The European Union Explained with Christiaan Alting von Geusau

"REFILL" - The Economics of Ozempic and Other Weight Loss Drugs (Originally Aired: May 2024)

DC EKG with Joe Grogan The Economics of Ozempic and Other Weight Loss Drugs Episode 136.5 (“Prescription Refill” – A replay from the archives) Original Air Date: May 2024 In this episode, Joe Grogan welcomes Ben Ippolito, Senior Fellow in Economic Policy Studies at the American Enterprise Institute, to discuss the rapidly evolving economics of GLP-1 weight loss drugs like Ozempic and Wegovy. Ben explains the two main competitors in this market—Novo Nordisk's Ozempic and Wegovy versus Eli Lilly's Mounjaro and Zepbound. Revealing how insurance coverage decisions drive pharmaceutical marketing strategy. The conversation reveals a critical irrationality in Medicare policy: the statutory prohibition on covering weight loss drugs despite their profound clinical and quality-of-life benefits. Yet these same drugs are covered for diabetes and cardiovascular risk reduction. Ben explores the surprising economics of drug pricing through gross-to-net pricing—the massive gap between list prices and what insurers actually pay through rebates and discounts. The episode examines critical implications of the Inflation Reduction Act's price negotiation provisions. Once Medicare negotiates Ozempic's price, that same price applies to all products using the same active ingredient. This creates cascading market effects: competitors must match those prices to remain on formularies, new entrants face lower pricing power even if clinically superior, and pharmaceutical companies may abandon promising programs due to regulatory uncertainty. Ben argues Congress doesn't need to act immediately to expand Medicare coverage, but likely will within a few years. Joe and Ben discuss unintended consequences of government price regulation, including effects on innovation and drug development pipelines. They explore how price controls announced before elections affect pharmaceutical strategy and development timelines. Concluding with Ben's research on Medicare Advantage and why both Democrats and Republicans scrutinize this private alternative to traditional Medicare. With over 50 percent of seniors enrolled in Medicare Advantage plans, bipartisan interest in reform is reshaping healthcare policy conversations on Capitol Hill. Key Topics GLP-1 drugs, Ozempic, Wegovy, Mounjaro, Zepbound, weight loss medications, obesity treatment, Medicare coverage, drug pricing, Inflation Reduction Act, pharmaceutical competition, rebates, gross-to-net pricing, health economics, cardiovascular benefits, diabetes treatment, Medicare Advantage, healthcare policy, innovation incentives Key Timestamps 00:00 Cold Open: "Turned Up to 11" 00:24 Welcome to DC EKG 00:46 Meet Ben Ippolito (AEI) 03:48 The GLP-1 Landscape: Ozempic, Wegovy, and the Field 05:04 One Drug, Two Names 06:45 Medicare's Weight-Loss Coverage Ban 07:21 Blockbusters and Big Effect Sizes 09:32 Why Isn't Congress Acting? 10:17 Why It Costs Less Than You Think 12:34 The Coverage Irrationality 14:05 Quality of Life as a Real Benefit 15:17 Beyond Weight: Cravings and Addiction 18:21 Devil's Advocate: Why Cover It At All? 19:48 Gross-to-Net and the Rebate Problem 22:41 Why Can't You Just Pay Cash? 25:43 The IRA and the Ozempic Price Cut 27:32 One Ingredient, One Price 30:10 Unintended Consequences in Part D 34:01 New Competitors and Killed Programs 38:03 What's Next: Medicare Advantage 42:04 Wrap-Up and Credits About the Guest (As of May 2024) Ben Ippolito is a Senior Fellow in Economic Policy Studies at the American Enterprise Institute. He holds a PhD and Master's degree in Economics from the University of Wisconsin-Madison and a Bachelor's degree in Mathematics and Economics from Emory University. Ben examines drug pricing policy, Medicare Advantage, and healthcare innovation economics with regular engagement with Congress. Podcast: DC EKG with Joe Grogan Guest: Ben Ippolito Sponsor: Survivors for Solutions Producer: Stay on Course Studios Executive Producer: John CZ Czwartacki, DC EKG Podcast

Tom Barker on The Truth About Drug Pricing Policy

In Episode 136 of DC EKG, Joe Grogan hosts Tom Barker, a top drug-pricing attorney at Foley Hoag and former acting general counsel of Health and Human Services (HHS) under the Bush administration. Tom helped implement Medicare Part D and now advises drugmakers and policymakers on complex pricing issues. The episode traces 20 years of policy: what went right with Part D, what the Inflation Reduction Act (IRA) did, and what effective policy should look like. Tom explains that Part D's success rested on three pillars: private plans only, limited government control over benefit design, and a non-interference clause barring the government from intervening in negotiations among plans, pharmacies, and manufacturers. Competition worked and premiums stayed low, until the government asserted more control and weakened those pillars. The IRA, he argues, was a 16-year Democratic effort to repeal non-interference, creating price controls disguised as negotiations. The Trump administration has taken a different tack, focusing not on the IRA but on MFN and Globe Guard models pegged to other developed countries. Tom also breaks down the 340B program, now the country's second-largest expenditure program, and the fight between manufacturers and covered entities over contract pharmacies. His prescription is simple: let competition work. Speed FDA approval of generics and biosimilars, and trust the marketplace over price controls. He points to hepatitis C, where prices fell sharply once competition entered. In This Conversation The three pillars that made Part D successful for 20 years How non-interference kept government from setting drug prices The IRA as a 16-year Democratic push to repeal non-interference Why Tom calls the IRA price controls disguised as negotiations The Trump administration's focus on MFN and Globe Guard pricing 340B and the battle between manufacturers and covered entities The Chevron repeal's impact on drug pricing law HRSA's proposed rebate model and ongoing 340B litigation Why effective policy means competition, not controls Tom's work helping North Korean defectors and refugees Key Timestamps 1:51 Tom's background at HHS and CMS 2:30 The three pillars of Part D's success 5:10 Why Democrats wanted to repeal non-interference 5:55 Ted Kennedy's compromise and bipartisan votes 11:38 The IRA as a 16-year repeal attempt 12:03 What the IRA changed in Part D 15:02 IRA negotiations vs. real negotiations 16:25 How the excise tax makes it no real negotiation 21:32 Trump's focus on MFN and Globe Guard 25:37 340B's history back to 1991 28:45 340B as the second-biggest expenditure program 29:30 Manufacturer vs. covered-entity acrimony 33:18 The Chevron repeal's impact on pricing 34:54 HRSA's rebate model, the next step on 340B 35:40 The lawsuit over "patient" in 340B 38:18 Tom's advice: let competition work 39:30 Hepatitis C: competition drives prices down 40:34 Competition for gene therapies and CRISPR 41:36 Tom's work for North Korean defectors 44:49 Sponsoring Free North Korea Radio Medicare Part D, drug pricing policy, Inflation Reduction Act, non-interference clause, 340B program, MFN pricing, Globe Guard pricing, pharmacy benefit managers, covered entities, contract pharmacies, biosimilars, generics, federal drug pricing, government price controls, Tom Barker About the Guest Tom Barker is a partner at Foley Hoag in Washington, DC, and one of the country's top drug pricing attorneys. He served as acting general counsel of HHS and chief legal officer at CMS under the Bush administration, where he helped implement Part D from its inception. He is now a go-to expert on drug pricing, and helps North Korean defectors navigate US immigration law. Podcast: DC EKG with Joe Grogan Episode: 136 Guest: Tom Barker Sponsor: Survivors for Solutions - https://survivorsforsolutions.org [https://survivorsforsolutions.org] Executive Producer: John "CZ" Czwartacki, DC EKG Podcast Producer: Stay on Course Studios - https://www.stayoncourse.studio [https://www.stayoncourse.studio]

Dr. Mark McClellan on How FDA and CMS Should Work Together

Dr. Redfield's Warning: Hantavirus| Bird Flu| Long COVID and More

In Episode 134 of DC EKG, former CDC Director Dr. Robert Redfield joins Joe Grogan to discuss his new book, Redfield's Warning, and break down three major threats to public health: Long COVID, Hantavirus, and bird flu. Dr. Redfield explains the persistent viral reservoirs in long COVID patients, the cognitive dysfunction and autonomic dysfunction that devastate these individuals, and why the federal government must partner with the private sector to develop meaningful treatments. He also walks through the current Hantavirus outbreak on a cruise ship, the human-to-human transmission of the Andes virus strain, and why bird flu is the most likely candidate for the next pandemic. Throughout, Dr. Redfield emphasizes the critical importance of antiviral development and the dangers of gain-of-function research. In This Conversation The current Hantavirus outbreak on a cruise ship and human-to-human transmission The Andes virus strain and why it differs from Sin Nombre and Four Corners Disease Two transmission routes: aerosolization and direct contamination Asymptomatic transmission and the intrinsic bias in testing Why has the US government not developed Hantavirus countermeasures in 70 years Bird flu is the most likely candidate for the next pandemic. Gain-of-function research and the public disclosure of dangerous genetic data Long COVID: viral reservoirs and the need for effective antiviral treatments Why antivirals should be the priority over vaccines for emerging viruses Operation Warp Speed and the importance of private sector partnerships The dismissal of long COVID patients as psychosomatic and the need for validation Key Timestamps 1:49  Details of the Hantavirus outbreak and cruise ship cases 3:00  Two methods of transmission: aerosolization and direct contamination 5:24  Asymptomatic transmission and testing bias 10:35  The Hantavirus family and why the Andes virus goes from human to human 12:35  How nervous should the public be 16:43  Shifting to bird flu and Redfield's Warning 19:00  Bird flu spread in US poultry and mammal populations 22:00  The four amino acids for bird flu to infect humans 23:30  The debate with Fauci over gain-of-function research 27:55  Unregulated gain-of-function research worldwide 33:35  Why antivirals should be the priority 37:55  Long COVID viral reservoirs and treatment gaps 42:37  The economic burden and need for solutions 43:57  The story of Joy and psychiatric misdiagnosis of long COVID 48:12  The solvability of long COVID and the importance of investing Hantavirus, Hantavirus transmission, Andes virus, Sin Nombre virus, Four Corners Disease, cruise ship outbreak, bird flu, avian influenza, gain of function research, Dr. Robert Redfield, CDC Director, antivirals, vaccines, long COVID, pandemic preparedness, infectious disease, virology, Redfield's Warning About the Guest Dr. Robert Redfield is the former Director of the Centers for Disease Control and Prevention. A trained virologist with decades of experience in infectious disease, he has been a leading voice on public health policy, pandemic preparedness, and biosecurity. He is the author of Redfield's Warning: What I Learned as CDC Director and What We Must Do to Be Prepared for the Next Pandemic, available on Amazon: https://www.amazon.com/Redfields-Warning-Learned-Couldnt-Might/dp/1510785051 Podcast: DC EKG with Joe Grogan Episode: 134 Guest: Dr. Robert Redfield, former CDC Director Sponsor: Survivors for Solutions –  https://survivorsforsolutions.org [https://survivorsforsolutions.org] Executive Producer: John "CZ" Czwartacki, DC EKG Podcast Producer: Stay on Course Studios –  https://www.stayoncourse.studio [https://www.stayoncourse.studio]

The European Union Explained with Christiaan Alting von Geusau

In Episode 133 of DC EKG, Joe Grogan welcomes back Dr. Christiaan Alting von Geusau for Part 2 of their conversation, this time turning to the European Union. Christiaan walks Joe through the post-World War II origins of the EU as a peace initiative built around the Schuman Plan, the pooling of coal and steel between France and Germany, and the visionary leadership of Robert Schuman and Konrad Adenauer. He explains why understanding the EU's founding purpose is essential to understanding what has gone wrong since. Joe and Christiaan unpack the principle of subsidiarity, the rise of EU bureaucracy and over-regulation, the ideological capture of Brussels institutions, and the long detour into cultural battles that were never the EU's job to fight. They discuss Germany's strategic mistake of abandoning nuclear energy, the widening economic gap between the US and Europe, and why Friedrich Merz himself has called the EU the world champion of over-regulation. The second half of the episode looks at the US-EU relationship under President Trump's second term, including the Digital Services Act and free speech, decades of European free-riding on American defense, and the rise of bilateral engagement between Washington and individual European capitals. The conversation closes with a sharp discussion of the leadership vacuum across the West and Europe's growing economic dependence on China. In This Conversation How the European Union began as a Franco-German peace project Why the Schuman Plan and the pooling of coal and steel still shape Europe today The principle of subsidiarity and how Brussels has overstepped it Why Germany's abandonment of nuclear energy was a strategic disaster How EU institutions have been captured by ideology The Digital Services Act and the threat to free speech in Europe Why the US-EU relationship is under serious strain Whether Washington should deal with Brussels or with national capitals Europe's leadership vacuum and growing dependence on China Timestamps 0:00  Why Brussels has become the global champion of over-regulation 1:10  Joe welcomes back Christiaan for Part 2 1:32  Christiaan reintroduces himself and his background 3:00  Why the EU is misunderstood on both sides of the Atlantic 4:15  The historical origins of the EU and the Franco-German conflict 6:00  The Schuman Plan and the pooling of coal and steel 11:30  Truman, the Marshall Plan, and Dean Acheson 12:37  What went wrong with the EU 14:50  Bureaucracy, nuclear energy, and the German mistake 19:35  The principle of subsidiarity and why it matters 23:24  Cultural overreach by Brussels 26:44  Friedrich Merz on EU over-regulation 27:28  The widening US-EU economic gap 32:03  Free speech, the Digital Services Act, and Trump 38:33  European free-riding on American defense 44:07  Should Washington bypass Brussels 48:30  The rise of bilateral engagement 51:23  The leadership vacuum across the West 58:30  Europe's economic dependence on China 1:01:12  Wrap-up European Union, EU history, Schuman Plan, Franco-German conflict, subsidiarity, EU bureaucracy, EU overregulation, German nuclear energy, Digital Services Act, free speech Europe, US-EU relations, Trump and the EU, NATO defense spending, Europe-China dependence, transatlantic relationship, Christiaan Alting von Geusau, DC EKG About Our Guest Dr. Christiaan Alting von Geusau is a lawyer, professor, advisor, and host of the podcast The Educated Leader. Born in the United States and raised in the Netherlands, he studied law at Leiden University and Heidelberg University. He earned his doctorate in philosophy of law at the University of Vienna. He leads the International Catholic Legislators Network, serves as the principal of Ambrose Advice, and is the Rector emeritus and Professor of Philosophy of Law and Education at ITI Catholic University in Austria. Podcast: DC EKG with Joe Grogan Episode: 133 Guest: Dr. Christiaan Alting von Geusau Sponsor: Survivors for Solutions –  https://survivorsforsolutions.org [https://survivorsforsolutions.org] Executive Producer: John “CZ” Czwartacki, DC EKG Podcast Producer: Stay on Course Studios –  https://www.stayoncourse.studio [https://www.stayoncourse.studio]