--:-- Natalie Kittrowev: From The New York Times, I'm Natalie Kittrowev. This is The Daily. In the coming year, GLP-1 drugs like Ozempic and Zepbound may become way more attainable for millions of Americans as President Trump promises to lower their costs and drug makers race to release them in pill form, paving the way for what could be the next revolution in weight loss.
--:-- Isha Nelson: Today, my colleague Isha 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.
--:-- Natalie Kittrowev: It's Friday, November 14th. Isha, 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.
--:-- Isha Nelson: 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.
--:-- Natalie Kittrowev: 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.
--:-- Isha Nelson: Yes. So last week, President Trump got into the Oval Office, the heads of Novo Nordisk and the heads of Eli Lilly. Both of these gentlemen, they really are stars in the truest sense. and it's an honor to have you in the White House. These are the two companies that are responsible for making the weight loss drugs that you probably know about.
--:-- [Sound of a room with people talking]
--:-- Isha Nelson: So Novo Nordisk is the maker behind Zempik and Wigofi. And then you also have Eli Lilly. They make Monjaro and Zep Bound. 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, you know, he calls this the fat drug. And he looks around the room and he starts asking. Do you take any of this stuff, Howard? Not yet. OK, good. You know, who is taking this? Oh, my God. We have Steve. Where's Steve? Is he here? Head of Public Relations for the White House. He's taking it. This is certainly one way to reduce the taboo of taking these drugs.
--:-- Natalie Kittrowev: 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 a Zempic, 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.
--:-- Isha Nelson: 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 we are democratizing access to these medications and dealing with a moral imperative to make sure that all Americans have access. And one of the things Dr. Oz says is that... Mr. President, our estimate, based on the company numbers as well, is Americans will lose 135 billion pounds by the midterms. But I don't measure it in pounds. I measure it in saved lives.
--:-- Natalie Kittrowev: 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. Whoa. That seems pretty difficult. So I'm assuming he meant 135 million. Which is still a lot.
--:-- Isha Nelson: 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, right, is just the latest beat in what has been now a years-long story of these medications spreading really quickly and widely.
--:-- Natalie Kittrowev: Like, 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 know so many people on them.
--:-- Isha Nelson: 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 Nordisk which is the Danish company behind the drug that I been covering and to some extent how they 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.
--:-- Natalie Kittrowev: So what is that story of how we got here?
--:-- Isha Nelson: So Nova Nordisk is this company that has been around for 100 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 into a medicine is that it's just really short acting. You know, you put it into humans and it vanishes instantly.
--:-- Natalie Kittrowev: So one of the things, Novo Nordic scientists and others, you know, 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 a 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.
--:-- Isha Nelson: Never heard of it. I'm honestly, I'm not surprised. Victoza, though it's discovered in 1997, doesn't hit the market till 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.
--:-- Natalie Kittrowev: Did you hear of that one? No, but what a name. I don't actually know how they come up with these names. I would maybe love to find out.
--:-- Isha Nelson: So you have this drug that is allowing people to lose weight, but it's moderate weight loss, you know, only about 5% 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. 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.
--:-- Natalie Kittrowev: 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 semiglutide, which you will know because that is Ozempic. Finally, Ozempic. We're here. We're here at Ozempic. Ozempic is approved in the U.S. 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.
--:-- Natalie Kittrowev: 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. When I look around this room, I can't help but wonder, is Ozempic right for me? Endless queries about kind of which celebrity was taking it or not. Right. Everybody lying, everyone's like, a smaller portion. Like, shut the f*** up. You're on Ozempic. You know, I felt like it fed a million tabloid headlines. My anti-aging doctor just hands it out to anybody, right? Who was on Ozempic, who wasn't. Loads and loads of TikTok videos. Here's everything you need to know if you are starting Ozempic. People documenting their journeys on Ozempic.
--:-- Isha Nelson: I start taking Ozempic in March of this year. I am officially 52 hours past my first Ozempic injection. And I just start dropping pounds left and right. But it's not until 2021 that they get FDA approval for the same drug, but for obesity. And that's called Wigovi. 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.
--:-- Natalie Kittrowev: Right. And this is the point at which we start hearing a lot about the company just being in this incredibly strong position, right? 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 U.S. patients, were so enormous that the company's market value was equal in the 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.
--:-- Isha Nelson: 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 We'll be right back.
--:-- Natalie Kittrowev: 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?
--:-- Isha Nelson: Absolutely. You know, 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 Wagovi and it's wildly popular, they just don't have enough of the drugs to meet all of this demand. A medicine used to treat diabetes is all over the Internet as the newest way to lose weight and to lose it fast. Now that off-label use is affecting the supply for those who need it most, diabetes patients. Some pharmacies say they just can't get it in stock.
--:-- Natalie Kittrowev: You know, Novonordis, 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?
--:-- Isha Nelson: 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. The Food and Drug Administration gave permission to other companies to make non-brand name versions of those drugs. Allowing compounding pharmacies to essentially make generic versions of the drug.
--:-- Natalie Kittrowev: And that essentially opens the door for something called compounding. Federal law allows state-licensed compounding pharmacies to dispense drugs that are essentially a copy of FDA-approved medications. Which is a way for other companies and pharmacies to buy in the active ingredient in a Zempicamugobi that's called semaglutide, and they can sell it, crucially at a lower price. The cost difference between the compounded generics and the name brand can be as much as $300 a month.
--:-- Isha Nelson: 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. 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, you know, finally reap the benefits of that investment.
--:-- Natalie Kittrowev: Exactly. Now, technically, you know, 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 Nova Nordisk.
--:-- Isha Nelson: And in the meantime... Weight loss for so long. I felt stuck. a competitor comes onto the market. But ZetBound means change. ZetBound is for adults with obesity to help lose weight and keep it off. Eli Lilly's drug comes on the market in 2022. Initially, they have Monjaro, 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 ZetBound, which is an obesity drug. And this is a big change because now Novo Nordis 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.
--:-- Natalie Kittrowev: 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 Zepan 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 Nordic's Wigovie.
--:-- Isha Nelson: Another reason is that some people say they simply prefer taking Z-Bound. You know, everyone responds differently to different drugs, but lots of people report having kind of milder side effects as well. And so we start to see access really expanding because of this alternative option
--:-- Natalie Kittrowev: And then earlier this year The FDA says Ozempic and Wagovi the popular GLP drugs for diabetes and weight loss are no longer in short supply The FDA has ordered compounding pharmacies to largely stop selling their version of the drugs. 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.
--:-- Isha Nelson: Now, Novonautis 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.
--:-- Natalie Kittrowev: 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 Nordis 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% in one day. It wipes out $70 billion in market value. So much money. It's so much money.
--:-- Isha Nelson: And it kind of snowballs, you know, 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 Outset CEO brings in someone else and then announces huge layoffs. You know, 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. And so over the course of the past year or so, the company's share price has dropped 70% from its peak. I mean, that is a huge decline.
--:-- Natalie Kittrowev: 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 described that were actually good for consumers, 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.
--:-- Isha Nelson: Yeah, you know, for Novo Nordisk, there is something amazing in being the pioneer here of leading the way. But it also gives you a lot of room to fool. 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. 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. will see more entrance 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 know where it stops.
--:-- Natalie Kittrowev: Isha, thank you so much.
--:-- Isha Nelson: You're welcome. I loved being here. We'll be right back.
--:-- Natalie Kittrowev: Here's what else you should know 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 20th. 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.
--:-- Natalie Kittrowev: Today's episode was produced by Ricky Nowetski, 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. That's it for The Daily. I'm Natalie Kittrowev. See you Monday.
