The first, I’m going to talk about is, commercial mix impact. And let me start with this because I think it’s a little bit easier to understand and the financial implications could be serious. But what you’ll hear is they are not and here’s why. So as you would expect, we’ve got a very robust model around this, that we’ve used to simulate the impact in a number of scenarios. We use this also to create a much simplified framework, that we can use to explain to you how we are thinking about this. So let me start that framework with some known inputs. First, we have approximately 22,000 commercial patients today that we know. And second, again, most of our patients, who are 65 and over are on — are not commercially insured. For modeling purposes, it is safe to assume that the population above 65 has a commercial mix of almost 0.
And for the commercial mix of our incident patients below 65, it is pretty constant. It doesn’t matter if they’re 40 or 50 or 60, it’s a pretty constant number and the number drops, when they hit 65. The result of that shape of the curve is that when we think about modeling the impact of a delay in progression from GLP-1s on commercial mix, all that really matters is the cohort of patients, who are just below the age of 65, who without GLP-1s would have been incident to dialysis with commercial insurance, but because of GLP-1s, their incidents will be delayed. And instead of being delayed at younger than 65, instead of being incident at younger than 65, they will be incident at older than 65. So with that framework, let me tell you our assumptions.
First, we are talking about a 25% delay in progression. We talked about that already. That translates, as I said, into a 2.5-year window of incident patients that we care about. And here’s an important fact. About 10% of our commercial population is incident in that 2.5-year window, before 65. Said another way, 10% of our commercial population is aged 62.5 through 64. And so here’s the math. You take 22,000 patients assume 10% of them are in that incident window that we care about of 62.5 to 64 and say 30% of them will be on the GLP-1 drug, and that gets you 22,000 x 10% x 30%, that’s 660 patients. That’s the number of commercial patients, we would expect to lose, as a result of GLP-1 penetration getting to 30%. That 660 patients divided by our 200,000 patients is 33 basis points of commercial mix.
So again, let me be clear what that 33 basis points of commercial mix means. It means the cumulative impact of the growth of GLP-1s, however, long it takes us to get to that 30% and to see that flow through our CKD population, will be a reduction of 33 basis points in total. If that happens over 10 years, that’s about 3 basis points a year. It is a negligible amount. To put it in perspective, our commercial mix went up 18 basis points this quarter alone, you would never find this in our numbers. That’s why we believe the commercial mix effectively will not change as a result of a delay in progression.
Joel Ackerman: All right. Pito, we said a mouthful just to set it up, there’s, of course, the second part, which is just an overall volume, but we wanted to start off with commercial patients first and the impact on that, which is, as Joel said, not financially important. So any questions on that?
Pito Chickering: So to sort of take all that and sort of reapply the models, but that was a very detailed answer. I will jump back in the queue for some more questions in a bit. Thank you so much.
Operator: Our next question comes from Justin Lake with Wolfe Research. Your line is open.
Justin Lake: Thanks. I appreciate all that detail. That was incredible. So let me just follow-up on one of those points, which is that 30%. So the 30% in a CKD population, that knows they’re progressing to ESRD and dialysis. Is there — what’s the kind of grounding behind that number? I thought it might be higher, given the end state of kidney [indiscernible]
Jeffrey Giullian: Yes. Thanks, Justin. This is Jeff Giullian. We’ve looked at a number of things. We know for the past two decades or longer that we’ve had generic medications, ACE inhibitors and ARBs on the market, that have good impact on potentially slowing progression of renal disease. When you look at the uptake of those medications, even in patients who you just described, know that they’re progressing through CKD, even that ranges between only 17.8% and about 30% to 35% of the population. And those medications tend to have a slightly lower discontinuation rate than the GLP-1s. And so looking at that, we have a pretty strong baseline of what to expect for uptake of these medications.
Javier Rodriguez: And remember, Justin, it’s better to think of it as 40% because 30% are neither diabetic nor obese. And so it’s 30% overall, but 40% of the applicable population. And we are assuming a 100% adherence which is not a normal assumption. We are just trying to be as conservative, as we can be because, as Dr. G said, many, many people get off the medicine actually more than 50% after year 1 is a stat, that’s useful.
