The latest diabetes drug could teach us a lot about pharma in 2019

Last week, Novo Nordisk won approval for Rybselsus, an oral version of a particularly effective injectable treatment for diabetes. And this week, the company said it would charge about the same amount for both, which is about $26 per day.

But the real interest wasn’t the list price — the one Novo markets — but the net price — the amount the company takes home after discounts and rebates. And we won’t know that until we have a few quarters of revenue to compare against prescription data.

What makes Rybselsus an interesting test case is that it appears to be a more convenient but just as potent take on an already effective drug, which is to say it’s the kind of meaningful invention people want drug companies to make. But if cracking the crowded diabetes market requires Novo to offer steep rebates that line the pockets of middlemen, Rybselsus could become a case study for pharma’s oft-stated argument that the system is rigged in favor of PBMs.