April 23, 2026
10 min watch
Key takeaways:
- All four novel drugs have been approved by the FDA last year.
- Cost could be a barrier to their use.
SAN FRANCISCO — For the past 15 years, Gerald W. Smetana, MD, MACP, from Harvard Medical School, has given a presentation at the ACP Internal Medicine Meeting about new drugs that primary care physicians should be aware of.
This year, he highlighted four:
“Overall, I found this to be a very promising year,” Smetana told Healio, referring to the number of new drugs that might have a role in the primary care setting this year, “which is more than I’ve seen in previous years.”
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We caught up with Smetana again at the meeting this year and talked about his presentation.
Healio: It’s worth noting that you have no relevant financial disclosures — you’re doing this simply for educational purposes. Can you briefly walk us through how you identify the treatments that PCPs should know about from year to year? What’s your process?
Smetana: I start by reviewing all the recently approved drugs over the past year. The best place to find all this information in one place is the FDA’s website.
This is continuously updated. It does not, however, include drugs in the pipeline that are still under review by the FDA and have yet to be approved.
This is a good resource for clinicians who are seeking information about new drugs. In addition to labeling information, it often includes FDA meeting minutes, correspondence and presentation material from the manufacturer. The information on this website is particularly helpful when guidelines lag behind and have not yet incorporated advice about the newest novel drug options.
From this list, I categorize new drugs into four general categories: subspecialty medications, subspecialty biological medications, me-too drugs and novel drugs for primary care. The past year was much richer in potential novel drugs for primary care than in most years. I selected four drugs that work by novel mechanisms and have the potential to change primary care practice. In many cases, these are also drugs that have generated interest in the lay press and among our patients.
Healio: Generally speaking, how do you see these treatments shaping primary care? Are they filling important treatment gaps?
Smetana: This varies from year to year. Some drugs are revolutionary and reshape primary care. Good examples from recent years include the GLP-1 receptor agonists and nirmatrelvir. Other novel drugs change our options more incrementally.
For my talk this year in 2026, I selected four new drugs that work by novel mechanisms — tradipitant, suzetrigine, gepotidacin and remibrutinib. The two that have the most potential to fill treatment gaps are tradipitant for motion sickness and suzetrigine for acute pain.
As an example, suzetrigine is the first novel nonopioid pain medication in decades. It is equally effective as moderate-potency opioids for acute pain (<2 weeks duration) but so far has shown no sedation, GI side effects, or potential for addiction or tolerance. In the published trials, the side effect profile is similar to placebo.
Tradipitant is more of a niche drug. It is most likely more effective than existing drugs to prevent motion sickness but does carry a potential for sedation, which is a major barrier with existing therapies as well.
Healio: You said this was the first time that you’ve “given all four drugs a thumbs up with the potential to change practice.” But you also said that these were among the most expensive drugs that PCPs might use. How challenging will it be to implement the drugs in practice given their cost?
Smetana: I am always concerned about cost, so I present cost data, when available, when discussing new medications. It is understandable that new drugs will nearly always be more expensive than existing generic alternatives. But the degree of the higher cost varies quite a bit. Having prepared a different version of this talk yearly for about 15 years now, I have learned that it is common for new drugs to be priced in the range of approximately $500 to $700 per month. Each of this year’s four new drugs were substantially more expensive. For example, a 5-day course of the antibiotic gepotidacin is approximately $3,000.
For some expensive medications, the manufacturer may offer cost assistance for eligible patients, but often only for those with commercial insurance (ie, no cost assistance for those on Medicare or Medicaid). Coupons can reduce costs, but for many patients these new medications are simply too expensive. A related barrier is the need for insurance prior authorization for many expensive new medications, where the prescriber has to justify the selection of the new medication rather than a less expensive generic alternative. This is a hoop through which we often must jump.
So, it is important to consider the tradeoff between the advantages of novel medications and their cost implications.
Healio: In your presentation, you quoted Hippocrates: “For some patients, though conscious that their condition is perilous, recover their health simply through contentment with the goodness of the physician.” For those who were unable attend your presentation, can you elaborate on that?
Smetana: Thanks for asking this question. I enjoy weaving art history and historical quotations into my talks. This particular quote from Hippocrates is one of my favorite quotes in medicine. I ended my talk with this quote to remind the attendees that we have so much more to offer our patients than prescriptions alone. We all know this of course, but it is nice to be reminded of this from time to time. Our career choice to help others, and to reassure and support them when appropriate, is what drove many of us to choose medicine as a career. This is just as true now, even with many advances in the science of medicine, as it has always been.
Editor’s note: Click here to watch previous interviews with Smetana at the ACP Internal Medicine Meeting.
Sources/Disclosures
Source:
Healio Interviews
References:
Disclosures:
Smetana reports no relevant financial disclosures.
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