Boehringer US head talks GLP-1s, PBMs, Trump at Reuters USA

Brian Hilberdink says he wasn’t looking for a new job when he got the call from Boehringer Ingelheim to join up as their new head of US Human Pharma. But he was intrigued by the company’s diverse pipeline.

“The pipeline that this company has goes way beyond cardiometabolic,” Hilberdink shared in an onstage interview with Reuters journalist Patrick Wingrove at the Reuters Pharma USA conference in Philadelphia last week. “There's future innovation in kidney disease, but then when you get into pulmonary fibrosis, [we’re working on the] first major breakthrough treatment, hopefully, in a decade; oncology; mental health, which goes way beyond just new treatments, but also digital therapeutics; other assets of immunology. I mean, this opportunity to work at the size and scale across multiple therapy areas, it was just that proverbial opportunity I couldn't resist.”

In a short but wide-ranging conversation, Hilberdink, who was only about a month into his job at the time, talked about the opportunity in GLP-1s, transparency in drug pricing, and the Trump Administration. Read on for some highlights from the on-stage conversation, then check out pharmaphorum’s video interview with Hilberdink, to be posted soon.

On the massive market opportunity for GLP-1s

No doubt one of the reasons Boehringer Ingelheim was interested in bringing Hilberdink aboard is his experience with GLP-1s, helping to launch Ozempic at Novo Nordisk. He stressed that the addressable market for these drugs is much bigger than the current utilisation – leaving lots of room for new entrants like Boehringer.

“There are approximately 100 million Americans that would fit the current prescribing criteria for a GLP-1 and there's probably less than 3 million that are actually getting some type of evidence-based pharmacological treatment,” he said. “So clearly there's a huge unmet need. So there is a need for multiple competitors to come to the marketplace and to have options.”

The current boom in GLP-1s isn’t just an innovative drug – it’s a sea change in how we, as a culture, think of obesity.

“I look at it like Type 2 diabetes,” he said. “Twenty-five years ago, we used to blame the patient for giving themselves Type 2 diabetes. And the narrative would be, you know, you didn't take care of yourself, you put on some extra weight and now you've gone and given yourself diabetes. Fortunately, I think we all understand as a society now it's a complex cardiometabolic disease, but why is obesity any different?”

There’s especially an opportunity now in understanding different causes and effects of weight loss. Boehringer’s candidate is currently in Phase 3 trials and the company is hoping to differentiate by pursuing an indication for metabolic dysfunction-associated steatohepatatis (MASH).

On PBM reform and pricing transparency

Hilberdink said he thinks greater transparency around drug costs is the important first step to reforming the system.

“There’s a lot of narrative on why are prices the way they are within the United States and I think that often we can pick on drug manufacturers for having these high list prices,” he said. “But when you start digging into it and understand the rebate model, understanding all of the various elements that contribute to prices and what we refer to as our gross net, meaning the percentage of what we make from the list price, I think the greater the transparency, the greater there's understanding of all the ways those costs break out.”

Pharmacy benefit managers aren’t necessarily all doing a bad job, he said, noting that Boehringer works with PBMs in its capacity as an employer.

“The PBM has a role to play to make sure that as a we're able to provide [employees] with medications at a reasonable cost,” he said. “Again it's just a case of how do we make sure that we're more transparent and therefore when policymakers are making decisions, it's eyes wide open. It isn't just looking at this high list price and blaming the drug company. It's understanding the cascade of everything that's happening.”

On the American manufacturing

Hilberdink was careful in navigating several questions about the current Administration in the White House. On tariffs, he emphasised that he’d like to see the conversation broaden from just being about how much manufacturing is happening in the US vs abroad, to instead look at all kinds of domestic investment.

“I understand that the President has a strong desire to really kind of pump up manufacturing in the United States," he said. "What I would highlight is ‘What about research and development?’ What about other investments that are leading to jobs within the US? So Boehringer, as an example, we do major research here in the U.S. If any of you have ever been to Ridgefield, Connecticut, you come to our campus, it's 350 acres. There's a huge R&D facility. There's almost 1,000 jobs working at Ridgefield doing basic science. We're doing half a million dollars a year in the United States providing jobs, putting money into the economy.”

On job cuts at federal agencies

Wingrove asked Hilberdink his thoughts about the current situation at the FDA.

“I would hope that there is not disruption of the FDA,” he said. ‘We have a number of filings that are at the FDA right now and of course we want to make sure that that continues as planned. I think that the whole concept however, of can we make the FDA more efficient? Can we make life streamlined? Can we find ways that we can ensure that we're still making sure that patients that products are fully scrutinised to make sure that they're safe and efficacious, but to do it in a way that is perhaps even more efficient? I mean that's something again we can probably contribute to.”

Asked to give his closing thoughts on life under Trump, Hilberdink said that he still believes the President is supportive of innovation, and ultimately that’s where companies should continue to focus their energy.

“I still think that the one thing that'll win out over everything else is innovation will be rewarded,” he said. “I think that if companies truly develop innovative drugs that make a real difference for patients, they're truly differentiated, I think there's ultimately no substitute for that.”