Ozempic for All? – The New York Times

This transcript was created using speech recognition software. While it has been reviewed by human transcribers, it may contain errors. Please review the episode audio before quoting from this transcript and email [email protected] with any questions.

From “The New York Times,” I’m Natalie Kitroeff. This is “The Daily.”

[THEME MUSIC]

In the coming year, GLP-1 drugs like Ozempic and Mounjaro may become way more attainable for millions of Americans, as President Trump promises to lower their costs and drugmakers race to release them in pill form, paving the way for what could be the next revolution in weight loss. Today, my colleague Eshe Nelson on how that story of accessibility actually started years ago when one company invented the first version of these drugs and then lost control of them.

It’s Friday, November 14.

Eshe, you’ve been covering Ozempic and this new class of weight loss drugs. And we’re coming to you because it seems as though we may be approaching a real turning point in our collective relationship to these medications. So just tell me about how you’re thinking about this moment.

Yes, I think we are definitely at some sort of turning point, or at least heading towards the next stage of these new class of weight loss drugs. They’ve been available for a few years now. But despite there being 100 million Americans, for example, who are classified as obese, only a few million people are using these drugs. So we are, I think, getting to this point where access will really broaden and many more people might start to use them.

And that’s because one of the big changes we can expect is that these drugs will become available in pill form, because at the moment, you can only use them as injections. They’re weekly injections. That might deter some people. But I think these pills could really revolutionize the access to weight loss drugs. And those pills just start to hit the market early next year.

That’s huge.

Yeah, it is. And the other thing that could widely increase access to many more Americans is the deal President Trump recently announced.

Right. Tell me about that deal.

Yes. So last week, President Trump got into the Oval Office, the heads of Novodarivka Nordisk and the heads of Eli Lilly.

These are the two companies that are responsible for making the weight loss drugs that you probably about. So Novo Nordisk is the maker behind Ozempic and Wegovy. And then you also have Eli Lilly, they make Mounjaro and Zepbound.

There’s a lot of people in the room, I should say. Dr. Oz is there. RFK, Jr. is there. Several other members of staff who have worked on these negotiations are there as well. And President Trump, he calls this the fat drug.

And he looks around the room and he starts asking —

Who is taking this?

Oh, my God.

This is certainly one way to reduce the taboo of taking these drugs.

Yeah, yeah. Just tell people who’s on it.

Exactly. And President Trump got the heads of these companies into his office to announce that they were going to lower drug prices and massively increase access to these weight loss drugs.

So up until now, you couldn’t get these weight loss drugs through Medicare. So you could get Ozempic, which is the drug that is marketed for diabetes. But Medicare prohibited access to drugs that are purely for weight loss. And this deal will change that.

President Trump is the friend of the forgotten American. Obesity is a disease of poverty, overwhelmingly. And these drugs have only been available for people who have wealth.

RFK, Jr. and Dr. Oz, they talk about President Trump being here for the forgotten man of America.

And one of the things Dr. Oz says is that —

He expects Americans to be able to lose 135 billion pounds by the midterms? Now, I’m assuming that’s a mistake, because if it were billions, that means each American would have to lose 400 pounds by next year. That seems pretty difficult. So I’m assuming he meant 135 million.

Which is still a lot. And it sounds like for a couple of reasons at this point. Pretty soon, we could be seeing many more Americans gaining access to these drugs. And that very much is just the latest beat in what has been now a years long story of these medications spreading really quickly and widely.

We started out hearing about them being used for weight loss among A-listers. It seemed like celebrities were the only ones who could get their hands on them just about. And now I so many people on them.

Yeah, these drugs have become really popular and quite widely available to some people in a very small amount of time, which is probably why you’re hearing so many people talk about it, why you know so many people taking these drugs.

And to really understand this democratization that is starting to take place, you need to understand Novo Nordisk, which is the Danish company behind the drug that I’ve been covering. And to some extent, how they’ve managed and at times mismanaged the rollout of the drug because efforts to increase supply, efforts to increase access have really been at the heart of this story the whole time.

So what is that story of how we got here?

So Novo Nordisk is this company that has been around for hundreds years. And for almost all of that time has been doing one thing, which is diabetes treatments. It has been making insulin. And to this day, it still makes about half of the world’s insulin supply.

But in the 1980s, GLP-1s are discovered. And it’s the hormone in your body that can help manage glucose levels. And the problem that is had in trying to make GLP-1s one into a medicine is that it’s just really short-acting. You put it into humans and it vanishes instantly.

So one of the things Novo Nordisk scientists and others, this is not just happening in one place, but one of the things they’re trying to figure out is how to make it long lasting. Eventually, they do come up with way to make it last long enough so you can have a daily injection, and you end up with this drug that becomes known as Victoza.

Never heard of it.

Honestly, I’m not surprised. Victoza, though it’s discovered in 1997, doesn’t hit the market until 2010. And even though they start to see the weight loss effects of it, it is still only for diabetes. Not until 2014 do they have the same drug, but for weight loss. And that becomes Saxenda. Did you hear of that one?

No. But what a name.

I don’t actually how they come up with these names. I would maybe love to find out. So you have this drug that is allowing people to lose weight, but it’s moderate weight loss. Only about 5 percent of weight loss, which is probably why you don’t hear much about it at the time.

Now, the company is aware that it’s on to something because this is pretty good weight loss. And the other thing is it doesn’t come with all these nasty side effects effect. Back then, especially in the ‘90s, weight loss drugs have a bad reputation. This is a time when these drugs have all sorts of side effects. Sometimes they’re pretty dangerous. Sometimes they’re not very effective.

And also, the culture is very different. Obesity isn’t considered a disease. It is all about willpower, diet, and exercise. So people aren’t thinking how should you medically treat obesity.

But they do not give up on this. And the team behind it do not give up on this. And they keep looking for a way to make these drugs last even longer. And that’s how we get to semaglutide, which you will because that is Ozempic.

Finally, Ozempic.

We’re here. We’re here at Ozempic.

Ozempic is approved in the US in 2017. It’s a weekly injection, for starters, so no more daily injections. And it also leads to much more weight loss, about 15 percent in clinical trials. So it’s a huge difference from this first generation of GLP-1 drugs.

But I should say, at this time, Ozempic is supposed to be prescribed for diabetes and diabetes only. But because it’s leading to this big weight loss effect, you start to see doctors prescribing it off label.

Right. I remember this was when Ozempic suddenly exploded into our national consciousness. It was like at the Oscars. There were jokes about it. It seemed like it was everywhere. All of a sudden.

Oh, jokes about it?

Endless queries about which celebrity was taking it or not.

I felt like it fed a million tabloid headlines.

Who was on Ozempic. Who wasn’t. Loads and loads of TikTok videos.

People documenting their journeys on Ozempic.

But it’s not until 2021 that they get FDA approval for the same drug, but for obesity. And that’s called Wegovy. And while we’re seeing it all over social media, the reason this company is getting a lot of attention, and actually the reason why people call this a miracle drug is because it has a lot of other benefits alongside weight loss.

It is known to lower the risk of heart attack, stroke, and death from other cardiovascular issues. It can treat severe liver disease, sleep apnea, kidney disease. And at the moment, they’re even studying its effect on treating Alzheimer’s.

Right. And this is the point at which we start hearing a lot about the company just being in this incredibly strong position. I remember there were these headlines about how this was like propping up the entire Danish economy at one point.

Absolutely. I mean, the sales of this drug, and I have to say, to US patients, were so enormous that the company’s market value was equal in size of the Danish economy. It was the thing that was keeping the Danish economy out of recession at the time. Like these were huge numbers, huge sales, a lot of popularity for these drugs.

But actually, the popularity also becomes a problem for the company. And this is the part of the story that Novo Nordisk, I imagine, wished it could avoid altogether.

[MUSIC PLAYING]

We’ll be right back.

So before the break, you said something counterintuitive, which is that the massive uptake of this drug becomes a challenge for Novo Nordisk. What did you mean by that? How’d that happen?

Absolutely. Novo Nordisk, they don’t see this popularity coming. You have to remember that Novo Nordisk is a 100-year-old company that was making insulin, which is steady volumes, steady growth. But to be fair to them, no one sees this coming. Analysts don’t. Investors don’t. Other pharmaceutical companies don’t. So everyone is playing catch up.

So after they’ve launched Wegovy, and it’s wildly popular, they just don’t have enough of the drugs to meet all of this demand.

[MUSIC PLAYING]

Novo Nordisk, this is a huge increase in demand for them, and they don’t have the production capacity to meet it. And this is the beginning of some really difficult problems for the company.

Like, what?

The challenge is that because these drugs become so popular and people are using them for diabetes, but also for off-label reasons, there is a concern that there’s not going to be enough of these drugs out there. And so they end up on an FDA shortage list.

And that essentially opens the door for something called compounding.

Essentially, the company is losing their monopoly on making them, and you get all these knockoff versions that are allowed to be sold to people.

Yeah. There are other versions of this drug out there now. It kind of lifts the exclusivity that Novo Nordisk has on making and selling these drugs.

[MUSIC PLAYING]

This seems like a pretty big deal for Novo Nordisk, because the company, as you’ve told us, had spent decades working to develop these drugs. It’s just a lot of money and time that Novo had invested. And normally, drug patents give a company like Novo time to finally reap the benefits of that investment.

Exactly. Now, technically, Novo Nordisk has not actually lost its patent, but it is an unusual situation in the sense that because of this shortage, the federal law does allow companies to produce versions of a patented drug. And so while we have seen this before and it’s happened with other drugs, what analysts tell me is that this is a really unusual scenario because it’s such a popular drug.

And because it can be used for many different reasons alongside weight loss, because we talk about these other health benefits it has, there are so many incentives for other companies to do this compounding because there is a big market out there of patients who are looking for semaglutide, and especially looking for semaglutide. If it’s cheaper than what they can get it at directly from Novo Nordisk. And in the meantime —

A competitor comes onto the market.

Eli Lilly’s drug comes on the market in 2022. Initially, they have Mounjaro, which is for diabetes, in the same way that Ozempic is for diabetes. And a year later, in 2023, Eli Lilly get FDA approval for Zepbound, which is an obesity drug.

And this is a big change because now, Novo Nordisk has gone from being the only patented FDA-approved drug on the market for several years to having a formidable competitor in the form of Eli Lilly.

So Novo, at this point, is dealing with competition from the compounded versions of its own drug and from this new big player in the market.

Absolutely. Eli Lilly’s Zepbound becomes really, really popular. And there’s a few reasons for that. One of the reasons is that Eli Lilly is very quick to allow customers to buy this drug directly, and so it helps people, who are willing to pay out of pocket, get access more quickly than they do through Novo Nordisk’s Wegovy.

Another reason is that some people say they simply prefer taking Zepbound. Everyone responds differently to different drugs, but lots of people report having milder side effects as well. And so we start to see access really expanding because of this alternative option.

And then earlier this year —

The FDA said, these drugs are no longer on the shortage list, and they told compounders to stop. But we’ve really not seen that actually happen.

Now, Novo Nordisk has tried to get involved in this as well. It is issuing lots of cease and desist orders. It’s starting up all of these lawsuits. But really, it’s in the hands of the FDA who say they are trying to crack down, who may be looking into how to stop these drugs being imported into the country.

But from the perspective of the compounding pharmacies, this is a huge market that’s out there still. So they’re still using other loopholes to find ways to offer these drugs to their patients.

And what’s the impact on the company at this point? I imagine it’s stark.

The fortunes of this company are completely reversed. In the summer, Novo Nordisk basically had to tell investors what its profits and sales would look like, assuming that compounding was still going to happen. Shareholders did not react well. The company’s share price plummets 20 percent in one day.

Whoa.

It wipes out $70 billion in market value.

So much money.

It’s so much money. And it kind of snowballs. The negative feelings around this company that had had massive enthusiasm about the promise of these drugs, it’s like, those same people got spooked. So on top of that, the company ousted CEO, brings in someone else, and then announces huge layoffs. This was a company that was hiring tens of thousands of people who have just announced they’re going to get rid of 9,000 people.

Wow.

And so over the course of the past year or so, the company’s share price has dropped percent from its peak. I mean, that is a huge decline.

It is pretty surprising to hear that the company that created this miracle drug is in such a tough spot now. And yet, the reason it’s in a tough spot or part of it are things that you describe that were actually good for consumers — generics entering the market, Eli Lilly offering a competitor. People have more options now. And so I wonder if the upshot of this story is bad news for Novo Nordisk, but good news for consumers and potentially, public health.

Yeah. For Novo Nordisk, there is something amazing in being a pioneer here of leading the way. But it also gives you a lot of room to fall. And as with lots of things, when it’s really popular, when it’s good, when it works, and when you create a market, you are bound to get competition. And so that’s what we’re seeing. And in some ways that is natural.

[MUSIC PLAYING]

The company knew that it was going to start to face competition, and it absolutely is. For everyone else, you start to see much more access. We’ll see more entrants into the market and more variety of actually the science behind these drugs and how people respond to them and the forms that they take as well. So not just injections, but also the pills, also the frequency that you’ll be likely to take them for the side effects that they might give you or not give you. So this is definitely the beginning of an expansion of access to these drugs, and it’s hard to actually where it stops.

[MUSIC PLAYING]

Eshe, thank you so much.

You’re welcome. I loved being here.

[MUSIC PLAYING]

We’ll be right back.

Here’s what else you should today. On Thursday, the government slowly reopened as the longest shutdown in history came to an end. Agency workers returned to their offices and federal courts resumed their normal dockets. Government employees expect to see paychecks again as early as November 20.

And in good news for travelers. Ahead of the Thanksgiving holiday, disruptions to air traffic eased as federal officials canceled a plan to further expand restrictions on flights at 40 busy airports.

And Blue Origin, the company started by Amazon founder Jeff Bezos, successfully launched its New Glenn rocket and landed the booster on a platform in the Atlantic Ocean. It was a major breakthrough as the company tries to rival Elon Musk’s SpaceX.

SpaceX had landed a booster for the first time a decade ago, but no other company had pulled off the feat for an orbital class rocket until Blue Origin. It was a major accomplishment for a company that’s long been seen as sluggish and disappointing when compared with SpaceX, which now dominates the space industry. Blue Origin is also planning a large robotic moon landing next year.

[THEME MUSIC]

Today’s episode was produced by Rikki Novetsky, Caitlin O’Keefe, and Diana Nguyen. It was edited by Lisa Chow. Contains music by Marion Lozano and Diane Wong, and was engineered by Alyssa Moxley.

[THEME MUSIC]

That’s it for “The Daily.” I’m Natalie Kitroeff. See you Monday.

[THEME MUSIC]