To commercialize curative 'one-and-done' genetic medicines, Eli Lilly is considering a subscription-like model. The procedure could be free upfront, with patients or insurers paying an ongoing fee only as long as it works.
The satiation signal from GLP-1s to the brain stem also down-regulates dopamine and the desire for it. This explains anecdotal reports and active studies on their effect in reducing cravings for nicotine, alcohol, shopping, and gambling.
The direct-to-consumer channel exploded for Eli Lilly with Zepbound. The drug was a perfect fit because the diagnosis is simple, efficacy is easily measured by the patient, and it allows motivated self-pay customers to bypass insurance friction.
For its handful of major annual decisions, Eli Lilly's leadership team has a rule to never make a final call in the initial meeting. This process intentionally builds in time for reflection, debate, and persuasion.
Eli Lilly ran the fastest-accrued Alzheimer's study in history by going direct-to-patient. This model, using televisits and centralized diagnostics, is highly effective for preventative medicines where motivated patients can be recruited online.
The median $40,000 cost per trial enrollee is high because pharma companies essentially run a parallel, premium healthcare system for participants. They pay for all care and level it up globally to standardize the experiment.
The large gap between insulin's list and net price was driven by Pharmacy Benefit Managers (PBMs). Their business model, which takes a percentage of the rebate, incentivized pharma to raise list prices to offer bigger discounts.
A significant number of Eli Lilly's compelling inventions came from unsanctioned projects. The company intentionally provides budget flexibility and avoids micromanagement at its R&D sites, allowing scientists to pursue their curiosity.
GLP-1 drugs cause a precipitous drop in inflammation markers within weeks, much faster than the timeline for weight loss. This independent anti-inflammatory mechanism may explain their efficacy in conditions like knee pain and psoriasis.
With 150 years of mostly internal CEO succession, Eli Lilly develops leaders who deeply understand the company's culture—its 'unspoken operating system.' This allows them to solve problems effectively without relying on formal committees.
China’s biotech rise is fueled by its 'first to file' patent system. Companies feed newly published patents into computers to design trivially different but functionally identical molecules, effectively creating a 'shadow generic industry' that undermines IP.
The CEO uses AI tools like Claude and XAI during every meeting to ask science questions, enabling continuous, mastery-based learning on complex topics outside his formal training. This serves as a personal autodidact tool.
To fix the R&D funding imbalance, the CEO proposes a 'one fair price' system. A drug would have one US price with no rebates, and a price in other developed nations would be indexed to their GDP per capita.
To solve the insulin price bubble, Eli Lilly launched its own low-list-price biosimilar. However, insurers and PBMs initially refused to cover it because its low price and small rebate threatened their lucrative business model.
To avoid the pitfalls of scale in R&D, Eli Lilly operates small, focused labs of 300-400 people. These 'internal biotechs' have mission focus and autonomy, while leveraging the parent company's scale for clinical trials and distribution.
A key part of Eli Lilly's R&D strategy is tackling large-scale health problems that currently have no treatments and therefore represent a 'zero-dollar market.' This blue-ocean strategy contrasts with competitors who focus on areas with established payment pathways.