Jacob Kimmel

So what I'm saying here is one hypothesis about what the future might look like, but I think there are alternative, clever approaches people might think about for reimbursement.

I also think over time, we're going to move more toward a direct-to-consumer model for many of these medicines, which preserve and promote health rather than just fixing disease.

You're seeing what I think are really some of the most innovative examples of this right now from Lilly around the incarnate memetics, where they actually launched Lilly Direct.

So for the first time, rather than going to

a pharmacy, which interacts with a PBM, which interacts with your primary care physician.

Now you can get a prescription from your doctor, go straight to Lilly, the source of the good stuff, and you're able to order high-quality drug from them when you're not involved, you know, some intermediary compounder in the middle that might not even make your molecules properly.

And I think as these medicines develop that have actual consumer demand because you feel it in your daily life, you're actually seeing a benefit from it.

It's not just something that your physician is trying to get you to take, that that model will start to dominate.

And that means that this sort of like payment over time for some of these long-term benefits might be able to be abstracted away from our current payer system where it turns every few years.

And now a sort of like payment over time plan, the same way we finance other large purchases in life, seems very feasible.

I think that's correct.

So I think the stat is something like drugs are roughly 7% of healthcare spend.

I could be a little bit wrong on that, but the oom is right.

So just as like some quick heuristics, part of the reason I think, there are many reasons that healthcare costs so much in the US.

One of them is something like Baumel's cost disease, which is, you know, very unrelated to pharmaceutical discoveries, but, you know, is something that we will have to solve in the system.

Part of it's like the disintermediation of the actual customer and the actual provider.

And these are things that biotech probably isn't going to be able to solve as an industry alone.

That's probably a larger economic problem.

But when you think about how will this affect sort of the total amount of healthcare that will need to be delivered, if you have more of these, what I like to think of as sort of like medicines for everyone, medicines that keep you healthier longer rather than medicines that only fix a problem once you're already very sick, I think you actually avoid a lot of the types of administration costs, not just administration like admins at hospitals, but healthcare.

the cost of administering existing medicines and therapies to you going down.