YouSaid · the spoken record

Julie Yu

lines on the record: 21
first: 2023-12-08
most recent: 2023-12-08
sittings or episodes: 1
sources: podcast

Every line below is reproduced as it was said and linked to the record it came from. Nothing here is summarised or generated. Directory · Search · Corrections

“But we're at an election year, and so I think expectations are that that cycle will be slow. However, we are, I think, getting to a tipping point where both the number of these kinds of drugs that have already been approved, that are already on the market, that are already crippling individual companies and employers and insurance companies and even the manufacturers are already hitting a tipping point where lots of companies are potentially going to go bankrupt if they have to pay for these drugs, if they have even one employee who ends up being eligible for one of these therapies. And so I do think there is a siren call already from the industry that will sort of ignite a cycle of innovation, as we're already seeing, as I mentioned, with a lot of startups that are spinning up in this space. So I think as most things in healthcare, it'll be a combination of both sort of top-down regulation and policy combined with some of the bottoms-up activity that we already see starting to happen from those who are just feeling the pain today and just need to kick into action.”
2023-12-08 · a16z Podcast · 2024 Big Ideas: Miracle Drugs, Programmable Medicine, and AI Interpretability · IDENTIFIED FROM THE TRANSCRIPT · source
“Yeah, I think policy will definitely play a critical role in the long run, and we already have seen certain sort of guidance briefs come out from various government bodies around this particular issue. A lot of requests for feedback from the sort of private sector on how they should be approaching this. But I think probably namely two bodies. So the FDA, I think there's going to need to be a lot of change in terms of how they handle approvals of these drugs because they are so different and also ongoing monitoring of these drugs to be able to design the right type of approach for these therapies. And then CMS, which administers Medicare and Medicaid, the government-sponsored insurance programs in our country, they generally tend to be at the tip of the spear of any payment innovation for new classes of drugs and new classes of services. And so the expectation is that they will likely roll out some sort of program that teaches the industry how they should be approaching these kinds of therapies and financing them.”
2023-12-08 · a16z Podcast · 2024 Big Ideas: Miracle Drugs, Programmable Medicine, and AI Interpretability · IDENTIFIED FROM THE TRANSCRIPT · source
“From those approaches, and so we are seeing a number of startups start to say, okay, how can we design sort of new fintech approaches, basically, to be able to spread this risk in a very different way? So all of those things are out there today and sort of what I would call kind of point solution form. And I think the big opportunity and why this is kind of a hard problem space to go after is that there is a bit of a cold start problem, right? To actually build kind of a holistic solution that solves the entirety of this problem space, you actually need to convene payers. You need to convene providers. You need to convene manufacturers and obviously also the patients themselves who require a ton of services to get this right. And so I think that remains sort of the big unmet need and huge opportunity for entrepreneurs to go after is can you thread the needle on bringing together these multiple players with a holistic solution that can actually unlock this cold start problem to be able to address this at scale across the entire industry?”
2023-12-08 · a16z Podcast · 2024 Big Ideas: Miracle Drugs, Programmable Medicine, and AI Interpretability · IDENTIFIED FROM THE TRANSCRIPT · source
“Closed loop of data on how your product was being used in the real world or any feedback from your end users. That is unfortunately like the state of affairs for many drugs that we have on the market today is that once the drug is prescribed and it's out there, there's not really great ways for the body manufacturing companies to get feedback back. But in the case of these really expensive therapies, you obviously it's critical to have some degree of feedback loop both to continually justify the price of those therapies and make sure that they're working, but also frankly to iterate and just make sure that you understand any of the side effects and potential implications of those drugs. And so there's companies that are just building really data infrastructure to enable the collection in a continuous fashion of how these drugs are performing post-market. And then the last piece is on the financing side. I think we've seen both like traditional incumbent insurance companies trying to spin up new solutions for this area, but they still tend to be pretty one-off and not systematic and scalable across the full class of drugs that could benefit.”
2023-12-08 · a16z Podcast · 2024 Big Ideas: Miracle Drugs, Programmable Medicine, and AI Interpretability · IDENTIFIED FROM THE TRANSCRIPT · source
“So, the exciting thing is that we've already seen quite a number of great entrepreneurs who are out there building various aspects of solutions that address all the different components of that problem space that I just described. So there are companies that are certainly innovating on the manufacturing side, as I mentioned, to systematize and really industrialize what today is a highly bespoke process to actually produce these cell-ine therapies in a scalable fashion. There are companies who are helping hospitals and physicians deliver operational and clinical logistics services related to everything from transporting the drugs to kind of the care management services that the patients need, both pre and post the administration of these drugs, even things like hardware for remote monitoring of these patients, such that they don't have to stay in the hospital for many weeks on end. There are companies really addressing the data aspect of this. So one of the things that I always think about as an ex-product person is like, imagine as a product manager, if you didn't have any”
2023-12-08 · a16z Podcast · 2024 Big Ideas: Miracle Drugs, Programmable Medicine, and AI Interpretability · IDENTIFIED FROM THE TRANSCRIPT · source
“Between now and then, it's really that price point that makes it really, really challenging to justify, again, paying this annual cost when you're not sure that you're going to actually see the cost savings associated with it within the time horizon that the person is on that given plan.”
2023-12-08 · a16z Podcast · 2024 Big Ideas: Miracle Drugs, Programmable Medicine, and AI Interpretability · IDENTIFIED FROM THE TRANSCRIPT · source
“So GOP1s are also relatively expensive, cheaper than cell and gene gene therapies, but we're talking $1,000 a month, roughly speaking, for this class of drugs. And so tens of thousands of dollars over the course of someone's tenure at a given employer that you'd have to cover with the hope that, again, in that time horizon, you are also going to see the cost savings associated with that person avoiding certain downstream health implications. And so there is probably a certain price point at which it becomes a no-brainer. So if you think about something like a high blood pressure drug, which are these pills that the vast majority of the population in the US is popping these pills on a daily basis, they cost maybe a few dollars per month for the health plan. And so at that price point, it's really a no-brainer because over a whole population, you will see the threshold for that financial benefit is relatively low. And so there is actually hope that there's a whole pipeline of cheaper versions of the current GLP1 therapies that are in the pipeline expected to be approved in the next several years.”
2023-12-08 · a16z Podcast · 2024 Big Ideas: Miracle Drugs, Programmable Medicine, and AI Interpretability · IDENTIFIED FROM THE TRANSCRIPT · source
“Monitor the patient while this is happening because you might have an immune response that could be really severe and things of that sort. And then that patient generally needs to be monitored in the hospital for many, many weeks subsequently so that you can see that the drug is working. And all of that, it requires highly specialized expertise on the clinical side, on the operational logistics side, on the manufacturing side. There's entire companies that are being built just to create competencies around manufacturing these kinds of therapies because it's so fundamentally different than any of our previous sort of pill-based therapies or even the injectible therapies. It's just a very different paradigm. And so that whole landscape is also something that, again, the current status quo biopharma value chain is just not suited to handle and therefore we need new capabilities to handle it.”
2023-12-08 · a16z Podcast · 2024 Big Ideas: Miracle Drugs, Programmable Medicine, and AI Interpretability · IDENTIFIED FROM THE TRANSCRIPT · source
“Sort of spread the risk as the person moves across insurance plans or create a portable product that sort of follows that person throughout their entire life. And that just requires a lot of, again, innovation on the underwriting side in terms of the services that need to wrap around that and lots of other things that relate to that. So that's kind of the financing piece. And then on the sort of breaking the system piece, these drugs, as I mentioned earlier, are very, very complicated to administer. So in the case of selling gene therapies, which are probably the most extreme case, you are literally removing cells from a person's body who's been diagnosed with cancer. You need to transport them to a manufacturing facility where you reprogram the cells, you genetically engineer them, you regrow those cells, and then you package them to be sent back to a hospital that is trained and qualified and certified to actually deliver this highly complex therapy. These cells are infused into the patient, and you need to really”
2023-12-08 · a16z Podcast · 2024 Big Ideas: Miracle Drugs, Programmable Medicine, and AI Interpretability · IDENTIFIED FROM THE TRANSCRIPT · source
“And as an employer who covers the health insurance benefit for my employees, the average tenure of any employee in my company is maybe three to four years on average and even lower for tech companies. And so what incentive do I have to pay this upfront fee for something that will benefit this person over the entirety of their life? But that person is going to leave my insurance plan in maybe two or three years. And so I'm not actually going to reap the benefits of that upfront cost for many, many years after that person's gone. And so that's kind of the premise of how the current insurance system is designed and why it's not set up to incentivize people to be willing to pay for these drugs up front. And so that's one huge area where there just needs to be sort of fundamental innovation on just financing mechanisms to underwrite that risk profile in such a way that any individual payer only really has to pay their fair share, let's call it, while that person is on their plan and that you can”
2023-12-08 · a16z Podcast · 2024 Big Ideas: Miracle Drugs, Programmable Medicine, and AI Interpretability · IDENTIFIED FROM THE TRANSCRIPT · source
“So, the original sort of blurb here referred to two things. One is that we could bankrupt the system and one is that we could break the system. So on the bankrupting of the system side, some of these cell-ungene therapies that I mentioned can be a one-time cost of two to three million dollars and sometimes more. And so if I'm a health insurance company and you're telling me, okay, I've got this individual, I obviously would love to administer a drug that can literally save their life and eradicate this disease that they would have to deal with for the rest of their life. But it's going to cost me $3 million up front.”
2023-12-08 · a16z Podcast · 2024 Big Ideas: Miracle Drugs, Programmable Medicine, and AI Interpretability · IDENTIFIED FROM THE TRANSCRIPT · source
“Complex to administer. But effectively, the way I'd put it is that our current system just is not designed at all to be able to handle the adoption and absorption and access to these kinds of therapies today, the ones that are available on the market today, are administered in a very, I would say, bespoke and kind of one-off fashion in terms of how insurance companies cover them, in terms of how doctors are sort of managing the therapeutic administration piece and how patients are being handled as far as their patient journeys. And so it's a huge problem. And there are dozens of drugs of this ilk that are projected to be approved and brought onto the market in the next several years. And so we think there's a very sort of imminent why now dynamic around why we need to solve for this sooner than later.”
2023-12-08 · a16z Podcast · 2024 Big Ideas: Miracle Drugs, Programmable Medicine, and AI Interpretability · IDENTIFIED FROM THE TRANSCRIPT · source
“After you're born. And so historically, we've had a thesis that if you were to be able to program drugs, cells, and genes essentially to be able to address those kinds of diseases that you could actually entirely cure those diseases so that you no longer have to deal with that for the rest of your life. And so we now are in an era where we finally have the first versions of those drugs that are now available on the market. These are programmable medicines, as we call them. So you're either programming a cell to go target a certain cancer type within your body and it'll be programmed to kill those cancer cells to completely eradicate it from your body. Or you can do a gene therapy which actually changes the genetic makeup of your body so that the disease that you were born with is completely gone. And so those genes are generally speaking orders of magnitude more expensive than really anything that we've seen in society to date. And they're also very”
2023-12-08 · a16z Podcast · 2024 Big Ideas: Miracle Drugs, Programmable Medicine, and AI Interpretability · IDENTIFIED FROM THE TRANSCRIPT · source
“Yeah, I would even argue that cell and gene therapies are probably the more extreme version of what we just described with GOP ones, both in terms of the miraculous nature of what they do, but also in terms of the cost burden and the clinical burden to our current healthcare system. So there are many chronic or fatal diseases that stem from genetic code mishaps. So you might be born with a gene mutation in your actual native genetic code that results in some kind of debilitating disease. One common example is sickle cell anemia, in which there's a single gene mutation that arises when you're born and that impacts the shape of your red blood cells and has all sorts of very negative implications on your health status throughout your life. And you actually have to get sort of ongoing blood transfusions basically is kind of the current state of the art of how we treat that. So it's both expensive, but also extremely taxing for patients and providers. There's also other types of diseases like cancer in which mutations might arise during your life.”
2023-12-08 · a16z Podcast · 2024 Big Ideas: Miracle Drugs, Programmable Medicine, and AI Interpretability · IDENTIFIED FROM THE TRANSCRIPT · source
“That year. And the interesting thing is that I think we're just getting started, right? So that's obviously a small subset of those who are clinically eligible, technically speaking, as far as type 2 diabetes and obesity go. But the insurance policies covering these drugs are still very, very immature. And that's a lot of the sort of recent media attention that's been paid to this drug class is that you hear about all these insurance denials and people struggling to get coverage for these drugs through their employer-sponsored benefit plans and even on Medicare and Medicaid. And so there's still a ton of questions about under what circumstances it actually makes sense to reimburse for these drugs because they are very, very expensive, as we'll talk about, and that these drugs also, if you stop taking them, are likely to very much lose their benefits. So you could refer in terms of your weight loss and your type 2 diabetes management.”
2023-12-08 · a16z Podcast · 2024 Big Ideas: Miracle Drugs, Programmable Medicine, and AI Interpretability · IDENTIFIED FROM THE TRANSCRIPT · source
“Just to baseline everyone's sort of view on this, there's a drug called humera, which was the best selling drug ever in the history of American drug industry. And that drug was used by roughly 300,000 Americans each year. And so it had a huge level of impact, but a fairly finite number of humans who were impacted by it. In the case of GLP1s, there was a study that showed in 2022, based on prescription claims data analysis, that there was roughly 3.6 million prescription claims for GLP1s.”
2023-12-08 · a16z Podcast · 2024 Big Ideas: Miracle Drugs, Programmable Medicine, and AI Interpretability · IDENTIFIED FROM THE TRANSCRIPT · source
“Fixing a disease that has such negative implications for health of our population. So there's been a lot of hype about these drugs. I think the miracle part of it sort of stems from two things. One is its weight loss capabilities and obviously we as a society are just obsessed with weight loss in general. And so that's obviously been one reason that these drugs are part of the zeitgeist. But then two, from a clinical perspective, I think what we are all so excited about is that there appears to be a really compelling set of side benefits related to all of the comorbidities of obesity. So if you are obese, you're very likely to have other illnesses, namely things like cardiovascular disease that lead to heart attacks and strokes and early death, basically. And there's been a number of recent studies that show potentially very significant benefits of these drugs as it relates to cardiovascular benefits, which, as we'll get to, has very big significant implications in terms of how health insurance companies would look at this and in general.”
2023-12-08 · a16z Podcast · 2024 Big Ideas: Miracle Drugs, Programmable Medicine, and AI Interpretability · IDENTIFIED FROM THE TRANSCRIPT · source
“Action. And so therefore, on the basis of that observation, a subset of GLP1s have actually been approved for treating obesity. And obesity opens up the aperture even broader in terms of the applicability across our population. Sadly, it affects 42% of the American population, which is remarkable. And there's been a wave of celebrities on TikTok touting their ability to lose upwards of 20% of their weight from taking these drugs. And there's this popular analogy that people say GLP ones are too obesity, what eyeglasses are to nearsightedness. And so it has that level of sort of societal impact in terms of”
2023-12-08 · a16z Podcast · 2024 Big Ideas: Miracle Drugs, Programmable Medicine, and AI Interpretability · IDENTIFIED FROM THE TRANSCRIPT · source
“Yeah, so GLP ones are all the rages you're implying. So the premise of GLP ones is that GLP1 is actually a hormone that is naturally occurring in our bodies, and it's generally secreted in response to food intake. So when we eat this hormone is secreted by our intestinal tract. And the main job of that hormone is to help manage blood sugar levels. And so the initial core use case for the drug form of this hormone was to treat type 2 diabetes. And obviously type 2 diabetes has huge prevalence in the American population. It affects over 11% of us. And so one in 10 of the people that you know are likely to be diagnosed with type 2 diabetes at some point in their life. So that in and of itself is obviously hugely impactful. But I think probably what's driving more of the sort of popular awareness of GLP1s is that it has this quote unquote side effect that it also has been shown to lead to weight loss. And part of the reason for that is that it actually suppresses appetite as part of the mechanism.”
2023-12-08 · a16z Podcast · 2024 Big Ideas: Miracle Drugs, Programmable Medicine, and AI Interpretability · IDENTIFIED FROM THE TRANSCRIPT · source
“Hi, everyone. I'm Julie Yu, General Partner on the BioHealth team here at Andreason Horowitz, and this is my big idea for 2024. It is about democratizing miracle drugs. So in 2023, a wave of therapies hailed as miracle drugs, including GLP1s and cell and gene therapies, had a profound impact in patients' lives. But our current healthcare insurance system is just not set up to bear the cost of these therapies or to accurately gauge their value, given that some are curative, nor are healthcare providers prepared to manage the complex logistics, data collection, and clinical operations needed to realize the full benefits of these therapies. We look forward to seeing builders innovating at the intersection of policy, biopharmaceutical manufacturing, financing, and clinical operations to market without bankrupting or breaking the system.”
2023-12-08 · a16z Podcast · 2024 Big Ideas: Miracle Drugs, Programmable Medicine, and AI Interpretability · IDENTIFIED FROM THE TRANSCRIPT · source
“Lots of companies are potentially going to go bankrupt if they have to pay for these drugs, if they have even one employee who ends up being eligible for one of these therapies. And so I do think there is a siren call already from the industry that will sort of ignite a cycle of innovation.”
2023-12-08 · a16z Podcast · 2024 Big Ideas: Miracle Drugs, Programmable Medicine, and AI Interpretability · IDENTIFIED FROM THE TRANSCRIPT · source