The Ledger
Every statement that passed quotation and attribution checks. Mix any filter with any other: certainty 1/5, debate potential 5/5, or both at once.
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Ricks: PBM rebate incentives should be eliminated as unethical
“These PBMs and there's some group purchasing organizations like this. That should go away. And I think health is different than other commodities. It's probably has a much more important social role in deciding that the smallest, the little guy gets the worst …”
Ricks: Insurers initially refused to cover Eli Lilly's discounted generic insulin
“In the first year, no formularies covered this. So it was really only for that cash payer. No insurance company picked it up, even though it was dramatically cheaper. Now it's about half of the volume, but still half not because that model of this margin sprea…”
Ricks: Machine-designed drugs haven't reached clinical trials yet, but are coming
“I don't know of one that's come through the machine driven discovery process, which is really machine plus human that's made it to the clinic yet, but they're coming.”
Ricks: AI won't solve biology until we understand over 50% of it
“And today, I don't know, I would estimate we might know 10 to 15% of human biology. So the machine's not going to be good at all until we get way above 50%.”
Ricks: Claude and xAI beat ChatGPT for science because references check out
“I don't use that one for science actually. It's too, too horrible.
Patrick Collison: So which one do you use for science?
Dave Ricks: I tend to use either Claude or the XAI one. I find it more terse. And more, the references actually check out more often.”
Ricks: Lilly's industry-leading R&D ROI comes from process, not picking winners
“I think one of the reasons Lilly has probably the highest return on investment in R&D in the industry is because not the picking of winners and losers, but the, actually the process by which we run it.”
Ricks: Cardiovascular trial rules added five years to diabetes drug development
“The Evandia one, we know well, we work in diabetes, actually caused a policy change, and the policy change was you must rule out cardiovascular risk prior to market entry, and as you may know some conditions like diabetes have a more continuous variable you're…”
Ricks: Expensive cardiovascular trial mandates protect GLP-1 incumbents from low-cost competition
“Now, by happy accident, we are all now really pleased with, like, incretins, like our trisepetide to run them because they frequently demonstrate massive benefit. Uncardiovascular. And in some ways, it creates a barrier to entry for the next low-cost Chinese p…”
Ricks: ICER found tirzepatide and semaglutide cost-effective at current pricing
“They just analyzed our medicines, trisepatide and semaglutide, and they said, actually, they're both cost effective at current pricing. In fact, Zepbound or Trisepatide was, the threshold they have is to save a 100,000 dollars per person per year in downstream…”
Ricks: Lilly is considering SaaS-style recurring pricing for common gene therapies
“It's conceivable that one could create like a licensing concept, stealing from the SAS model, where you say, we'll do the procedure for free. And as long as it's working for you will deposit X amount in our bank account, and you're getting the value, and we're…”
Ricks: Medicine accounts for only 10 cents of every US healthcare dollar
“In the US, the most expensive healthcare system in the world, we spend 10 cents on the dollar on medicine. The other 90 cents go through everything else that medicine's trying to prevent.”
Ricks: Lilly's net insulin price stayed near $30 despite $275 list price
“Our actual net on insulin really hasn't changed. It's like 30 or 40 dollars, but the list price got up to two 75.”
Ricks: Early-stage biotechs pitch 80% to 100% of revenue from the US
“If you fund, if you went out and said, hey, I want to back some biotechs, and they sent you their business plan, 80 to a hundred percent of the revenue in return they'll pitch you on is the US. Meaning there is no return outside the US if you start at the poin…”
Ricks: Eli Lilly's chronic knee pain study is going to work
“We have a study reading out toward the end of this year in chronic knee pain. It's going to work.”
Ricks: Taltz plus Zepbound trial is certain to boost psoriasis efficacy
“So we're doing a study with our psoriasis drug, Taltz, and ZepBound. That will read out this fall. And I'm certain we'll show a boost in efficacy with the weight loss.”
Ricks: Pharma must invest 20-25% of revenue in R&D for double-digit growth
“I have a belief that if you're not generating, to generate double digit growth in the sector, you need to invest at 20 to 25% of sales in R&D. That's sort of a good, a positive return R&D stack.”
Ricks: Eli Lilly is building pharma's largest biological supercomputer
“Building a supercomputer on our, on-prem for us, really just to run proprietary drug discovery models. We think it's the biggest biologically focused supercomputer there is. And certainly the biggest pharma's done. Yes. With B 300 latest chipset.”
Ricks: Developing a drug costs $4B, with over 60% spent in Phase 3
“The final stage of testing, the average drug costs three and a half, four billion to make more than 60% of that is the last step.”
Ricks: US cancer trial enrollment is 4% versus over 25% in Spain
“Only four percent of patients who have cancer in the US are in clinical trials, whereas in Spain and Australia, it's over 25%.”
Ricks: Lilly develops clinical drugs in under 7 years versus industry average
“Drug development time in the industry, It's about 10 years in the clinic, a little less right now. We're running a little less than seven at Lilly”
Ricks: Current GLP-1 drug pricing will fall amid competition and pressure
“And the current pricing isn't going to stay. Let's be honest. There'll be more competition. The government wants to lower our prices.”
Ricks: Non-Lilly large pharma multiples are at a 20-year low
“If you look at the large cap farmers, not Lilly, but the other ones, the multiples, the most compressed it's been in 20 years. If you look at biotech, the XBI, I think half of the XBI is trading below cash. And then if you look at. Venture. Half of the rounds …”
Ricks: Drugs lose 97% of their pricing when patents expire
“Typically a generic event, you'll lose 97% of your pricing the day your patent expires.”
Ricks: Most major hospital systems have failed price transparency compliance
“Compliance is terrible. Most major hospital systems have not complied. Or if they have, they put on a website somewhere a coded database that is impossible to interpret with ICD-X codes and price points that consumers cannot digest.”
Ricks: Lilly conducts early clinical trials faster and cheaper than any biotech
“There is no doubt in my mind. We are faster, more robust, probably cheaper than actually every biotech out there trying to do their own early phase clinical trials.”
Ricks: China had Pfizer-BioNTech vaccine rights but never approved it
“They had rights to the BioNTech-Pfizer vaccine for almost the entirety of their pandemic. They never approved it.”
Ricks: Virtually no generic pharmaceuticals are manufactured in the US
“There are no generics manufactured in the U.S. Really.”
Ricks: Generic small-molecule medicines face no regulatory efficacy requirement
“There is no requirement For small molecule chemical medicine to show proof of efficacy of any kind. So you can do pretty simple laboratory experiments and absorption experiments in a small number of people.”
Ricks: Healthcare systems should pay a premium for generic drug resilience
“And we probably should pay a little bit more for generics. You sometimes read about injectable generics in particular that run short. That's a more complicated manufacturing process. So if you do it cheaply, you run into more problems. We probably should pay a…”
Ricks: Self-pay Zepbound is the #1 prescribed form of GLP-1s
“Actually, the number one prescribed form of these medications is Zep-bound self-buy. We sell more than that than our insured business, a new patient starts, and more than all of we go.”
Ricks: LillyDirect annualizes in billions as largest online prescription platform
“Today we'll annualize, you know, in the billions of dollars. I think it's the largest Prescription platform online in terms of revenue. We run it on Stripe, I think, and going north from here.”
Ricks: Eli Lilly captures 70-75% of new US GLP-1 starts
“Right now in the US, across all forms of GLP-ONE, on new patient capture, we're basically 70, 75% right now.”
Ricks: Lilly will spend nearly 25% of revenue on R&D this year
“We'll spend almost 25% of sales this year.
John Collison: I liked your way of putting us that you spend more on medical R&D than Germany does.
Dave Ricks: Yes.
Dave Ricks: Yeah.
Dave Ricks: We're at the nation state level. It'll be, you know, fourteen billion …”
Ricks: Tirzepatide would be universally reimbursed if introduced in 1972
“If the first medicine we had to treat metabolic conditions was terzepatide in 1972, I have no doubt it would be reimbursed everywhere and broadly used in the system.”
Ricks: Eli Lilly is developing a one-time PCSK9 gene editing medicine
“We have a medicine development that will Knock down your LDL, if it's safe enough, and then one undone, PCSK nine edit in your liver, and presumably that will last the rest of your life, and your LDLs will be between 20 and 40 forever.”
Ricks: Around 80 GLP-1 drug candidates are in clinical pipelines globally
“We only have two right now, but there's probably 80 in clinical pipelines right now globally. We have 11 others, but there's probably 70 others not coming from Lilly.”
Ricks: The US and China hold 70% of global diagnostic capacity
“The US and China have something like 70% of all diagnostic capacity in the world.”
Ricks: Over half of approved drugs originate in biotech, but few finish
“While it's true that the origin of, I think it's a little more than half of medicines approved in the last 10 years have come from biotech, hardly any of those traveled all the way through biotech.”
Ricks: 80% of effective COVID treatments were produced in US
“Basically, 80% of the medicines and vaccines that worked were produced in the United States.”
Ricks: Marketing halves medical adoption time from 16 to eight years
“And there's been studies on this of medical inventions that are not promoted... It's about a sixteen-year path to full adoption. With the medicine promoted, it's half that. We have an internal goal to half that again, to get to four years, to full whatever it …”
Ricks: Extending human lifespans inherently increases total disease burden
“You know, there's no limit to human disease, and actually the longer we help people live, the more disease they'll be.”
Ricks: Lilly has small molecule and siRNA Lp(a) drugs in Phase 3
“Like we talked about LP a earlier. That was the case there. We discarded the antibody. There is one that's been developed. And we went after the small molecule and the siRNA. They're both in phase three.”
Ricks: Lilly executives have a rule to never decide in one meeting
“We actually have a rule to like never decide in one meeting.”
Ricks: There are roughly 2,000 approved synthetic medicines across 400 mechanisms
“We probably have 2000 manmade approved medicines versus natural products or vitamins or other things, and maybe 400 unique mechanisms.”