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The new drug looked so promising except for that one warning sign.

This story also ran on Fortune. It can be republished for free.

At the American College of Rheumatologys annual meeting in 2008, Duke Universitys Dr. John Sundy proudly announced that pegloticase, a drug hed helped develop, was astoundingly effective at treating severe gout, which affects perhaps 50,000 Americans. In about half of those who had taken it, the drug melted away the crystalline uric acid deposits that encrusted their joints to cause years of pain, immobility, or disfigurement.

But Sundy also disclosed an unsettling detail: In one clinical trial, patients who got the drug were more likely to develop heart problems than those who didnt. The day after Sundys talk, the stock price of Savient Pharmaceuticals, which developed the drug with Duke scientists, plunged 75%.

That danger signal would disappear in later studies, and the FDA approved pegloticase, under the trade name Krystexxa, two years later. But the small biotech company never recovered. In 2013, Savient was sold at auction to Crealta, a private equity venture created for the purpose, for $120 million.

Two years later, a young company now called Horizon Therapeutics bought Crealta and its drug portfolio for $510 million.

Even at that price, it proved a good deal. Krystexxa brought in $716 million in 2022 and was expected to earn $1 billion annually in coming years.

Although Horizon says it now has 20 drugs under development, in its 15 years of existence it has yet to license a product it invented. Yet the company has managed to assemble a war chest of lucrative drugs, in the process writing a playbook for how to build a modern pharmaceutical colossus.

As the White House and both parties in Congress grapple with reining in prescription drug prices, Horizons approach reveals just how difficult this may be.

Horizons strategy has paid off handsomely. Krystexxa was just one of the many shiny objects that attracted Amgen, a pharmaceutical giant. Amgen announced in December that it intends to buy Horizon for $27.8 billion, in the biggest pharmaceutical industry deal announced in 2022.

Horizons CEO, Tim Walbert, who will reportedly get around $135 million when the deal closes, has mastered a particular kind of industry expertise: taking drugs invented and tested by other people, wrapping them expertly in hard-nosed marketing and warm-hued patient relations, raising their prices, and enjoying astounding revenues.

Hes done this with unusual finesse courting patients with concierge-like attention and engaging specialist clinicians with lunches, conferences, and research projects, all while touting his own experience as a patient with a rare inflammatory disease. Walberts company has been particularly adept at ensuring that insurers, rather than patients, bear the costly burdens of his drugs.

A federal prosecutor in 2015 began examining allegations that Horizons patient assistance program had worked with specialty pharmacies to evade insurers efforts to shun Horizons expensive drugs. A separate probe opened in 2019 over alleged kickbacks to pharmacy benefit managers, companies that negotiate to get Horizons drugs covered by insurers. Those investigations appear to be no longer active, Horizon spokesperson Catherine Riedel said. The company this year disclosed a third probe, concerning methods the company allegedly used to get prior authorization of its drugs. Justice officials did not respond to requests for comment on the investigations. Email Sign-Up

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An Injection of Marketing

To help sell its drugs, Horizon blankets specialist physicians with marketing and peer-to-peer appeals. Its payments to physicians for things like consulting, speeches, and meals totaled $8.7 million in 2021, compared with the $10 million it paid them for research, federal records show. By contrast, Seagen, a biotech company of roughly the same size, paid doctors a total of $116 million, with nearly $112 million of that pegged for research. Riedel said Horizons marketing and educational approaches were necessarily unique because of the challenges of treating rare and neglected diseases.

Walbert launched Horizon in 2008 in the Chicago area by combining and refashioning generic drugs into single pills. Duexis, Horizons first drug, is a mixture of generic Motrin and Pepcid. Its Vimovo combines generic Aleve and Nexium. In a 2017 article, a ProPublica reporter described being prescribed Vimovo for a shoulder injury. It cost him nothing, but his insurer was billed $3,252 for pills that together cost about $40 for a months supply in generic form. Horizon sold more than $57 million worth of Vimovo that year.

In 2014 and 2015, respectively, Horizon picked up two relatively new drugs that had no generic versions: the immunosuppressant Actimmune and Ravicti, which treats a rare genetic disorder. Soon Horizon was charging more than $50,000 a month for each, placing Actimmmune fourth and Ravicti second on GoodRxs 2020 list of the most expensive U.S. drugs.

Horizons net sales soared from $20 million in 2012 to $981 million in 2016; Walberts pay package followed suit, topping an astronomical $93.4 million in 2015 in salary and stock. Stock analysts questioned the long-term soundness of a strategy of simply selling old drugs for mind-boggling prices, but Walbert was using the cash to refashion the company as a rare-diseases franchise.

His approach would make Walbert a darling of pharmaceutical investors and his board, which lavished him with over $20 million in compensation each of the past three years. While most biotechs and startups borrow heavily from venture capital to do science and have no idea how to develop and market a drug, Walbert got cash coming in quickly. He did it backwards, said Annabel Samimy, an analyst at Stifel Financial Corp. Horizon built commercial platforms before they got into drug development.

Generating robust sales of what sounded like not very interesting drugs allowed Walbert to start a company on not very much, said Oppenheimer analyst Leland Gershell. All the while, Horizon funded and cultivated the patient advocacy groups that can help lobby for a drug to be approved by the FDA and placed on insurers formularies, the lists of drugs health plans cover for patients.

Capitalizing on His Own Illness?

As Walbert and his spokespeople often point out, Walbert and his youngest son suffer from a rare disease, and Walbert also has an autoimmune disease. Walbert wont name the diseases, but has said hes taken the anti-inflammatory injectable Humira since 2003 the year he led that drugs commercial launch as a vice president at Abbott Laboratories. Humira has become the bestselling drug in history, with about $200 billion in all-time global sales.

In 2014, Walbert moved Horizons headquarters to Ireland, which nearly halved its tax rate. A year later it gained control of Krystexxa, and in 2017 it bought, for $145 million, a failing company that produced Tepezza, a drug for thyroid eye disease, which causes unsightly eye bulging and pain.

Tepezza quickly became a blockbuster, with $3.6 billion in total sales in 2021 and 2022. The company conducted additional clinical research on both Tepezza and Krystexxa, but it also spent heavily promoting these and other drugs to specialists who could prescribe them.

All the while it steadily raised prices. Savient put Krystexxa on the market in 2011 at $2,300 per injection. Horizon charges roughly 10 times as much. Six months of Tepezza treatment can run more than $400,000.

Horizons publicity emphasized the companys sensitivity to patients, and its constant contact with disease advocates.

Our scientists are attuned to the unmet needs of patients, their diagnostic and therapeutic journey, Bill Rees, Horizons vice president for translational sciences, told KFF Health News. Its the marrying of the basic clinical science with a focus on the needs of the patient that differetiates us.

To make sure patients keep using its drugs, clinicians say, Horizon staffers negotiate with insurance carriers, and the company offers drug discounts to lower-income patients while swaddling them with attention from its medical staff.

Horizon has a nurse talk to each and every patient before every appointment, said Dr. Brigid Freyne, who treats around half a dozen patients each year with Krystexxa at her Murrieta, California, rheumatology clinic. The patients who come in here are highly motivated to get their IV. They get the message that its very important and they are fortunate to get the medicine.

None of the manufacturers of her other infusion drugs shower patients with this kind of attention, she said.

While at Abbott, Walbert pioneered direct-to-consumer advertising for specialty drugs like Humira, a trend that aggravated insurers, who anticipated, correctly, that they would soon be shelling out billions for expensive drugs.

Horizons marketing plan for Krystexxa includes direct-to-consumer ads aimed at driving patients to specialists. The drug is designed for recalcitrant gout patients, who often have large lumps on their fingers, feet, and kidneys. Many, though not all, are heavy drinkers of beer or soda sweetened with high-fructose corn syrup, which can increase the buildup of uric acid, the cause of gout, said Dr. Robert McLean of Yale University.

While Krystexxa can help patients with advanced gout, the American College of Rheumatology views it as a drug of last resort, with plenty of cheaper, early intervention alternatives available.

I prescribe it maybe once a year, McLean said. From a cost-effectiveness standpoint, it warrants questioning.

Horizon recently started a publicity campaign addressed to all gout sufferers, urging them to see a rheumatologist or a nephrologist the specialists it has targeted with Krystexxa educational materials before the disease does too much harm.

Horizon would like you to say, Everyone with serious gout should be started on Krystexxa, said Dr. James ODell, a rheumatologist at the University of Nebraska Medical Center. The Horizon pitchmen he deals with are nice guys, but we dont believe thats the best way.

The company defends its marketing practices. We learn what matters most to patient communities and act. This approach has been validated by independent third-party research, said Riedel.

The Federal Trade Commission said in January it was seeking more information on the Amgen-Horizon merger. Sen. Elizabeth Warren (D-Mass.), citing high prices for Horizon and Amgen drugs, urged the agency to nix the deal.

Arthur Allen: ArthurA@kff.org, @ArthurAllen202 Related Topics Health Care Costs Health Industry Pharmaceuticals Drug Costs Prescription Drugs Contact Us Submit a Story Tip

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Tesla (TSLA) soars on Trump making easier path for Tesla’s non-existent self-driving tech

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Tesla (TSLA) soars on Trump making easier path for Tesla's non-existent self-driving tech

Tesla (TSLA) is soaring in anticipation that Trump’s administration will make an easier path for Tesla’s self-driving tech, which still doesn’t work, to be approved federally.

Currently, self-driving technology is addressed at the state level, with each state having its own regulations for approving self-driving systems on its roads.

During a conference call following Tesla’s last earnings results, CEO Elon Musk, who has been financially backing the reelection of Donald Trump and “fully endorsed” him, hinted that he could work with the new federal government to get a federal self-driving approval process going.

Now, Bloomberg reports that Trump’s transition team is discussing making it a priority:

Members of President-elect Donald Trump’s transition team have told advisers they plan to make a federal framework for fully self-driving vehicles one of the Transportation Department’s priorities, according to people familiar with the matter.

This news sent Tesla’s stock up 7%, or an increase of 470 billion in value.

That’s surprising because before now, the regulatory aspect of Tesla’s self-driving effort didn’t seem like the biggest hurdle – making the technology work still seems to be the biggest hurdle.

Tesla has been wrong about its self-driving timeline too many times to count, but the latest one is to release unsupervised self-driving in California and Texas in Q2 2025.

Ashok Elluswamy, the head of FSD at Tesla, stated that Tesla’s goal is to achieve over 600,000 miles between critical disengagement, which is based on NHTSA’s data of accidents between human-driven miles.

Tesla has not released any data about its self-driving effort, and therefore, the best data available is crowdsourced. That data currently shows about 241 miles between critical disengagement:

Tesla would need a 2,500x improvement in miles between disengagement to reach a safer-than-human level, which has been the goal before getting regulatory approval.

Electrek’s Take

That sounds like a much bigger hurdle than getting regulatory approval.

I actually agree with the Trump administration that it makes more sense to have a federal framework for approving self-driving systems than at the state level.

But I don’t see how it will help Tesla since there’s no clear path to Tesla achieving a level safer than human with their current approach any time soon.

At the current pace, the 2,500x improvement would take 10 years and we have yet to see a significant acceleration to the pace of improvement.

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Sports

College football takeaways: Key storylines and performances from Week 12

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College football takeaways: Key storylines and performances from Week 12

What a week it was in college football: Five AP Top 25 teams lost to unranked opponents, and after No. 6 BYU’s defeat to Kansas, the Big 12 appears to be up for grabs after victories by Colorado and Arizona State.

The Buffaloes and Sun Devils have proved football fans wrong this season as Colorado is tied for the top spot in the Big 12 and Arizona State is a game behind. With both teams on a winning streak, what can they credit for their success?

After a rough start to the season, Billy Napier and Florida have turned things around and the Gators are one win from bowl eligibility. With an upset win over No. 22 LSU, is it time to stop questioning Napier?

Our college football experts break down key storylines and takeaways from Week 12.

Losses might be as important as wins in the CFP committee meeting room

With six new committee members, a new committee chair and a new College Football Playoff executive director, there are a lot of new faces at selection central. Each group is different. Ranking the top 25 teams is a subjective system, and this year’s committee appears to be putting an emphasis on losses — maybe more than in years past.

Who teams lose to and how has always mattered, but it might be more of a factor this year with multiple two-loss teams to sort through. It’s also a big reason why Ohio State is No. 2 and Penn State is No. 4 — close losses to highly-ranked teams. It’s never a good time for a bad loss, but it could mean the difference this year between a first-round bye, a first-round home game — or a seat on the couch. — Heather Dinich


Rivalries matter more than ever

Texas has never viewed Arkansas on par with rival Oklahoma, but Arkansas lives to torment Texas. Three years ago, the No. 15 Longhorns came to Fayetteville and were stomped 40-21. Jubilant Arkansas fans stormed the field.

But returning as conference rivals for the first time since the Razorbacks left the Southwest Conference in 1991 seemed to mean something to No. 3 Texas, too, after a tough 20-10 win over the 5-5 Razorbacks. “It was personal for sure,” senior edge rusher Barryn Sorrell said.

Quinn Ewers sealed the win by running for three yards on fourth-and-2 with 2:14 left. Rather than trying to evade linebacker Larry Worth III, Ewers decided to bull his way over him. “I just tried to put a little statement into it, that’s all,” Ewers said with a smile. “Just the history that these two programs have together, it’s going to be tough.”

Texas joining the SEC reconnected old grudge matches with Texas A&M and Arkansas. The 74,929 who showed up Saturday — the 10th-largest crowd in Arkansas history — threw their Horns Down at every opportunity. With an eight-game SEC schedule, there’s only one permanent rivalry guaranteed per school, and for the Longhorns, that will always be Oklahoma. Texas-Arkansas and Texas-Texas A&M could come and go. When college football is becoming more unrecognizable by the day, regional rivalries should be a priority. — Dave Wilson


Congrats to Colorado and Arizona State for proving us all wrong

It’s probably time to admit we were wrong about Deion Sanders’ Colorado and Kenny Dillingham’s Arizona State in 2024.

OK, maybe not all of us. But as both schools improved to 8-2 on Saturday, a preseason poll from CBS Sports resurfaced that ranked Sanders and Dillingham, respectively, as the 15th- and 16th-best coaches among the Big 12’s 16 football programs. And whether you had either coach/program that low in August, there can’t be many of us who expected either school to be here in Week 12: level alongside Iowa State for second in the Big 12 standings and in line to play at least some kind of role in the College Football Playoff picture over the final weeks of the regular season.

Colorado earned its fourth win in a row and Travis Hunter logged another entry to his Heisman Trophy résumé in a 49-24 win over Utah on Saturday, yet Sanders says the Buffaloes still “haven’t even played our best game.” Meanwhile, Arizona State reached its highest win total since 2021 on Saturday night after storming to a 21-0 first-half lead and holding off No. 16 Kansas State after halftime in a 24-14 road win, fueled by the aerial connection between Sam Leavitt (275 passing yards, three touchdowns) and Jordyn Tyson (12 catches, 176 yards, two touchdowns).

The successes at Colorado and Arizona State are a credit to the respective coaching jobs Sanders and Dillingham are executing. They’re also a credit to the concept that there remain many different paths to winning in a seemingly homogenized era of college football dominated by NIL, the transfer portal and the rest. Through 12 weeks, Colorado and Arizona State represent two of the sport’s great surprises this fall, and there are perhaps no two people more acutely aware of the doubters than the coaches leading this pair of impressive turnarounds in 2024.

“We were a three-win team twice,” Dillingham said Saturday night. “We were under NCAA sanctions. Most head coaches, to be brutally honest, you get fired if you take a job under sanctions. You don’t survive. You’re hired to be fired. That’s the nature of the beast. And right now we’re sitting here at 8-2 and couldn’t be prouder.” — Eli Lederman


South Carolina is clearly the nation’s best three-loss team

Shane Beamer’s team is not part of the logjam atop the SEC. The Gamecocks are not in the College Football Playoff mix, essentially eliminated Oct. 12 when they couldn’t hold a fourth-quarter lead at Alabama or tie the score in the closing minute. But since falling to 3-3 in Tuscaloosa, South Carolina has won four straight and continued to be one of the most consistently compelling squads on Saturdays.

After riding Kyle Kennard and the defense to wins over Oklahoma, Texas A&M and Vanderbilt, South Carolina needed the offense to outlast Missouri, going 70 yards in 47 seconds to score the winning touchdown with 15 seconds left. Redshirt freshman LaNorris Sellers is blossoming into one of the nation’s best young quarterbacks, as he set career highs for passing yards (353) and passing touchdowns (five) against Missouri. South Carolina has defeated three straight AP-ranked opponents for the first time in team history.

“We’re on the right track,” Beamer said. “The young players we have in this program right now, the quarterback, Dylan [Stewart]. You talk about the recruits that are here tonight, the ones that are committed to us. The best days of South Carolina football are right in front of us.”

There will be some what-ifs for the Gamecocks, especially in their losses to LSU and Alabama. But after a 5-7 season last fall, Beamer has recaptured his big-game magic and built a program that no opponent should want to face right now. — Adam Rittenberg


A resolute Billy Napier and his Florida team just keep getting back up

When it starts to go bad for a coach in the SEC, especially one who’s in his third season and has yet to manage a winning record, it’s usually like a two-ton truck cresting over an icy slope.

There’s no stopping the slide.

Even with the recent and dreaded vote of confidence for Florida’s Billy Napier, there are no guarantees about his future. But nobody would have predicted he had any future at Florida two months ago after an ugly home loss to Texas A&M, two weeks removed from a 41-17 beatdown by Miami at home. The speculation late that night was that Napier might be out as early as the next morning.

But he had just enough support in key areas to hang on, and most importantly, the players in his locker room still believed in him. And here we are, with two weeks left in the regular season, and the Gators are one win away from bowl eligibility after taking down LSU 27-16 at home Saturday. Another huge opportunity awaits this weekend when No. 11 Ole Miss visits the Swamp.

The Gators (5-5) have been resilient, just like their coach, and responded from a 49-17 blowout loss at Texas to play one of their most complete games of the season at home against LSU. Simply making a bowl game is hardly the standard at Florida, but the way Napier has kept his team together, continued to develop young quarterback DJ Lagway and gone about his business with accountability, humility and a quiet confidence is proof he deserves a fourth season to show he can get this program to that standard.

It’s time to get behind Napier and quit questioning him. It’s clear the Gators have a talented nucleus of younger players and that those players have their coach’s back. — Chris Low


Louisville … what are you doing?

Stanford vs. Louisville was an inconsequential game that should have flown under the radar, regardless of the result. And while the outcome — a Stanford win that ended a six-game losing streak — was a significant upset, it’s the way it happened that deserves some added attention. It might be the most improbable way a team has lost a game all season. Let’s dive in.

After trailing 35-21 in the fourth quarter, Stanford scored touchdowns with 6:37 left and 45 seconds left to cut the deficit to 35-34. At this point, I thought Stanford coach Troy Taylor, a coach who once went an entire high school season without punting, would go for the win with a 2-point conversion try. He did not. Tie score.

On the ensuing kickoff, Louisville opted against taking the ball at the 25-yard line and returned it to the 19. After a spike, a deep shot, a short pass and another deep shot all fail, Stanford took possession at its 45 with 4 seconds left. Overtime felt inevitable. Wrong.

Stanford completed a 1-yard pass only to be gifted 15 yards by an unsportsmanlike conduct penalty by Louisville, giving the Cardinal a chance to win the game on a 57-yard field goal attempt. Improbable, still. So, what does Louisville do: jumps offside to make the kick easier. And Stanford’s Emmet Kenney took advantage, making a 52-yard field goal as time expired.

An all-time collapse. — Kyle Bonagura


Kennesaw State’s Bohannon shows class on way out

Last weekend, Kennesaw State fired coach Brian Bohannon, who helped build the program from scratch nine years ago, then ushered it from the FCS into the FBS this season. That firing didn’t stop the former FCS Coach of the Year from supporting his players before its game Saturday against Sam Houston.

In a video posted by a Kennesaw State football alum, Bohannon showed up to the team’s pregame walk to the stadium and gave the players hugs and high-fives as they walked by.

The Owls ultimately lost in overtime to fall to 1-9 but showed fight against the Bearkats, who remain in contention for the Conference USA title.

Despite being fired, Bohannon should be revered in Kennesaw for taking the Owls to the FCS playoffs four times, for elevating the program to the FBS — and for the way he graciously exited. — Jake Trotter

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Science

Rare 2,000-Year-Old Gladiator Knife Handle Found Near Hadrian’s Wall

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Rare 2,000-Year-Old Gladiator Knife Handle Found Near Hadrian's Wall

Archaeologists have uncovered a remarkable 2,000-year-old Roman knife handle in Northumberland, England. The discovery, made in the River Tyne near Corbridge Roman Town, features a detailed depiction of a gladiator. This unique find sheds light on the influence and popularity of gladiators across the Roman Empire, including its farthest reaches in Britain.

As per a report by English Heritage, the handle, crafted from copper alloy, portrays a secutor gladiator, identifiable by his heavy armour and helmet. Secutors, named after the Latin term for “chaser,” were known for engaging in close combat against their agile counterparts, the retiarii. Notably, the figurine represents a left-handed fighter, a rarity in Roman culture, where left-handedness was often considered inauspicious. Researchers from English Heritage have suggested that this specific detail may indicate the handle was modelled after an actual gladiator, rather than serving as a general representation.

Gladiator Culture in the Roman Empire

Gladiatorial games were a significant feature of Roman public entertainment, drawing large crowds to amphitheatres across the empire. While these fighters were typically enslaved individuals or criminals, some gained celebrity status, despite their marginalised social standing. The events, often hosted by elite Roman citizens or emperors, aimed to display power and wealth.

Frances McIntosh, Collections Curator for Hadrian’s Wall and the North East at English Heritage, stated that gladiators’ popularity extended far beyond Rome, a fact underscored by the discovery of this artefact. Although memorabilia such as pottery and figurines have been documented, similar finds in Britain are considered rare.

Plans for Public Display

Corbridge Roman Town, originally established as a supply base in 79 AD, served as a key site during the Roman occupation of Britain until around 400 AD. English Heritage plans to exhibit the knife handle, along with other artefacts recovered from the river, at the Corbridge site next year.

This discovery continues to emphasise the enduring fascination with gladiators, both in ancient times and modern culture.

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