Dispensed: Prescribing guidelines at a buzzy men’s health startup, a depression drug moves one step closer to approval, and a leaked letter that’s fueling a fight over high drug prices

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Hollis Johnson/Business Insider

Hello,

This week was busy with a big M&A deal for a surgical robotics company and lackluster results for the super-hot, $35 billion NASH market. But in between the breaking news, here were the stories that caught our attention this week.

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First off, if you haven’t read it yet, be sure to check out Emma Court‘s investigation that came out Saturday into the prescribing practices of the doctors that work with the men’s health company Hims, which is reportedly nearing unicorn status.

Hims doctor worries

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Hims; Shayanne Gal/Business Insider

Trendy startup Hims wants to shake up men’s health by prescribing generic Viagra online and is nearing a $1 billion valuation. But a move to relax guidelines has raised concerns among some of its doctor partners.

  • The trendy men’s health startup Hims sells generic Viagra and other prescription medications online. Splashy ad campaigns have propelled the San Francisco-based company to prominence, and towards a $1 billion valuation.
  • But a Hims-led effort to expand the number of online patients whom doctors could treat with generic Viagra has sparked concerns among some doctors who work with Hims.
  • Those doctors worried that Hims may be pushing them to write more prescriptions. Some clinicians said late last year in an internal poll that they felt patient care was deteriorating. Hims executive Melissa Baird says that there is no pressure to prescribe.
  • Hims’ Baird told Business Insider that the original erectile-dysfunction guidelines had been overly conservative.
  • “The level of patient care and safety on hims’ platform is best in class in accordance to all medical and clinical standards,” Hims said in a statement.
  • Business Insider is the first to report on the change in prescribing protocols and the physician concerns.

Elsewhere in the pharmaceutical supply chain, tensions are running high between drugmakers and middlemen. I wrote about the drama that unfolded last Friday in the Medicare Part D realm between OptumRx and drugmakers. OptumRx had asked for almost 2 years worth of a heads up before decreases to list prices, and drugmakers weren’t too pleased.

A leaked letter is fueling a new fight in healthcare over who’s to blame for the high cost of prescription drugs

  • A leaked letter is fueling a battle between drugmakers and the intermediaries in charge of negotiating discounts on prescription drugs.
  • In the letter, a middleman in the drug business demanded almost two years of advance notice from pharma companies before they lower the prices of their drugs, according to a note to investors from the Bernstein analyst Ronny Gal.
  • According to Gal, the middleman, OptumRx, also made a second demand of the pharmaceutical companies that could make it difficult for those companies to reduce the list prices of their medications.
  • OptumRx said the goal of its letter was to make sure its costs for Medicare prescription plans were predictable so it could set the appropriate prices.

Earlier this week, the FDA hosted a meeting of experts to make a recommendation on whether a new depression drug should be approved. The drug, esketamine, is expected to get a final decision by March. Erin Brodwin has the story on that.

A depression drug that’s been called ‘the most important discovery in half a century’ just got a big step closer to FDA approval

  • A first-of-its-kind treatment for depression got a big nod on Tuesday from a group of scientists convened by the US Food and Drug Administration.
  • Experts concluded that the drug, called esketamine and inspired by ketamine, is safe and effective and said its benefits outweighed its risks.
  • Their input will play a key role in the FDA’s final approval decision, expected in March.
  • If given the official green light, the drug would be the first novel therapeutic for depression in 35 years.

An aspect of Bill and Melinda Gates’ most recent annual letter caught Erin’s eye as well. They called personal DNA tests one of the biggest surprises of 2018.

Bill and Melinda Gates shined a spotlight on at-home DNA tests like 23andMe, calling them one of last year’s biggest surprises

  • In their yearly letter, Bill and Melinda Gates called personal DNA tests, such as the kind 23andMe offers, the second-biggest surprise of 2018.
  • The Gateses shined a spotlight on the tests’ surprising utility in two divergent areas: crime and maternal health.
  • “We didn’t see this coming,” the Gateses wrote at the top of their annual letter.

At 23andMe, drug development is picking up. 23andMe CEO Anne Wojcicki said at a conference last week that the company has 13 drug candidates in the works.

23andMe is upending how we find new drugs, and the CEO says 13 are now in early trials

  • Silicon Valley genetic testing startup 23andMe is making progress in its efforts to develop new drugs for everything from skin conditions to cancer and heart disease, the CEO said at an event last week.
  • Therapeutics with the 23andMe label would be a “source of pride” for the company, she added.
  • 23andMe now has 13 drug candidates in its pipeline with two compounds in the animal testing phase of research.

Speaking of consumer DNA tests, I re-opened my Ancestry results last week and found that the company had made a big update to its reports last fall. I’m still reeling from the new revelations, so of course I had to blog about it.

Oh, and if you have the chance, check out this killer video by INSIDER’s Jay Reed. She took an in-depth look at why the cost of insulin is so high for patients with type 1 diabetes (and I make a little cameo!).

And, if of interest, we got our first look inside CVS Health’s HealthHUBs down in Houston.

What’s interesting to me about the locations – which are a big part of CVS’s plan to change how we get healthcare – is just how much of the store seems to be dedicated to different services, from nutrition, to primary care, to screenings. I’ll be curious to see how well this works among the Aetna population in Houston that has access to these health hubs, as well as how consumers react to the changing feel of the store they once knew as the place to pick up prescriptions and maybe a snack on the go.

Hope everyone has a lovely President’s Day! I’m venturing out to Stowe, Vermont for the first time to do some skiing this weekend. Here’s hoping the snow’s as good as it looks on Instagram!

As always, thoughts, tips, après ski recipes I should try this weekend? Find me at lramsey@businessinsider.com or the entire healthcare team at healthcare@businessinsider.com.

– Lydia