elamje

I’m always excited when Cloudflare starts offering things that I had to use other providers for because I know it will be solid.

We used Statsig at Function. It started out as 2 of us using it on one product and within 12 months, large amounts of our product copy and rollouts were driven off of it.

Statsig has client side evals so you can write rules and rollouts based on internal concepts without Statsig’s servers processing a piece of user data. Hoping Cloudflare can build a sophisticated product here so I don’t have use another product in the future!

> Not only does this obviously not result in lower US prices

Maybe in Pfizer’s portfolio this is true. However, I just watched the Amazon Pharmacy pricing for GLP-1s drop substantially immediately following this. I think you may be being too black and white on claiming this categorically does not work.

Businesses will adapt pricing models, obviously this hurts Pfizer in some way, but Lilly and Novo found the new system was worth negotiating into. Like most things - when people say “always” or “never” - it’s reducing the spectrum of possibilities

Not arguing on broken internal pricing dynamics that are skewed by all sorts of gov programs and payors.

It’s about external, global pricing dynamics. The site clearly isn’t going to be able to give clean payor/pbm/gov subsidized pricing tables - that is almost an impossible exercise in our system.

What the agreement does accomplish is saying Americans will not pay $1150/mo while EU pays $400/mo while Argentina pays $120/mo.

It guarantees drugs will be greater than or equal to US pricing abroad which effectively forces pharma to find deeper profits outside of the US, or lower prices for all countries to acquire demand.

That is extremely effective. Now it’s up to a really complex group of people to figure out what that means inside our weird system of pharma/pbm/rebates/insurance/medicare.

But that’s not what trumprx is aiming to solve for right?

Can you explain from first principles how the US market gaining MFN pricing does not benefit Americans? Open to changing my mind

The situation is basically this -

Novo and Lilly spent billions making Semaglutide, Tirzepatide, and future formulations/modalities.

They are going to monetize this heavily while they have IP coverage. There is no world they will let HIMS or any compounding pharmacy of scale undercut them.

On the insurance front - expect your insurance to decline this forever unless you are at serious risk of diabetes. It would make you cost them $3-6k/yr more. Insurance premiums would rise for everyone if insurance was subsidizing this - no free lunch.

Fortunately, the prices are coming down. Amazon pharmacy has Wegovy in an auto-injector starting at $199 without insurance. And that’s delivered to your door in under 24 hrs in most major cities.

I highly recommend checking out the terms of trumprx.gov - not endorsing the entire government here, but it is actually working and quite cleverly written to ensure Americans are getting the lowest cost drugs in the world now. Historically, we subsidized R&D globally by allowing pharma to make most profits on Americans then have cheaper prices abroad. That is changing and hopefully that’s a net positive.

Where did you hear this?

I was talking to someone about this the other day. I was part of a team at NASA that developed a cooling system for the ISS and this whole premise makes no sense to me.

1. Getting things to space is incredibly expensive

2. Ingress/egress are almost always a major bottleneck - how is bandwidth cheaper in space?

3. Chips must be “Rad-hard” - that is do more error correcting from ionizing radiation - there were entire teams at NASA dedicated to special hardware for this.

4. Gravity and atmospheric pressure actually do wonders for easy cooling. Heat is not dissipated in space like we are all used to and you must burn additional energy trying to move the heat generated away from source.

5. Energy production will be cheaper from earth due to mass manufacturing of necessary components in energy systems - space energy systems need novel technology where economies of scale are lost.

Would love for someone to make the case for why it actually makes total sense, because it’s really hard to see for me!

this hides major dilution until future financings

best to treat it like an expense from the perspective of shareholders

think about how to start and maintain a better founder dynamic for the next company more than trying to course correct what you already have

you’ll be happier on the morning after you leave than you even remembered was possible

Have a friend high up at one of the “Big 3” in this space.

The entire business model is predicated on injecting themselves as the last click for attribution even when they weren’t remotely responsible for the conversion. Cool business, but can’t keep going on forever without someone catching on.

The closest software analogy I’ve heard is like passing around a callable/function with a standard interface. An LLM can call the callable and work with the returned data without needing to go back and forth between your application logic.

Do you think SpaceX or similar would be attacking this problem space if there was a business to be had here? Seems like a fun pet project that will lose money indefinitely, but love seeing small teams do big things!

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