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A shortage of dementia specialists and testing capacity could result in significant wait times for new Alzheimer’s treatments as the U.S. population ages.
Patients could face wait times ranging from 18 months to four years to get diagnosed and then treated for Alzheimer’s disease, according to studies.
Time spent waiting only robs early Alzheimer’s patients of their memory and ability to live independently.
But there are innovations on the horizon that could make diagnosis and treatment much easier.

Juanmonino | E+ | Getty Images

Seniors with early Alzheimer’s disease will face major hurdles to get treated even if promising new drugs roll out more broadly in the coming years, putting them at risk of developing more severe disease as they wait months or perhaps years for a diagnosis.
The U.S. health-care system is not currently prepared to meet the needs of an aging population in which a growing number of people will need to undergo evaluation for Alzheimer’s, according to neurologists, health policy experts and the companies developing the drugs.

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There are not enough dementia specialists or the needed testing capacity in the U.S. to diagnose everyone who may benefit from a new treatment like Eisai and Biogen’s Leqembi. After patients are diagnosed, the capacity may not exist — at least initially — to provide the twice monthly intravenous infusions for everyone who is eligible.
Researchers estimate that the wait time from the initial evaluation to the confirmatory diagnostic tests to the infusions could range anywhere from a year and a half to four years or longer. Those months are critical for people with Alzheimer’s.
“The whole process from that time of the family physician conversation to the point of infusion, I worry how long it will take and the complexities of the patient navigating through all of that to successfully get to the end,” Anne White, president of neuroscience at Eli Lilly, which is developing its own Alzheimer’s treatment, told CNBC.
There are promising innovations in development, such as blood tests and injections that patients would take at home, which could make it significantly easier to get diagnosed and treated in the future.
White also said Lilly is confident that more doctors will get into the field and help to alleviate capacity issues, as awareness grows that medicines are entering the market to treat Alzheimer’s.

But time spent waiting robs early patients of their memory and ability to live independently. Alzheimer’s gets worse with time, and as patients deteriorate into more advanced stages of the disease, they no longer benefit from treatments like Leqembi that are designed to slow cognitive decline early.
More than 2,000 seniors transition from mild to moderate dementia from the disease a day, according to estimates from the Alzheimer’s Association. At that stage, they become ineligible for Leqembi.
The central challenge is that a large and rapidly growing group of people have early memory loss and other thinking problems known as mild cognitive impairment. This condition is often, though not always, a sign of early Alzheimer’s disease.
An estimated 13 million people in the U.S. had mild cognitive impairment last year, according to a study published in the Alzheimer’s and Dementia Journal. As the U.S. population ages, the number of people with this condition is expected to reach 21 million by 2060, the study projected.
The U.S. health-care system will deal with major logistical challenges in diagnosing the growing population of people with early Alzheimer’s — even before patients face potential issues with accessing treatment.
“There’s a very large population of undiagnosed cognitive impairments that need to be evaluated in order to determine if people are eligible for treatment,” said Jodi Liu, an expert on health policy at the Rand Corporation.

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Access to drugs like Leqembi is severely restricted because Medicare for now will only cover the $26,500-per-year treatment for people participating in clinical trials. Medicare has promised to provide broader coverage if Leqembi receives full approval from the Food and Drug Administration, which Eisai expects to happen in July.
Eisai has estimated that 100,000 people in the U.S. will be diagnosed and eligible for Leqembi by the third year of the treatment’s rollout. The sum is a fraction of the total population that could benefit.
Those patients could have other options if new treatments emerge from trials with positive marks.
Eli Lilly will publish clinical trial data on its antibody infusion donanemab in the second quarter of this year. If the data is positive, the company will ask the FDA to approve the drug.
Eisai’s U.S. CEO Ivan Cheung and Lilly’s White said during the companies’ respective earnings calls in February that they are focused on working with the U.S. health system to address the challenges of rolling out of Alzheimer’s treatments.
“The primary goal right now during this launch phase […] is really get the market ready in terms of the diagnostic pathway, the infusion capacity, the education on how to monitor for this therapy, get all the hospitals and clinics ready,” Cheung said.

Not enough specialists

Long lines are expected at the offices of geriatricians, neurologists and radiologists as millions of people with mild cognitive impairment undergo evaluation to diagnose whether they have Alzheimer’s disease.
Demand for geriatricians — doctors who are experts in diseases that affect the elderly — is expected to outstrip the number of specialists available in the field through at least 2035, according to projections from the federal Health Resources and Services Administration.
The American Academy of Neurology told Medicare in a February letter that increased demand for Alzheimer’s treatments will put substantial pressure on neurologists, who will need additional resources. The federal data predicts a substantial shortage of these specialists in rural areas through at least 2035.
“You just look at the neurologists, look at geriatricians — there are fewer and fewer geriatricians per person in the U.S.,” Rand’s Liu said. “It’s just a few number of specialists to do this kind of work.”
White said Lilly has heard stories of patients waiting six to 12 months to see a neurologist or other doctors who treat dementia due to current capacity issues.
The number of radiologists — who also play a role in diagnosing the disease — is expected to decline in the U.S. through 2035 even as demand increases, the data shows.
In a study published in 2017, Liu and other Rand researchers estimated an initial wait of 18 months for patients to get evaluated by a dementia specialist, tested to confirm a diagnosis, and then treated in the first year that an Alzheimer’s antibody treatment becomes available. The wait would decrease to 1.3 months by 2030 as the patient backlog is cleared, they estimated at the time.
But more recent research found that the wait would actually increase as demand created by an aging U.S. population outstrips the supply of specialists.
Patients seeking a first specialist visit could face an initial wait of 20 months, according to a study by researchers at the University of Southern California published in the journal Alzheimer’s and Dementia in 2021. The delay could increase to about four years as early as 2028 and grow longer through 2050, the study found.
The journal is published by the Alzheimer’s Association.
Both studies are based on assumptions made before Leqembi received expedited approval from the FDA in January. Actual wait times could differ from the studies’ projections.

PET scans cumbersome

Two types of tests can diagnosis Alzheimer’s disease: PET scans and spinal taps. PET scans are accurate and safe diagnostic tools, but they are also cumbersome and expensive, said Dr. David Russell, a neurologist.
Patients are injected with a tracer that makes brain abnormalities visible to the machine that does the imaging. Tracers have to be made for each patient and used on the same day.
“We don’t have the infrastructure to roll out PET scanning on a major scale,” said Russell, director of clinical research at the Institute for Neurodegenerative Disorders in New Haven, Connecticut. He is the principal investigator on the clinical trials of Leqembi and donanemab at the institute.
Medicare coverage of PET scans for Alzheimer’s patients is also limited right now. The insurance program for seniors will only cover one scan per lifetime, and only when the patient is participating in a clinical trail approved by the federal Centers for for Medicare and Medicaid Services.
“That’s concerning because people may actually test negative at one point but then obviously as they age, they may need to get tested again,” White said.
Early Alzheimer’s disease can also be diagnosed with a spinal tap, in which fluid around the spinal cord is extracted with a catheter and tested. While there’s plenty of capacity to do spinal taps, this option isn’t attractive to many patients due to unfounded fears that it’s painful and dangerous, Russell said.
Though “there’s a lot of resistance” to the procedure, it is well tolerated and safe, he noted.

Rural areas at a disadvantage

The lack of access to PET scans is even more of an issue for patients who live in rural areas.
There are an estimated 2,300 PET scan machines in the U.S., according to a 2021 study published in Alzheimer’s and Dementia. But the machines are often in bigger cities, which puts people in rural areas at a disadvantage.
“There are certainly areas that don’t have a PET scanner, rural areas, so people would need to travel to a health center that has a PET scanner,” Liu said.
In a large, sparsely populated rural state like New Mexico, many patients would have to drive three to five hours to get a PET scan in a city such as Albuquerque, said Dr. Gary Rosenberg, a neurologist and director of the New Mexico Alzheimer’s Disease Research Center.
“It’s not California or the East Coast where everything’s very compressed and people can travel and get to a center pretty easily and go through these kinds of treatments,” Rosenberg said.
The state has an estimated population of 43,000 people with dementia, and there are very few neurologists outside of the Albuquerque area, Rosenberg said. The New Mexico Alzheimer’s Disease Research Center in Albuquerque is one of only three such facilities funded by the federal National Institute of Aging in a vast region stretching west from Texas to Arizona.
To do a PET scan, a tracer has to be made for each patient off-site in Phoenix, flown on a private plane to Albuquerque and used within hours because the tracers have a short shelf life, according to Rosenberg. The whole process costs more than $12,000 per patient, he added.
“It’s logistically going to be very challenging,” Rosenberg said.

IV infusion capacity

After spending months or possibly years waiting to get diagnosed with early Alzheimer’s, patients would then be eligible for intravenous infusions of Leqembi. But the U.S. doesn’t currently have the capacity to give infusions twice monthly for everyone who likely has the disease, Russell said.
“Having an IV infusion every two weeks would sort of ration people to availability and that’s a problem,” Russell said.
The University of New Mexico Hospital is already maxed out with demand for infusion therapies for cancer, rheumatoid arthritis and autoimmune diseases, and could have a “problem” adding new capacity, said Rosenberg.
Intravenous infusions of monoclonal antibodies like Leqembi aren’t difficult to administer, Russell said.
The infrastructure to offer infusions should expand rapidly once industry sees there’s demand for treatments like Leqembi. But the process of building out capacity could still take a couple years, Russell said. He believes big players like CVS will provide infusions for Alzheimer’s disease on a major scale if they see there’s a large and stable market.
“In one sense, capitalism works, and if it looks like that’s going to be the future, I think infusion centers will explode onto the scene,” the neurologist said.
Eisai and Biogen hope to move early Alzheimer’s patients to a single monthly dose of Leqembi after they’ve completed their initial course of twice monthly infusions, which could help alleviate some of the capacity issues with infusions over time. They plan to ask the FDA to approve this plan in early 2024.
Eli Lilly’s Alzheimer’s candidate antibody treatment donanemab is a single monthly dose, potentially making the logistics of administration easier if the drug gets approved. Dr. Dan Skovronsky, Lilly’s chief medical officer, told analysts during the company’s first-quarter earnings call that he expects many patients will be able to stop taking donanemab at 12 months.

Blood tests could reduce wait times

Though the projected wait times to get diagnosed and treated are sobering, innovations on the horizon promise to significantly improve access to Alzheimer’s drugs over time.
Blood tests for Alzheimer’s are in development and some are already on the market. Primary-care doctors could administer the tests, which would ease the burden on patients, especially those in rural communities where the closest PET scan machine is hours away.
These tests detect proteins in the blood associated with Alzheimer’s. They promise to help diagnose the disease before people display cognitive symptoms, potentially giving patients the chance to get treated before they suffer irreparable brain damage, according to the National Institutes of Health.
At least three blood tests made by C2N Diagnostics, Quest Diagnostics and Qaunterix are currently on the market. But they are used to evaluate people who are already presenting symptoms and aren’t available on the mass scale needed for the expected increase in Alzheimer’s patients.
C2N’s PrecivityAD test costs $1,250 and is not covered by insurance — though the company has a financial assistance program. Quest Diagnostics’ AD-Detect test costs $650. Quest’s test is covered by some insurance plans but not Medicare at the moment. The company also has a financial assistance program. Quanterix wouldn’t disclose the price of its test, which insurance does not cover.
Right now, these are not stand-alone tests that can definitively diagnose Alzheimer’s. But the tests could help identify the patients who likely have the disease, which would narrow the population that needs further evaluation and reduce wait times for dementia specialists or confirmatory PET scans.
A study in the journal Alzheimer’s and Dementia estimated that a cognitive test combined with a blood test could slash wait times for dementia specialists from 50 months down to 12 months.
Eisai believes that inexpensive blood tests could completely replace PET scans and spinal taps by the fourth year of Leqembi’s rollout. The quicker diagnosis could increase the number of people eligible for treatment.
Rosenberg said widespread availability of blood tests will allow mobile clinics to go into rural communities and identify who has markers associated with Alzheimer’s. This would allow patients in remote towns avoid the hours-long drive to cities with PET scan machines, Rosenberg said.
“It’s a game changer,” the neurologist said.
Lilly is developing at least two blood tests. The company is already using one test in clinical trials and hopes to commercialize it sometime this year. It is developing a second test through a collaboration with Roche. White said it is reasonable to expect that in a few years blood tests could replace more burdensome PET scans.

Injections could make treatment easier

Biogen and Eisai are also developing an injectable form of Leqembi which patients could administer themselves with an autoinjector similar to insulin pens, saving the trip to a site that provides intravenous infusions. They plan to ask the FDA to approve these so-called subcutaneous injections in early 2024.
Eli Lilly is also conducting clinical trials on an antibody treatment called remternetug as a self-administered injection. But the promise of injections that can be administered at home could make companies reluctant to invest in building out intravenous infusion capacity, Russell said.
In the future, Alzheimer’s diagnosis and treatment could be folded into routine checkups with a family doctor, Russell said. When people turn 50 and head in to get a colonoscopy or a cholesterol check, the doctor could also run a blood test for Alzheimer’s.
If the test comes back positive, the doctor could then schedule patients for an MRI and get them started on an autoinjector treatment, Russell said.
“That’s going to be the way that we’re looking at it in the not too distant future,” he said. More

Elon Musk expects SpaceX to spend about $2 billion on its Starship rocket development this year, as the company pushes to build on its first launch earlier this month.
“My expectation for the next flight would be to reach orbit,” Musk said on Saturday.
The Starship flight got off the launchpad and achieved several milestones, but Musk gave more details on a variety of the problems the rocket suffered.

The SpaceX Starship lifts off from the launchpad during a flight test from Starbase in Boca Chica, Texas, on April 20, 2023. 
Patrick T. Fallon | Afp | Getty Images

Elon Musk expects SpaceX to spend about $2 billion on its Starship rocket development this year, as the company pushes to build on its first launch earlier this month.
“My expectation for the next flight would be to reach orbit,” Musk said, speaking during a discussion on Twitter Spaces on Saturday.

While SpaceX does secondary rounds about twice a year, to give employees and other company shareholders a chance to sell stock, Musk said the company does “not anticipate needing to raise funding” to further bolster the Starship program and its other ventures.
“To my knowledge, we do not need to raise incremental funding for SpaceX,” Musk said.
As for the dramatic first fully stacked Starship rocket launch on April 20,” the SpaceX CEO said, “The outcome was roughly in what I expected, and maybe slightly exceeding my expectations.”

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SpaceX has multiple further prototypes in various stages of assembly and aims to launch the next attempt at reaching space with the towering rocket within a few months.
“The goal of these missions is just information. Like, we don’t have any payload or anything — it’s just to learn as much as possible,” Musk said.

He put the probability of reaching orbit with a Starship flight this year at “probably” 80%, but espoused that he thinks there is a “100% chance of reaching orbit within 12 months.”

Launch review

Starship launches for the first time on its Super Heavy booster from Texas on April 20, 2023.

The Starship flight got off the launchpad and achieved several milestones, but Musk gave more details on a variety of the problems the rocket suffered.
The rocket took off with only 30 of the 33 Raptor engines ignited at the base of the Super Heavy booster. Musk said SpaceX “chose not to start” three engines, as they were not “healthy enough to bring them to full thrust. Starship slid laterally off the launchpad as it climbed into the sky, which Musk said was “because of the engine failures.”
About 27 seconds into the flight, SpaceX “lost communications” with another engine — an incident that happened “with some kind of energetic event” that removed the heat shield around several other engines. “Things really hit the fan” around 85 seconds into the launch, when SpaceX lost “thrust vector control” — or the ability to steer the rocket.
Additionally, Musk reported that it took about 40 seconds for the rocket’s AFTS (Autonomous Flight Termination System, which destroys the vehicle in the event it flies off course) to kick in, which SpaceX will need to correct before the next launch attempt.
The strongest part of the rocket’s performance was how well it held together, including passing through a launch milestone called “Max Q,” or the moment when atmospheric pressure is strongest on the rocket.
“The vehicle’s structural margins appear to be better than we expected, as we can tell from the vehicle actually doing somersaults towards the end and still staying intact,” Musk said.
Looking forward, Musk said SpaceX has “made so many improvements” to future prototypes. The company needs to ensure “that we don’t lose thrust vector control” with the next launch.

‘Rock tornado’

Members of the public walk through a debris field at the launch pad on April 22, 2023, after the SpaceX Starship lifted off on April 20 for a flight test from Starbase in Boca Chica, Texas.
Patrick T. Fallon | Afp | Getty Images

Back on the ground, Musk said the booster created a “rock tornado” underneath the rocket as it was lifting off. While SpaceX has not seen “evidence that the rock tornado actually damaged engines or heat shields in a material way,” Musk noted that the company “certainly didn’t expect” to destroy the launch pad’s concrete and create a crater in its wake.
“One of the more plausible explanations is that … we may have compressed the sand underneath the concrete to such a degree that the concrete effectively bent and then cracked,” Musk said.
A priority for the next flight will be starting the 33 Raptor engines “faster and get off the pad faster,” Musk said. It took about five seconds for SpaceX to start the engines and launch the rocket, which Musk noted “is a really long time to be blasting the pad.” The company aims to cut that time in half for the next attempt.

A dust cloud grows underneath Starship as the rocket launches on its Super Heavy booster from Texas on April 20, 2023.

Photos of the aftermath have shown the violent result of the Super Heavy booster’s engines. A report from the U.S. Fish and Wildlife Service said the launch flung concrete and metal “thousands of feet away” and created a cloud of dust and pulverized concrete that fell as far as 6.5 miles from the launch site.
On Saturday, Musk said “the pad damage is actually quite small” and should “be repaired quickly.” He estimated the needed repairs mean SpaceX will be “probably ready to launch in six to eight weeks.” SpaceX will replace some of the propellant tanks near the launchpad. The 500-foot tall tower “is in good shape,” with “no meaningful damage” even though it was struck by “some pretty big chunks of concrete.”
Musk believes the biggest hurdle to flying again “is probably requalification” of the AFTS that destroyed the rocket, since “it took way too long” to detonate.
SpaceX is moving forward with a plan to put steel plates, which will be cooled by a water system, underneath the launch tower for the next Starship rocket.
Environmental activists and researchers have raised alarms about the cloud of pulverized concrete and dust that the launch created. Musk argued that the debris was “not toxic at all,” but said that “we don’t want to do that again.”
“To the best of our knowledge there has not been any meaningful damage to the environment that we’re aware of,” Musk said. More

As America’s cheapest EV, U.S. sales of the Chevy Bolt were up more than 50% last year and GM said it would make a record 70,000 units in 2023.
But GM CEO Mary Barra on Tuesday said the automaker would end production of the car later this year.
To reach those goals, GM needs the production capacity, profits and market positioning of its forthcoming next-generation EVs. It doesn’t believe it needs the Bolt.

A Chevrolet Bolt EUV on display at the New York Auto Show, April 13, 2022.
Scott Mlyn | CNBC

DETROIT — After years of lackluster performance and a fire-provoked recall, the all-electric Chevrolet Bolt EV was finally gaining traction for General Motors.
As America’s cheapest EV following significant price cuts, U.S. sales of the Chevy Bolt were up more than 50% last year and the automaker said it would make a record 70,000 units in 2023.

But instead of leaning further into the vehicle’s recent success and increased production, GM CEO Mary Barra on Tuesday said the automaker would end production later this year of the vehicle she once hailed as a “real game-changer” for the industry and an “EV for everyone.”
“We have progressed so far that it’s now time to plan to end the Chevrolet Bolt EV and EUV production, which will happen at the very end of the year,” Barra told investors during an earnings call.
Barra’s comments about the vehicle getting axed were as swift as a butcher cutting the head off a chicken but spoke volumes when combined with the company’s plans to churn out profitable electric vehicles in the years ahead.
GM is on a path to deliver single-digit profits off its EV portfolio by 2025, when it aims to have a production capacity of 1 million electric vehicles in North America.
To reach those goals, GM needs the production capacity, profits and market positioning of its forthcoming next-generation EVs. It doesn’t believe it needs the Bolt.

Production predictions

To industry experts, the writing was on the wall for the Bolt’s end of days. But the timing of the decision caught many experts off guard. Expectations were GM would produce the vehicle at least into next year.
“It was more sudden than I expected,” said Michelle Krebs, executive analyst for Detroit-based Cox Automotive. “I thought it would go away at some point when new batteries came on and they went to more body styles, but it struck me as rather abrupt.”

2024 Sierra EV Denali Edition 1
Source: General Motors

A company spokesman said the timing of the announcement coincided with GM’s need to notify suppliers about the end of production and about progress associated with the $4 billion the company is spending to retool the Bolt plant in Orion Township, Michigan, for the GMC Sierra and Chevrolet Silverado electric pickup trucks.
It’s part of GM’s EV strategy to retool existing plants rather than building new ones, although it could do so in the future. Others such as Ford Motor and Hyundai Motor have announced new plants in addition to retooling current facilities.
GM has said retooling saves time and capital, and it’s also allowed the company the flexibility to partially convert plants and build different gas-powered models in tandem. But in the case of the Orion plant, which solely manufactures the Bolt, it didn’t make sense to take that tack, because GM believes it needs the additional capacity. Plus, the Bolt doesn’t contribute to the company’s bottom line like plants that produce money-making gas-powered vehicles.
Barra on Tuesday said once the Orion plant reopens next year, the company will have a total production capacity of 600,000 EV pickups annually, including a Detroit plant that’s been slow to ramp up production of the GMC Hummer EVs.
“We’ll need this capacity because our trucks more than measure up to our customers’ expectation, and we’ll demonstrate that work and EV range are not mutually exclusive terms for Chevrolet and GMC trucks,” Barra said Tuesday.

Profits tied to Ultium

GM has promised investors its next-generation EVs, built on a new architecture known as Ultium, would be profitable. That’s a milestone that the Bolt models, including a larger “EUV” version, never were believed to have achieved.
To spur interest and make the Bolt more affordable, GM cut the starting prices by as much as $6,300 for the 2022 model year. The Bolt EV would start at $26,595, followed by the Bolt EUV at $28,195.
“Bolt is selling better than it ever has since the company dropped the price. On the other hand, that probably also means that they’re losing more money than they ever have on that car,” said Sam Abuelsamid, a principal analyst at Guidehouse Insights. “So, they don’t want to keep it going longer. They’re losing money on it.”

US President Joe Biden, with General Motors CEO Mary Barra, looks at a Chevrolet Silverado EV as he tours the 2022 North American International Auto Show at Huntington Place Convention Center in Detroit, Michigan on September 14, 2022. – Biden is visiting the auto show to highlight electric vehicle manufacturing.
Mandel Ngan | Afp | Getty Images

GM expects to earn low to mid-single-digit adjusted profit margins on its EV portfolio in 2025, excluding any positive impact of clean energy tax credits such as those included in the Inflation Reduction Act.
Taking those credits into account, the company has said it expects its new EV portfolio to be as profitable as its cars and trucks with traditional engines by 2025 — years earlier than what many thought was possible.
While those credits likely would have boosted the profit margin on the Bolt as well, the car uses older battery technology purchased from LG, and GM is currently focused on scaling up more cost-effective in-house battery production through a plant it operates as a joint venture with the South Korean company.
That Ultium ramp-up, plus cost efficiencies achieved with the new EV pickups, means margin improvements that the Bolt couldn’t have realized, especially in the long term.
“As we scale EVs, we will lower fixed costs and will continue to drive margin improvements,” Barra said Tuesday.

Mixed reputation

The Bolt will leave behind a mixed reputation. It was the first “affordable,” long-range EV to market, but it never achieved its stated potential.
The Bolt brand name also was damaged after the company in 2020 and 2021 recalled all of the vehicles ever produced due to fire concerns resulting from defects with supplier-manufacturer batteries. At least 13 Bolts spontaneously caught fire as a result of the issue.

A 2019 Chevrolet Bolt EV caught fire at a home in Cherokee County, Georgia on Sept. 13, 2021, according to the local fire department.
Cherokee County Fire Department

Still, GM touted the Bolt EV as proof of the concept for its electric-powered future. The company said the vehicles attracted new customers, with 75% of Bolt owners making the switch from non-GM vehicles.
Now, the company will need a new entry-level EV, and it’s looking to the upcoming Equinox EV, starting at around $30,000, to fill that void.
“We think this is our big opportunity here to really start to get a massive adoption, and we have that expectation with the price; the volume that we expect to do,” Scott Bell, global vice president of Chevrolet, said during a media briefing last year. “This is a game-changer for us and for the industry.”
Whether the Equinox EV, which will be produced at a plant in Mexico, can serve as more of a “game-changer” than the Bolt truly could be determined later this year when the car goes on sale.
Barra told CNBC’s Phil LeBeau last year that GM expects to ramp up production of the Equinox EV far more quickly than its current EVs. She said the vehicle should be close to full production by the first quarter of next year. More

Olipop is on track to sell more than $200 million of its prebiotic soda this year.
Olipop’s rise coincides with declining soda consumption in the U.S. and rising interest in “gut health.”
Founder and CEO Ben Goodwin said PepsiCo and Coca-Cola have already come knocking.

Olipop’s flavor lineup includes Orange Squeeze, Strawberry Vanilla, Classic Root Beer, Classic Grape, Vintage Cola, Cherry Vanilla, Ginger Lemon and Blackberry Vanilla.
Source: Olipop

Prebiotic soda maker Olipop is set to cross $200 million in annual sales this year, just five years after it arrived on grocery store shelves.
Founder and CEO Ben Goodwin said beverage giants PepsiCo and Coca-Cola have already come knocking. But he’s not interested in cashing out just yet.

“Right now, my focus is on blowing business through the roof,” Goodwin told CNBC.
Coke and Pepsi didn’t respond to requests for comment from CNBC.
Olipop is on target to more than double its sales this year. The startup presents itself as a healthier alternative to traditional soda but with the same familiar taste.
Olipop had raised $55.4 million as of Jan. 2, at a reported valuation of $199.8 million, according to Pitchbook data. Investors include Gwyneth Paltrow, former PepsiCo CEO Indra Nooyi and RXBAR founder Peter Rahal.
Goodwin estimates that roughly 10% of Olipop drinkers have replaced traditional soda entirely, but the rest swap it into their routines occasionally.

“We really are replacing that soda experience and soda occasion,” Goodwin said.
For roughly two decades, U.S. soda consumption has been falling. Americans have ditched the drinks for bottled water, flavored seltzer and other options that they view as healthier due to concerns about soda’s sugar — or sugar replacements, such as aspartame. Still, Coke and Pepsi aren’t in danger of discontinuing their namesake sodas.
“Consumers are drinking less soft drinks, but they’re still drinking a lot of soft drinks,” said Michele Scott, associate director of food and drink for Mintel’s U.S. research.
Consumers are also increasingly interested in “gut health,” one of the latest wellness trends. Matthew Barry, Euromonitor International’s insights manager for food and beverages, said the two trends — soda’s decline and gut health’s rise — have helped benefit Olipop and other similar brands, such as Poppi.
Functional soda accounts for 14% of the digestive health category, according to SPINS data.
Olipop’s formula includes nine grams of fiber and prebiotics, which are substances that help beneficial bacteria grow in the gut. Their health benefits haven’t been conclusively proven.
Rival Poppi, which was founded in 2015 and has also seen its sales accelerate over the last year, infuses its soda with apple cider vinegar, which contains prebiotics. Both Olipop and Poppi have leaned into influencer marketing on TikTok, where gut health became a trending topic last year.
In February, Olipop’s root beer overtook Keurig Dr Pepper’s A&W as the best-selling root beer at an unspecified top U.S. retailer, according to Goodwin. He takes it as another sign of Olipop’s potential, since root beer was one of the first flavors it started selling.
“My hope is that as other [flavors] in the system mature as well and get higher distribution and customer familiarity, we may be able to repeat this type of story with a range of different flavors,” he said.
Goodwin said he formulated the root beer himself and remains the company’s top formulator, leaning on his “super tasting” ability, thanks to taste buds that are more sensitive than the average person’s.
He dropped out of college at age 20 to help his friends start a kombucha company.
From there, he founded Obi probiotic soda with Olipop co-founder and Diageo alumnus David Lester. They sold Obi in 2016. They started working on Olipop’s formula the following year.
Despite its success, Olipop is still in the early stages of growth, with a retail footprint of just 20,000 locations and only 12 flavors. After launching first in natural food grocers in the Bay Area, it’s expanded to mainstream chains such as Target and Kroger. Its expansion in the Midwest helped fuel its soaring sales last year, Goodwin said.
Olipop’s skyrocketing sales have coincided with soaring prices across the grocery store. The price index for food at home increased 8.4% in March compared with a year earlier, according to Labor Department data.
Coke and Pepsi have raised their prices by double-digit percentages over the last year, saying the price hikes are necessary to mitigate inflation. The duopoly has seen mixed reactions. In the first quarter, Pepsi’s North American beverage business saw its volume fall 2%, while Coke’s North American drinks unit reported flat volume.
But even with Coke’s and Pepsi’s higher prices, Olipop is still the more expensive choice. A 12-ounce can of Olipop costs $2.49 at a Target store in New York City — the same price as a 20-ounce bottle of Pepsi.
“The challenge for Olipop and beverages like it is the premium price point right now during a time of inflation,” Euromonitor’s Barry said. “There is certainly a group of consumers who can afford to buy high-priced sodas regularly but that’s a limited subset of the population.”
But Olipop’s Goodwin is confident that consumers are willing to pay more for the drinks he formulates. He said that soda trails only coffee in its price inelasticity, meaning that consumers are willing to pay more. More

Elon Musk’s SpaceX launched its fully-stacked Starship for the first time a little over a week ago.
The company hopes to launch another Starship rocket as soon as June or July, but that timeline depends on a variety of factors.
The highest hurdle to a second launch attempt may be the daunting cleanup. 

Starship launches for the first time on its Super Heavy booster from Texas on April 20, 2023.

The dust has settled in Texas, but the work to clean up after the world’s most powerful rocket and get the next one flying in a matter of months is already underway.
Elon Musk’s SpaceX launched its fully-stacked Starship for the first time a little over a week ago. While the nearly 400-foot-tall vehicle flew for more than three minutes — achieving several milestones for a rocket of unprecedented scale — Starship also lost multiple engines during the launch, caused severe damage to the ground infrastructure and ultimately failed to reach space after the rocket began to tumble and was intentionally destroyed in the air.

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As NASA Administrator Bill Nelson told the House Committee on Science, Space and Technology on Thursday that SpaceX “blew a hole in that launchpad.”
The company hopes to launch another Starship rocket as soon as June or July, but that timeline depends on a variety of factors, including repair work, regulatory signoff and the readiness of its next prototype.

Launch site damage

Debris litters the ground on April 22, 2023, after the SpaceX Starship liftedoff on April 20 for a flight test from Starbase in Boca Chica, Texas.
Patrick T. Fallon | Afp | Getty Images

The highest hurdle to a second launch attempt may be the daunting cleanup. 
Soon after the launch, SpaceX began the process of cleaning up the launchpad and assessing the damage to its infrastructure. Photos taken by onlookers have shown the violent result of the Super Heavy booster’s engines, which carved a crater into the ground and smashed debris into the launch tower, nearby tanks and other ground equipment.
“I have asked, so I can report to you, that as of today SpaceX is still saying that they think it will take at least two months to rebuild the launchpad and concurrently about two months to have their second vehicle ready to launch,” NASA chief Nelson told lawmakers Thursday, providing the most recent update on the company’s timeline for returning to flight.

The space agency has a vested interest in the success of Starship, as NASA gave SpaceX a nearly $3 billion contract in 2021 to use the rocket to land astronauts on the moon as part of the Artemis program.

A member of the public walk through a debris field at the launch pad on April 22, 2023, after the SpaceX Starship lifted off on April 20 for a flight test from Starbase in Boca Chica, Texas.
Patrick T. Fallon | Afp | Getty Images

SpaceX leadership repeatedly said before the launch that not blowing up the launchpad would be considered a success for the first launch. But the infrastructure still took a hit. In a series of tweets after the launch, Musk described significant damage to the concrete launchpad the company had built and said he hoped that the rocket hadn’t too heavily damaged the mount that supports it before launch.
“All that’s left of the concrete lateral support beam is the rebar!” Musk said.

Debris litters the launch pad and dmaged tanks (R rear) on April 22, 2023, after the SpaceX Starship lifted off on April 20 for a flight test from Starbase in Boca Chica, Texas.
Patrick T. Fallon | AFP | Getty Images

The company CEO added that it was “still early” in SpaceX’s analysis, but surmised that “the force of the engines when they throttled up may have shattered the concrete, rather than simply eroding it.” When SpaceX briefly tested the booster’s 33 Raptor engines ahead of the launch, Musk said “the engines were only at half thrust,” which avoided tearing a hole in the ground previously.
One potential solution: Musk said SpaceX is “building a massive water-cooled, steel plate to go under the launch mount.” He said the plate was not “ready in time” for the first attempt and admitted that the company “wrongly thought” that the concrete would withstand the launch.

Regulatory review

A dust cloud grows underneath Starship as the rocket launches on its Super Heavy booster from Texas on April 20, 2023.

SpaceX’s launch license from the Federal Aviation Administration was a long-awaited final step to getting Starship off the ground, which makes the regulator’s investigation into this first flight a key overhang to the second one.
The Starship test flight triggered reviews from the FAA, which is effectively the lead federal regulator on the SpaceX rocket program. As is standard with a launch “anomaly,” such as this midair explosion, the FAA began an investigation into the flight and its fallout. The move grounds future Starship launches until it closes the investigation and clears SpaceX to move forward under the license the regulator gave the company earlier this month.
“A return to flight of the Starship/Super Heavy vehicle is based on the FAA determining that any system, process, or procedure related to the mishap does not affect public safety,” the agency said in a statement on April 20, the day of Starship’s launch and subsequent explosion. 

Members of the public walk through a debris field at the launch pad on April 22, 2023, after the SpaceX Starship lifted off on April 20 for a flight test from Starbase in Boca Chica, Texas.
Patrick T. Fallon | Afp | Getty Images

Additionally, the U.S. Fish and Wildlife Service disclosed this week that the Starship launch started a 3.5-acre fire on land owned by Texas’ Boca Chica State Park. FWS did not find dead wildlife on the local refuge lands, which are a habitat for endangered species, but found that the rocket’s destructive force flung concrete and metal “thousands of feet away” and created a cloud of dust and pulverized concrete that fell as far as 6.5 miles from the launch site.

‘Hardware rich’

A SpaceX Starship prototype stands in a bay at the SpaceX Starbase in Boca Chica, Texas on April 18, 2023.
Patrick T. Fallon | AFP | Getty Images

One piece of SpaceX’s second attempt is already largely in place: the production pipeline for another Starship prototype. 
The company had planned to launch the first Starship and Super Heavy booster flight as early as summer 2021, but president and chief operating officer Gwynne Shotwell said recently that the inaugural flight was delayed in part because the company was focused on developing “the production systems that will build the ship.” The company has expanded its “Starbase” facility steadily over the past few years. 
Thanks to the many enthusiasts who livestream every minute of SpaceX’s work in South Texas, it’s apparent the company has as many as 10 further Starship prototypes in various stages of assembly, as well as up to seven more Super Heavy boosters.
Nelson touted as much before members of Congress, explaining how the company approaches rocket development differently than the space agency.
“Now understand that the explosion, that’s not a big downer in the way SpaceX does things. They are hardware rich, meaning they’ve got a lot of those rockets ready to go, and that’s their modus operandi — they launch, if something goes wrong they figure out what it is, they go back and they launch it again,” Nelson said. 
As with any rocket-development program, and especially the largest ever assembled, SpaceX’s timeline for the next Starship flight is likely to evolve and change. More

United Airlines’ plan to retrofit dozens of its older narrow-body planes is running behind schedule.
The upgrades include seat-back screens, Bluetooth capabilities and other amenities.
Supply chain strains have pushed back the timeline.

United Airlines Seatbacks
Courtesy: United Airlines

United Airlines’ plan to revamp the cabins on its older narrow-body planes is running behind schedule because of supply chain strains, the carrier told CNBC this week. The upgrades include bigger premium cabins, seat-back entertainment screens throughout the planes, Bluetooth capabilities and other amenities.
The Chicago-based airline previously expected to have 100 of its narrow-body planes retrofitted with the new interiors by the end of the year but now expects 60 will be complete by then, a spokeswoman said.

“The reality is the supply challenges across the board whether it be [inflight entertainment] systems, chips, seats and many other things are just more challenging than they’ve ever been in our business,” United’s chief commercial officer, Andrew Nocella, said on an earnings call last week.
United unveiled the overhauled cabins in June 2021 on the heels of an order for 270 new Boeing and Airbus narrow-body planes, an effort to refresh its brand as airlines compete for passengers in the travel rebound, particularly big spenders.
United has also said it expects to have more premium seats for sale for each departure than any other airline in North America by 2026 as travelers compete for what can be elusive upgrades and the ranks of elite travelers with piles of frequent flyer points swell.
United’s Nocella said last week that the carrier will have multiple production lines revamping the interiors of the narrow-body planes this summer, helping to pick up the pace.
The carrier expects about one in three aircraft in its narrow-body fleet, including new aircraft, will have the upgraded interior by the end of the year.

“It will just take a little bit longer than we had originally intended,” he said. A United Airbus A319 was recently modified and should be flying soon, he added.
The airline had targeted 2025 to complete the narrow-body upgrades, but it’s unclear if United will make that goal.
Separately, United said that all of its wide-body aircraft will be outfitted with premium economy seats and its Polaris seats, the carrier’s top-tier class on international and other long-haul flights, by August.
Other airlines like JetBlue and Delta Air Lines have also added amenities on their planes in recent years, upgrading their top-tier classes, installing new seats and adding some services, including free Wi-Fi.
Delta executives have said that revenue growth for premium seats like business class or premium economy has outpaced sales from standard coach.
“We see high stickiness to those products,” Glen Hauenstein, Delta’s president, said on the company’s quarterly call earlier this month. “So once you start flying in those cabins, you tend not to go back.” More

The NBA’s Phoenix Suns and WNBA’s Phoenix Mercury are leaving behind cable TV, signing a deal with a local broadcast station owner and streaming service.
The Suns’ local games currently air on cable-TV channel Bally Sports Arizona, which is owned by Diamond Sports. Diamond is under bankruptcy protection.
The shift to a free over-the-air network for all games and streaming comes as the regional sports network business is under increasing pressure.

A general view during the second half in Game Two of the NBA Finals between the Milwaukee Bucks and the Phoenix Suns at Phoenix Suns Arena on July 08, 2021 in Phoenix, Arizona.
Christian Petersen | Getty Images

Arizona’s professional men’s and women’s basketball teams are bouncing out of the regional sports network arena.
The NBA’s Phoenix Suns and the WNBA’s Phoenix Mercury reached a deal with broadcast station owner Gray Television to air the entirety of their regular seasons on local broadcast networks available throughout Arizona.

The local networks are available for pay-TV subscribers as well as for those who opt to watch for free by using an antenna. The teams also signed a deal with Kiswe, a privately held video technology company, to start their own direct-to-consumer streaming service.
The deal marks a pivotal moment that will see a professional sports team exit the regional sports business and bring regular season games back to fans through their local TV stations.
“I am incredibly excited to let you know that we have finalized and signed a deal that is an absolute game changer for our organization, our fans and the future of how we grow the game,” Suns and Mercury owner Mat Ishbia said in an email to executives, viewed by CNBC. “In addition to being the first modern deal to go to exclusively over the air statewide, we are also building our own DTC product in partnership with Kiswe.” 
Part of what made this deal possible is that the Suns and Mercury have their own in-house production, as well as a commercial sales group, which will help simplify the transition from its RSN.
Regular season games for the Suns were previously available on Diamond Sports’ Bally Sports Arizona channel. Diamond filed for bankruptcy protection in March.

Beginning next season, the Suns will no longer be on the network. The Suns, who have advanced into the second round of this year’s NBA playoffs, are considered contenders to win what would be their first league championship.
Bally Sports Arizona also airs the NHL’s Arizona Coyotes and MLB’s Arizona Diamondbacks regular season games. Diamond Sports skipped a rights payment to the Diamondbacks, in a push to gain its streaming rights, prior to filing for bankruptcy. Diamondbacks games are still airing on the network while the battle plays out in court.
The RSN business model has long been lucrative for the leagues and teams, as networks pay big fees for the rights to games that aren’t nationally aired.
Financial terms of the Suns and Mercury’s deal with Gray and Kiswe weren’t disclosed. Overall, Gray and Kiswe will carry the Suns games for five years, while the deal with three-time WNBA champion Mercury runs for two years.
Regional sports networks in general have been under pressure as customers cut their pay-TV subscriptions and opt for streaming. The networks, including Bally Sports, have been launching streaming options at price points that many consumers balk at, but are not likely to upend the longstanding RSN business model.

US basketball player Brittney Griner, of the Phoenix Mercury, speaks during a news conference at the Footprint Center in Phoenix, Arizona on April 27, 2023.
Patrick T. Fallon | Afp | Getty Images

With this new deal, Suns and Mercury games will be available to nearly 2.8 million households in Arizona, which the teams say triples the current number of homes they now reach. The teams will be able to reach every home in Arizona once Gray launches in Yuma this summer.
“If you go back to the 1980s and 1990s there weren’t RSNs. These pro games were on local TV,” said Pat LaPlatney, Gray Television’s co-CEO. “This gives the Suns and the Mercury a really broad distribution platform. It will make TV advertising and promotion of the games significantly more valuable as the games will be reaching tons more people.”
With the WNBA season starting in a few weeks, Mercury games will already be available over the local networks and Kiswe’s streaming service. Mercury games will be available for free through the streaming option, in a push to broaden the team’s fan base.
The first two Mercury games will be nationally aired on ESPN, as it marks the return of WNBA star Brittney Griner, who was jailed on drug charges in Russia last year. She was released in December.
Mercury games will be available on local TV stations in Phoenix and Tucson, which covers more than 95% of the state’s TV households, and will be added to Yuma over the summer.
The Suns games, however, won’t be free on the streaming service next season, but will be more affordable than the pricing for other RSN streaming services, the executives said. This year, MSG Networks, which airs New York Knicks’ games as well as games featuring the NHL’s New York Rangers, Buffalo Sabres and New Jersey Devils, said it would launch MSG+ for $29.99 a month. The New York Yankees’ YES Network charges $24.99 a month for its new streaming service.
“The absolute intent is to change it up compared to what’s been out in the industry today from a price point perspective,” said Mike Schabel, Kiswe’s chief strategy officer. “I’d like for it to be soda money, not gas money, type valuation. We’re thinking about the audience and who we’d like to reach.”
Pricing for the Suns’ streaming option is still being finalized. More

Bed Bath & Beyond, which filed for bankruptcy, is expected to soon close hundreds of stores.
That is likely to result in a land grab by retailers and other companies that are looking to expand.
It could be a particular good opportunity for low-price chains and dollar stores.

A closed Bed Bath & Beyond store in San Francisco, California, US, on Monday, April 24, 2023. 
David Paul Morris | Bloomberg | Getty Images

In strip malls across the country, Bed Bath & Beyond stores have “Closing Soon” signs.
For other retailers, those may as well be “For Rent” signs.

The home goods retailer, which filed for bankruptcy Sunday, won’t only create opportunities for competitors to gain new customers and market share. Its shuttered stores will kick off a land grab for retailers hungry for additional space.
Bed Bath will join a list of other bankrupt companies, such as Kmart and Sears, that vacated spaces and made way for stores. Bed Bath has nearly 500 locations that could open up — between its 360 namesake stores and 120 Buy Buy Baby locations — for other companies to rent. It had already shuttered many spots, as it wound down 150 underperforming namesake stores and shut all 49 of its Harmon FaceValue beauty-chain locations.
The company’s stores remain open and its website is still operating. Liquidation sales began this week.
Yet Bed Bath’s coming closures are hitting at a good time, according to real estate firms and retail industry watchers. The retailer has locations in high-traffic suburban areas. Its stores are easily adaptable at their size — typically around 30,000 square feet, according to industry analysts. Off-mall shopping centers’ vacancy rates are low and demand is high, especially as discounters grow and traditional mall players experiment with new concepts.
Former Bed Bath stores could turn into a variety of other retail spaces, said Deborah Weinswig, CEO of Coresight Research, a retail advisory group. They could become doctor offices for CVS or Walgreens, as the drugstore chains push into primary care, or turn into grocery locations for growing chains such as Aldi or Lidl, she said.

Some may be sliced into locations for multiple companies. Others may be backfilled by a single tenant.
Bed Bath’s spaces are more move-in ready than Kmart and Sears locations because by and large they were better maintained, while the better-performing stores only “need a little light dusting,” she said.
“In the past, I may have been a bit more concerned if we were to go through something like this, but I’m just not,” Weinswig said. “I’m not worried at this point because of the fact you’ve had this tremendous change in terms of demand for physical spaces.”
An appetite for space
Bed Bath & Beyond’s stores will go on the market as the off-mall space is hot and shoppers are flocking back to stores.
Weaker retailers’ locations thinned out during the fallout of the Great Recession and again during the Covid pandemic, said James Bohnaker, senior economist with Cushman & Wakefield. Now, a mix of stronger retailers are vying for space in similar strip centers, including dollar stores, off-price retailers, direct-to-consumer players like Warby Parker and Casper, and traditional mall retailers like Macy’s.

Vacancy rates for shopping centers fell to 5.6% in the first quarter of this year, the lowest level since commercial real estate firm Cushman & Wakefield began tracking in 2007. Such locations, which often include a major grocer and businesses like gyms and restaurants, have gained popularity because of their convenience and proximity to growing communities, new subdivisions and wealthier shoppers.
Retail real estate had a banner year in 2022 in the U.S., as store openings outpaced closures for the first time since 2016, according to Coresight Research.
Major retailers opened roughly 2,500 net new stores in the U.S. in 2022, the firm found.

Year-to-date 2023 U.S. store opening announcements

As of April, discounters are leading the way so far this year with announced store openings in the U.S.
Dollar General: 1,065 stores
Family Dollar (owned by Dollar Tree): 328 stores
Dollar Tree: 308 stores
Five Below: 199 stores
JD Sports: 134 stores
TJX Companies (includes T.J. Maxx, HomeGoods, Marshalls): 102 stores
Wawa: 100 stores
Burlington Stores: 96 stores
Ross Stores: 92 stores
Bath & Body Works: 92 stores
Tractor Supply: 70 stores
Source: Coresight Research data

Industry watchers expect retailers to expand at a similar pace this year, even as interest rates rise and the economy gets choppier.
There are several factors driving the demand for retail space, according to Coresight’s Weinswig: Retailers have more money after shoppers’ pandemic-fueled spending spree. Companies see brick-and-mortar stores as both billboards for their brands and fulfillment centers for their e-commerce orders. Retailers also are adding technology to better understand customer behavior, as Google and Apple’s privacy changes make it harder to track them online. And hybrid work schedules mean shoppers visit stores throughout the day.
Discounters and off-price players, such as Dollar General, Dollar Tree and TJX Companies are leading the way with big plans for expansion, according to Coresight. They could become potential tenants, depending on how the former Bed Bath spaces are sliced and diced.
Bed Bath’s vacated boxes could also be ideal spots for gym chains such as LA Fitness, Crunch and Planet Fitness, as well as off-price banners like TJX-owned HomeGoods and Marshalls, said Matthew Harding, CEO of Levin Management. The New Jersey-based firm is a landlord and property manager with more than 100 properties in five states and Washington, D.C. Its properties include some former and current Bed Bath locations.
Even mall players may take a look. Foot Locker, for instance, closed an estimated 187 stores in the U.S. in 2022, more than any other retailer, according to Coresight. The footwear company’s CEO Mary Dillon, however, has spoken about plans to open new locations in strip centers. Macy’s has also opened stores beyond malls.
Think of it as retail’s circle of life.
Kimco Realty, a real estate investment trust with 27 Bed Bath stores in its portfolio, said it already has single tenants teed up to fill most of those locations. Through a spokesperson, the company said it can’t yet disclose names, but they include a mix of off-price, full-price, entertainment, grocery, furniture, and automotive or appliance stores.
At a strip mall in the Phoenix area, one of Kimco’s former Bed Bath & Beyond locations recently reopened as a Burlington store.
In one shopping center in Edgewater, New Jersey, a HomeGoods (owned by T.J. Maxx-owner TJX Companies) is moving into a former Bed Bath & Beyond, according to Levin Management.
In a Bergen County location in the state, negotiations are underway about turning a two-story Bed Bath & Beyond into multiple properties, according to Rick Latella, an executive managing director in the retail valuation practice of Cushman & Wakefield.
He said the owner is close to a deal with off-price retailer, Ross Stores, for one floor. And on the other floor, possible tenants include REI, Petco and Barnes & Noble. More