Wegovy and Ozempic are weight-loss drugs that promise to rework the treatment of obesity, heart disease and other chronic conditions that afflict thousands and thousands of Americans. But while everyone agrees that these drugs have the potential to alter lives, nobody can agree on the most effective approach to pay for them.

Wegovy sold for a List price – or price before discounts – from $1,349 per thirty days within the US. In Canada the identical drugs cost $265 and within the UK they cost lower than half. These dramatic differences illustrate a bigger problem: the list prices of patented drugs within the United States are far higher than in other wealthy countries.

US Senator Bernie Sanders spoke in favor of it many Americans when he said the high drug costs in America are “not just an economic issue” but “an profound moral question.”

Moral outrage results in the seek for villains. Joe Kernan, host of the CNBC business show “Squawk box“, summed it up when he asked: “Who’s kidding us here?” The PBMs? The drug manufacturers?”

As Health Economist Who writes about it? Innovations within the healthcare sectorI actually have spent much of the last five years excited about these questions. What I've learned is that prime list prices for drugs don't say much about who's screwing whom. To truly understand the drug pricing problem within the United States, it’s worthwhile to start with the tricky economics PBMs or pharmacy profit managers.

What are Pharmacy Benefit Managers?

More and more pharmacy profit managers were popping up Late Nineteen Sixties as a provider of claims processing and administration services for health insurers. Over time, they became key intermediaries between drug manufacturers and the various insurers, employers, and government entities that purchase drugs on behalf of their members, constituents, and beneficiaries.

Mergers between PBMs have resulted in a market dominated by a small variety of very large players. In 2023, the three largest – OptumRx, Express Scripts and CVS Caremark – have made it 79% of US prescription claims and served around 270 million customers.

The primary role of those corporations is to barter prices, affordability, and access to prescribed drugs. You do that through Operating and designing formsthese are lists of medicines covered by insurers.

Forms also assign medications different levels which determine what patients should pay out of pocket to get the medication. Generic medications are typically assigned to the tier with the bottom out-of-pocket costs. Patented drugs which might be preferred by insurers are placed in a higher-cost tier, and non-preferred drugs are placed in a tier that requires patients to pay much more. Some medications may even be excluded from the drug list entirely, meaning they will not be covered by insurance.

Tiering determines how inexpensive a drug is for consumers and the actual drug price insurers pay. Drug manufacturers compete with one another for placement at the specified formulation levels by offering PBMs significant discounts from their list price. The price at which the PBM obtains the drug for its customers is the web price – the list price minus the drug manufacturer's rebate.

When a drug manufacturer increases its rebate, the web price falls, even when publicly advertised list prices remain high. For this reason, specializing in list prices when determining the price of a drug might be misleading.

The price is correct?

Drug list prices are public knowledge, but drug manufacturers' rebates on PBMs are closely guarded secrets. That makes it difficult to know exactly how much insurers pay for many prescribed drugs.

This secrecy raises difficult questions. Are PBMs using their size and bargaining power to extract lower net prices from drug manufacturers? Or are PBMs using their dominant market positions and opaque business practices to counterpoint themselves on the expense of their customers and the remaining of society?

Surprisingly, the reply to each of those questions is yes. When competition for drug placement works because it should, competition forces drug manufacturers to supply significant discounts to the published list price. As a result, insurers and consumers profit from a reduced net price for medicines. However, formula competition might be undermined in various ways.

For example, in a 2024 report, the US Federal Trade Commission found evidence that the manufacturer was producing a patented type of insulin higher discounts offered to a PBM if competing insulins were placed at a less favorable level of a formulation or excluded entirely. This regulation limits consumer alternative. By excluding a less expensive generic equivalent, the agreement would also favor a dearer drug, increasing patient costs. The widespread use of such exclusion discounts could even discourage latest generics and reduce competition.

Introduction of biosimilar drugs made specifically for PBMs Substituting expensive biologics manufactured elsewhere can even undermine formulation competition. When PBMs favor their proprietary products in formulations, this reduces the inducement for other drugmakers to introduce competing products. The result’s each less competition and better prices.

Competition throughout the formulation can be distorted when drug manufacturers publish contributions very high list prices. This artificially increases rebates for PBMs without reducing net prices for insurers and other parties. Inflated list prices also increase drug costs for some patient groups – particularly those that would not have medical insurance or have high deductibles.

Market competition

Just as fair competition can break down throughout the PBM forms, it may also break down available in the market for PBM services.

The current regulatory environment within the US tolerates overly large PBMs that engage in anti-competitive practices to build up excessive profits. Without strong competitors, dominant PBMs can charge customers high fees and keep a bigger portion of drugmaker rebates for themselves.

In theory, this problem should correct itself. High profits are intended to draw latest competitors into the industry. Competition from these latest entrants is prone to drive down fees and reduce the share of discounts these corporations retain. However, things are different in practice as the biggest PBMs have done this merged with the biggest health insurers. CVS merged with Aetna. Express Scripts and OptumRx merged with Cigna and UnitedHealthcare, respectively. These mixtures reduce the variety of potential customers for brand spanking new PBMs and thus prevent latest competitors from entering the market.

Even belligerent upstarts who could upend the establishment are at a drawback because of ordinary contracting practices. Large PBMs, for instance, often insist on “Most-favored-nation agreements that require drug manufacturers to match or exceed the costs they provide to other buyers. These contracts eliminate the competitive advantage that a brand new PBM could gain by achieving higher prices than incumbents.

There is growing concern amongst experts that dominant PBMs are also using formularies to funnel profitable “specialty prescriptions” to pharmacies with which they’re affiliated. Pharmacies affiliated with the three largest PBMs increased their share of the specialty drug market 55% to 67% between 2016 and 2023. Concerns about such anti-competitive practices have led to this non-partisan laws to force PBMs to sell their retail or mail-order pharmacies.

Who are the villains?

So, are PBMs ripping us off? If we didn't have PBMs, we might should invent them – or something similar – to get reasonable prices for patented drugs. But the concentration of market power in a couple of corporations threatens to destroy the worth they create.

Increasing competition within the PBM market will likely require a bigger variety of smaller PBMs, and enormous insurers might also have to divest their PBM units.

Contrary to popular belief, smaller PBMs are prone to be just as capable of negotiate a low net price for Wegovy and other patented drugs as larger PBMs. Once a certain minimum size is reached, the competition for the position of the forms and never the PBM size is vital. A more competitive and transparent marketplace for PBM services will help be sure that this competition stays fair and transparent – for the Benefits for patrons and society.

In this sense, PBMs will not be the villain. Too much market power in too few hands is the issue, and that may very well be fixed with more competition, sensible regulation and vocal consumers.

About one in five American adults recurrently provide unpaid care or financial support to their adult relatives or friends. And about 1 in 7 young adults between the ages of 25 and 34 live with their parents.

But the true level of support amongst Americans is deeper and broader.

From parents covering the price of unexpected automotive repairs to co-workers fundraising for his or her colleagues' medical expenses, Americans help one another in countless ways.

As Social work scientist who explores these patterns of what I call “financial interdependence“I often see transactions that challenge the common American narrative that most people in this country manage their own spending.”

A protracted-standing tradition

The practice of sharing money with friends and family members has deep roots in American society. Many Native American communities have done this Traditions of sharing food and other resources one another.

In the nineteenth century Mutual aid associations formed in every single place from Philadelphia to Florida. Many of them have helped lift black people out of economic hardship. These organizations provided every little thing from unemployment assistance to funeral expenses.

Today's informal support networks reflect these historical patterns.

In particular, many immigrant communities maintain traditional practices joint saving and lending Money. Mexican American families often take part in “tandas,” where their savings are pooled to attain financial goals or meet urgent needs. Likewise the West African and Caribbean communities within the USA Organize “Susu” groupswhile many Chinese American communities form “hui” associations.

In addition, local “hometown associations” often offer each financial and social support to their members, helping immigrant communities within the United States and other people of their home countries.

Everyone does it

These mutual support agreements are very widespread and apply to all income levels, although in numerous forms. She will be secular or religious in nature. The true extent of this sort of activity is usually unknown.

Lower-income families often engage in frequent, smaller exchanges. She could share the food costsFor example, relatives may help one another pay large, unexpected bills.

Wealthier Americans tend to offer larger amounts of cash to larger relations, but less often. This may also include parents Help with a deposit on a young adult's first home or paying a part of the price of 1 Grandson's college education.

Some families establish formal structures resembling: Financial trusts or 529 Education Savings Accounts to facilitate the implementation and tracking of those transfers. The number of individuals using 529 accounts has steadily increasedbecause the states offer appropriate resources and tax incentives.

The nature of this financial support often reflects economic needs and cultural values. In many East Asian American communities, for instance, adult children routinely provide financial support to their parents – as a cultural expectation.

Regardless of the community involved, technology has modified the best way people share money with their family and friends.

Mobile payment platforms make it easier to allocate costs and supply quick help. Money transfer apps have normalized small-scale financial sharing amongst family and friends.

Online and social media platforms are used to assemble resources for medical expenses, funerals or emergencies. These tools extend traditional support networks beyond geographic boundaries.

Other forms of support

Financial assistance can go far beyond direct monetary assistance.

Families and communities could Buy groceries in bulk living together to get monetary savings or living together to deal with rising housing costs. Some parents create informal childcare cooperativeswhile others coordinate care responsibilities for aging relatives with their prolonged families.

Financial education often focuses on individual saving and budgeting. Still, many Americans practice financial interdependence by managing their funds and making decisions along with others.

Tackle challenges

To meet today's economic challenges, Americans are finding creative solutions using shared resources.

More and more young adults need more help becoming homeowners than what they will get from a bank. The average home price has far outpaced wage growth Family support is crucial for a lot of first-time buyers.

Tuition fees have stabilized, albeit at a high levelThis results in more families pooling their resources for educational support. This often arises long-term financial commitments across generations.

Medical expenses remain a number one reason for financial stress Families must depend on one another to pay health care costs.

These support systems operate at many levels, including family, community, workplace, and government.

Some employers now offer this Emergency loan programs and related resources for the plight of employees. Some firms create formal peer support systems for workers facing financial challenges.

A number of states also support caring relatives through tax credits to reimburse their expenses.

Understanding the financial burden of caregiving, Michigan Governor Gretchen Whitmer has proposed a tax credit to support nursing and transportation services for those in need of care.

Some complications

While financial interdependence is a vital help, it will probably also bring challenges.

Financial obligations can strain family and friendship relationships. Providing an excessive amount of financial help could cause or worsen problems Power imbalances in relationships. Some churches may not have the funds for to support all members equally and effectively.

Clear communication and healthy boundaries may also help manage these tensions.

As economic pressures increase for a lot of American families, these informal financial support networks have gotten increasingly essential. Studies show that costs are rising It is becoming increasingly difficult to attain financial stability on your individual.

Imperial County ranks consistently are amongst probably the most economically distressed Places in California. Its Salton Sea, the state's largest and most toxic lake, is an environmental disaster. And the politics of the region were dominated by a conservative white elitedespite its predominantly Latino population.

The district also happens to have enough lithium produce almost 400 million batteriesenough to convert the American automotive fleet completely to electric drive. Even higher, lithium may very well be extracted in a way that’s consistent with broader pollution reduction goals.

The Traditional methods of extracting lithium These are either hard rock mining, which produces loads of waste, or large evaporation ponds, which waste loads of water. In the Imperial Valley, firms are developing a 3rd method. They extract the mineral from the underground salt water created by geothermal energy production after which inject this salt water back into the bottom in a closed loop. It guarantees to present in the cleanest and most environmentally friendly lithium on the planet.

Hopes for a clean energy future have excited investors and officials a lot that the realm is being renamed “Lithium Valley.”

In a region desperate for jobs and income, the prospect of a “white gold rush” is tempting. Officials have been working to roll out the red carpet for major investors and in addition attempting to get something done a transparent plan for the infrastructure and a faster approval process. To gain support from community groups, they exploit the potential for jobs, including businesses Obligations to employ local employees.

But residents of the Imperial Valley who’ve up to now fallen victim to wealth schemes surrounding water and real estate are anxious that their political leaders might give away the shop. As we explore in our latest book: “Marching Forward: Lithium Valley, Electric Vehicles, and an Equitable Future“The U.S. has an opportunity to ensure these residents benefit directly from the lithium mining boom, which is an important part of the global transition to clean energy.”

Opportunities and dangers in “Lithium Valley”

Imperial Valley is emblematic of the potential and risks that impoverished communities in resource-rich regions have long faced.

To understand the opportunities and threats within the Imperial Valley, it is helpful to keep in mind that the world is moving away not only from fossil fuel extraction but additionally from mineral extraction. Today's battery technology – mandatory for electric vehicles and energy storage – is predicated on minerals resembling cobalt, magnesium, nickel and graphite. And mining minerals often comes with hidden environmental risks.

In the Imperial Valley, environmental and community organizations are concerned about water use, waste and air pollution from lithium extraction as production increases and truck traffic increases. If your region Asthma rates in children is already greater than twice the national average, and Dust from the drying lake is poisonouskicking up just a little more dust is an enormous deal.

Valle Citizens Committeea long-established environmental justice organization within the Imperial Valley, has sued To decelerate an optimized approval process for controlled thermal resources, an organization that plans to extract lithium There. The group fears that inadequate environmental assessments could lead on to health problems for residents. Both the corporate and authorities warn that the lawsuit could stop the lithium boom before it even begins.

Local communities are too anxious about how much profit You will see how the industry advantages from this. They note that the electrical vehicle boom that boosted lithium demand was precisely because of public policy. Tesla, for instance, has benefited from multiple rounds of state and federal incentives for zero-emission vehicles, including the sale of carbon credits that accounted for 85% of Tesla's gross margin in 2009 And increased to $1.8 billion per yr by 2023.

Public will and taxpayer money were behind these measures and financial incentives.

We consider that not only businesses but additionally local residents deserve a return on investment. Instead of promising to pay just for community “benefits” resembling environmental protection, community fund contributions or jobs, firms could pay “dividends” on to local residents and communities.

There are models of this dividend approach. For example this Alaska Permanent Fund gives to all residents of this state an annual amount from the revenues derived from underground oil.

In the Imperial Valley the actual one Ownership of lithium is complexThese are a combination of privately owned subsurface rights, public lease rights owned by firms, and public rights owned by the regional water district to which the businesses pay royalties.

Given the complexity of ownership and the need to profit from development, local authorities and community organizations persuaded the state to adopt one per ton in 2022 Lithium tax to answer local needs.

This “flat tax” was met with fierce opposition from some within the emerging industry on the grounds that it could make Imperial Valley’s extraction method less environmentally damaging too expensive to compete with environmentally damaging imports; After the vote, CTR's CEO called on lawmakers:clowns.” Meanwhile, CTR has also agreed to rent union employees in the course of the construction phase. Everyone – businesses, communities and government officials – is struggling to balance economic viability and accountability.

Lessons for a just transition

There is great reluctance amongst low-income residents of the Imperial Valley to right away embrace the lithium vision deeply rooted in history.

Decades of racial exclusion, patronizing practices and broken guarantees have led to deep distrust of outsiders who claim things will probably be higher this time.

Irrigation on the turn of the century was purported to result in an agricultural boom, however the initial result was a broken canal that released enough water to last nearly two years of decay Create what’s now the Salton Sea. The Salton Sea was then is meant to spice up recreational tourismhowever the failure to replenish it with anything aside from agricultural runoff contributed to the deaths of fish, birds and recreationists. A recent program to locate solar farms has resulted in low employment and more in recent a long time Concerns concerning the displacement of agriculture.

Build the provision chain here too

In recent years, some people have pinned their hopes on lithium. The previous important location was Imperial Valley CTR's Hell's Kitchen. On summer days when temperatures commonly rise above 110 degrees, that is an apt name.

Ensuring that surrounding communities profit from this latest lithium boom requires consideration of the best way to attract not only firms that may mine the lithium, but additionally those who will use it. So far, Imperial County has had limited success in attracting related industries. An organization was named in 2023 Statevolt said it will construct a “gigafactory.” there to assemble batteries. The company’s efforts to this point – Britishvolt within the UK And Italvot in Italy – have stalled without creating any tension. Imperial County will need serious applicants to try.

A potentially promising future for advanced transportation and energy storage may very well be brewing within the Imperial Valley. But achieving a greater future for all requires remembering a lesson from the past: that community investments are frequently hard-won. We consider that ensuring everyone advantages in the long run is critical to achieving a more inclusive and sustainable future.

More hybrids, fewer electric cars

Ford vs. GM

President Joe Biden and former President Donald Trump will not be the one examples of politicians working into their golden years. Members of the newborn boomer generation – Americans born between 1946 and 1964 – are the most quite a few in the homeand within the Senate they outnumber the legislators of all other generations combined.

Overall, two-thirds of US Senators and almost half of the members of the House of Representatives Entitlement to full old-age pension through the pension system for federal employees. And yet they proceed to work. The 4 Supreme Court judges over 65 years of age.

You will not be alone. If you might have the alternative, Americans appear to prefer working more quite than lessThis applies to their weekly and annual working hours in addition to to the They spend their lives working. To 1 in 5 Americans over 65 worksalthough they’ve passed the purpose at which they’re entitled to full old-age pension and social security payments.

The proportion of older people within the working population is increasing, even though it is unclear how a lot of them still stamp because they need and what number of cannot afford to stop because Holes within the US security net.

As Historian and anthropologist of medication within the USAI actually have spent years researching how American adults generally voted to earn higher wages as a substitute of reducing their working hours.

I consider that Biden’s Decision to retire after years in public service offers a possibility to reflect on what’s at stake for society when so many individuals over 65 years of age proceed to workespecially in outstanding roles.

Retirement conventions in other countries

Maybe not for politicians, but in lots of professions, fewer hours are needed today to realize the identical level of performance as a century ago, due to Advances in manufacturing and computing.

Still, Hardly anyone reduces their workload Despite these efficiency gains. According to the Bureau of Labor Statistics, a government agency, most full-time employees within the United States report about 40 hours of labor per week.

Many Europeans work shorter hours, take longer holidays and more generous pensions from their governments than their US counterparts. It isn’t any coincidence that the support of Retirement at 65 years or earlier, enjoys broad support within the European Union.

In the United States, the later retirement age is partly attributable to political changes. For Americans born in 1960 or later, The nationwide retirement age has been raised to 67 years from 65. This also includes the tip of those that are the newborn boomwho turn 65 between 2025 and 2028. Retirees who’re entitled to social advantages can receive a lower amount at age 62 and shall be rewarded with higher amounts Social security advantages in the event that they work until the age of 70.

As economist Dora Costa writes in her book:The development of retirement“The convention of a set retirement age emerged at first of the twentieth century in consequence of actuarial data on life expectancy and the introduction of pension and social insurance systems.

Ageing and health

To ensure, everyone ages in another wayand there are advantages to society when older people remain in employment after their sixty fifth birthday, including institutional memory and workplace experience.

The advantages of working in old age are sometimes debated. In some cases, research supports the Benefits some people gain from working after age 65But research also supports the Importance of hobbies and their health-promoting effects. It is obvious that Stay lively in old age is an important thing to remain healthy in old age.

However, there are also some disadvantages related to health problems in old age.

For example, routine illnesses outsized impact on aging bodiesand recovery from injuries and illnesses can take longer for those over 65 than for younger adults. This can mean long periods of time when an worker is unable to do their job.

Cognitive abilities can hardly decrease for some people, while others experience the dramatic changes in reference to age-related dementia.

Unfortunately, it’s difficult to find out who should really retire in the event that they don’t volunteer, because cognitive tests not all the time reliableThey often judge the Skills required to take the exam and never the underlying capacities.

For example, hearing tests inadvertently assess listening comprehension by attempting to Measure the power to recollect a sequence of words. Many tests functionally test an individual's personality quite than their cognitive abilities. People with certain personality types may hide their cognitive changes. In addition, bias in assessing cognitive changes is usually based on the Experience of the examiner in coping with the examinee.

Except in cases where someone is experiencing obvious changes of their cognitive performance and skill to interact with others, the argument that somebody must retire is usually rooted in ableist assumptions.

Social security concerns

When the necessity to retire someone is dependent upon their perceived ability to do the job, that call becomes unnecessarily biased. In my view, establishing a compulsory retirement age would offer a neutral mechanism to be certain that retirement from public service is smoother than it was for Biden.

Many older Americans who work beyond 65 accomplish that because they can not afford to retire. The cost of living, including those related to longevity, has outpaced the support provided by Social Security advantages. The poverty rate amongst adults over 65 is much higher than in Europe.

But just about all politicians and officials within the USA can stop working at 65 or shortly thereafter. They have the advantage of Pension system for federal employees and federal employees Savings planwhich some economists argue could function a job model for everybody else. Although they may exit their profession without financial worries, a lot of these leaders and employees stay within the job long after they leave.

If the United States were to introduce a compulsory retirement age for all federal employees, it might at the very least spare those Americans the difficult conversations about mental capability that a lot of us must have as we age.

In the meantime, Biden's decision to retire provides a possibility to think together about when Americans should retire.

OAKLEY – A profit dinner for the brand new Oakley library and community center might be held Aug. 16 to boost money for the power, which could cost nearly $28 million.

The fundraiser, hosted by the Friends of the Oakley Library and the Rotary Club of Oakley, begins at 6 p.m. on the Oakley Recreation Center on O'Hara Avenue. Tickets are $50 each and have to be reserved by Monday. There can also be a chance to sponsor or donate a raffle item; the last day to achieve this is Tuesday.

Liz Fuller, treasurer of the Friends of the Oakley Library, said 85 tickets have been sold to this point. There are sponsorships starting from $250 to $750 from 14 local businesses and individuals, and raffle items donated by 12 local businesses.

Fuller said it was encouraging to see so many individuals excited concerning the latest library and community center.

“Whether we're doing community outreach at a city event or asking major donors to contribute, the response is consistently positive and enthusiastic. … This event feels like a celebration of the fact that we're getting a facility that benefits everyone in the community,” Fuller said.

The profit dinner will include a Hawaiian buffet provided by Whiskey Tango Foxtrot Restaurant in Oakley, a hostess bar operated by the Rotary Club of Oakley, a raffle, a Hawaiian dance performance and guest speakers. Guest speakers for the evening include Jeff Palmquist, Oakley Union Elementary School District superintendent; Kristin Connelly, Contra Costa County Clerk, former president and CEO of the East Bay Leadership Council and executive director of the Contra Costa Economic Council; and Susan Hildreth, former California State Librarian and director of the National Institute of Museum and Library Services.

The current Oakley library, situated in Freedom High School, outgrew the community's growing population years ago. A brand new location for the library was to be found by 2004, but after 20 years, the brand new library has found a possible home within the Oakley Civic Center Plaza.

Oakley has put aside $9.5 million to fund the brand new library, but the town has set a deadline of Dec. 31 of this 12 months to boost additional money to construct a much larger library and community center. This 300,000-square-foot facility will house not only the library but additionally a senior citizen and veterans center and can cost $28 million.

To purchase tickets or learn more about sponsorship opportunities, visit https://www.oakleylibrary.org/new_fundraising_event.

Details of the long-term study