I’ve got a (new) Rx from Healthspan for Rapa & Metformin. I thought it would be easy to secure a local Rx for metformin as my A1c is 5.8. I clearly have prediabetes. Metformin is the AMA-recommended standard of care for pre-diabetes. (Despite metformin’s benefits for prediabetes, Rx rates lag) Obviously, if I don’t get T2 diabetes I will live longer - and cost my insurer less. It would also be much cheaper to buy the med locally than from Healthspan.
Problem is since Metformin is not FDA-approved for pre-diabetes, doctors are extremely reluctant to prescribe it, fearing retaliation from insurers or an extreme paperwork headache.
Metformin, like Rapamycin is out of patent. That means there is almost no private sector interest in doing studies for new, FDA approved uses.
It would seem to me that Metformin is a much better poster child medication for this problem than Rapamycin. Given the relatively high cost of Rapamycin without insurance, use is limited to well to do individuals. By contrast, T2 diabetes is a huge problem right now, and the AMA is backing use of Metformin. People roll their eyes when it comes to longevity interventions and categorize them with dodgy supplements and ever changing dietary recommendations. Heading off T2D is a much more immediate issue.
If we could get any political coordination together, it might be best to push for a program to use public money to expand FDA approvals for pre-existing, generic drugs. Rapamycin could be presented as a promising co-strategy, and as an example of what’s currently wrong. Present funding mechanism can’t even sustain a study long enough to see if dogs might live longer on Rapamycin.