust could help scientists refine their understanding of this underlying process.

Someday—thousands or even millions of years from now, but essentially tomorrow on a galactic scale—WR 124 will explode in a spectacular supernova. In addition to a large amount of dust and heavy elements, a black hole may remain after the explosion. But physicists don’t have a good way to predict this with certainty. Moffat suggests that the supernova remnant could instead turn into a neutron star, the last stop before the collapsing star reaches the ultimate oblivion of a black hole. Without a glimpse from some observatory that remains for us in the distant future, we may never know what will happen to WR 124. But in any case, its ultimate fate remains the same, written in stars and planets that are still not formed from his generous gift of cosmic dust.

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Geometric deep optical sounding | The science



The review discusses the latest developments in the field of optical sensing and imaging.

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