The Dirty Business of Weight Loss Drugs

losing weight is mental as much as it is physical and the biggest hurdle for most people is having the discipline and perseverance to make the necessary lifestyle changes but now with a single weekly injection anyone can drop weight without having to change what they eat or how they live with seemingly minimal side effects and a never-ending impressive before after testimonials weight loss drugs with names like OIC Zep bound wovi and Monaro have become all the rage despite costing up to $1,000 a month people can't get enough whether that the diabetic the Hollywood Elite or the

average chos and Janes these days it's the only thing hotter than AI the hype is not for one brand or one manufacturer but rather this entire class of drugs weight loss medications are also known as glucagon like peptide one drugs or gp1 for short the simplest scientific explanation is that these drugs mimic a natural hormone that occurs in your gut and it stimulates your pancreas to produce more insulin which in turn affects your brain signals on appetite and hunger when you're on these drugs food moves slower through your digestive system so you feel satiated with

less volume and for longer the application of these drugs go beyond the medically obese and body conscious obesity is recognized as the precursor to more lethal chronic diseases and it cripples economies just as much as societies if a population is getting sicker and spending more time in hospitals than at work it's a blow to productivity and public health just as much as it is to taxes and GDP the potential here is so massive that many speculate that obesity medication will be more lucrative than any other class of drug even cancer big Pharma is pounding the

drum that obesity is a disease not a cosmetic condition and if the insurance companies and World governments can agree with them on that a market of trillions of dollars is truly possible instead of talking about side effects and risks they frame the conversation to be about how these weight loss drugs have cured food addiction and how they can be the gateway to curing other forms of addiction like gambling and substance abuse This Promise has added hundreds of billions of dollars to the market cap of leading Pharmaceuticals in the past few years just like how Tech

startups have hitched their wagon to AI drug manufacturers have hitched their valuations on Obesity but despite their altruistic mission statements pharmaceutical companies through history have demonstrated that they're not to be trusted as the opioid epidemic showed if you give Pharmaceuticals an inch they'll take a mile in their world drugs are the hammer and everything is a nail their only goal is to get as many people on as many drugs at as high of a dose and frequency as possible to keep profits up if big Pharma succeeds in class class ifying obesity as a disease just

like oxycotton once classified pain as a disease they would be able to monetize the greatest patient pool in the world as the testimonials have continued the world has also forgotten that the manufacturers of these weight loss drugs are the same exact companies who endangered millions and killed thousands of Americans over decades with insulin price gouging in this episode we're diving into the dirty business of big Pharma and weight loss drugs from the perspective of the two biggest players Eli Lily and Novo Nordisk this episode is sponsored by fabric by Gerber Life a One-Stop shop built

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by incentives you either win big or you lose and there's not much room in between to make the most money you need to create the most critical life-saving drugs for the most lethal chronic diseases it's more profitable to sell cancer and diabetes medication that patients need to continuously take to stay alive than it is to sell oneandone antidotes and vaccines and that earnings Delta can can be seen when looking at sales by drug class when we look at the bestselling drugs in history and we exclude the covid vaccines and weight loss drugs they're all frequent

use drugs that fight against cancer stroke heart attack arthritis or Crohn's disease and must be taken once a day or every few weeks to be effective these are all Blockbuster drugs meaning that they each generate over a billion dollars of sales per year and contribute a meaningful percentage of each manufacturers annual business the reason why these drugs in particular make so much money is because they're legalized monopolies is protected by patents drug patents generally last for 20 years and treatment is only available in this brand from this one manufacturer when the patent finally expires the

Monopoly ends as other manufacturers are now free to produce generics the flood of Supply means that prices come down as patients now get Alternatives and generics are often substantially cheaper than brand named drugs there's a few nuances manufacturers typically get their patents while they're still in R&D meaning that if the drug works and by the time it's available on the market there's only 10 or so years left on the patent as their reward for inventing the drug in the first place Pharmaceuticals get not just Market exclusivity but also Monopoly pricing they can set any price

they want and they can also hike prices year after year there's nothing anyone can do until the patent expires short of government intervention but no government wants to be involved as the entire pharmaceutical system hinges on incentives when patents expire manufacturers instantly lose a significant chunk of their business and the only way to restore profits is to keep innovating drug Innovation is essential but also so cost prohibitive and risky that no government could ever fot the bill for it costs on average a billion and 10 to 15 years of R&D for a single successful drug

and throwing more money doesn't improve success as 90% of drugs still fail there's many reasons for failure the research doesn't go as expected there's too many side effects the FDA deems it unsafe or the treatment is simply not effective enough only one out of every 10 drugs actually reached the market this is why there's always so many pharmaceutical penny stocks floating around that seek funding for research they promise a real payout if the stars align which is why these stocks always Spike whenever there's news of promising trials or hints of regulatory approval but they always

generally Plum it back down to lottery ticket territory as the odds of success remain low and the time Horizons are too long for the average retail or Institutional Investor it's feast or famine and the industry is littered with the corpses of many well-funded startups getting approval can be just as complex as every country has its own agencies and standards and the hurdles don't end when the drug finally makes it to the market the drug has to win over doctors on Merit and doctors have significantly higher standards than Regulators if the drug is not effective enough

to be standard of care doctors won't prescribe it and if patients don't know about it they won't ask their doctors to prescribe it just like how hundreds of millions of dollars are burnt in R&D Millions more have to be plowed into marketing advertising lobbying and sales for any one drug to turn a profit post launch science is unpredictable and the winners by Nature are so few drug manufacturers have to be incentivized to keep trying in the spite of the massive risk low success rates and capital burn when they do win governments almost have to let

them win big in order to encourage other manufacturers their message is simple if you innovate you'll be rewarded with a guaranteed Monopoly and billions of dollars for a fixed period of time and the only way to make more money in the future is to keep innovating in this regard drug Innovation is better off privatized where manufacturers of all sizes are all promised the same massive payday and thus compete with each other to develop the fastest most effective treatments for the world's deadliest diseases no government could afford or replicate this pace of innovation off tax revenue

alone living under a monopoly is harsh for the current patients in the short-term but it's a net positive in the long run as once the patent expires the same treatment will be accessible and get cheaper for future Generations under this system drugs start off expensive but then get more affordable and better over time which is huge compared to not getting the drugs at all this is why governments try not to get involved whenever manufacturers aggressively raise prices during their monopolies ultimately the drug industry is a modern example of how the world is not black and

white and while no system is perfect it's still one of the better ones today in the net positive that it's created along the facets of shareholder wealth drug Innovation and Public Health weight loss drugs are a big deal because they've bucked all the levers of the American Health Care System Americans consume and spend more money on drugs illegal and legal than any other country in the world they're the most valuable market for both cartels and pharmaceuticals but you can't buy most drugs over the counter and doctors by Design are Gatekeepers Pharmaceuticals spend Millions every year

wooing doctors through traveling salesmen lavish dinners free products and all expenses paid trips cted doctors are more likely to recommend one manufacturer over the others and write prescriptions at higher doses thereby converting their patient bases one at a time into high value customers for the pharmaceutical to pressure doctors from the other end Pharmaceuticals blast the public with advertising every year with the same call to action ask your doctor about this drug but even if a pharmaceutical gets all the doctors and patients on board none of it matters much if the drug isn't covered by Insurance

Pharmaceuticals move in lock step with insurers and both sides work together to maximize profits Americans pay for drugs either out of pocket at list price or pay the discounted price that's been negotiated down by their health insurance insurance it's sometimes cheaper to pay out of pocket but for patented brand names the list prices are generally so high that patients must go through Insurance to afford treatment consumers will generally always prioritize the drugs covered under their insurance before going out of pocket because manufacturers want their drugs to be purchased by as many people and as frequently

as possible they're willing to give discounts to insurance companies in exchange for access to their members Pharmaceuticals could force patients to pay the astronomical list prices out of pocket but that would only shrink their total addressable Market as only a slice of Americans could ever afford those rates it's essential for manufacturers to ensure their drugs are covered under as many insurance plans and carriers as possible even if that means giving up a bit of margin the US is the only developed country in the world without Public Health Care and spends twice as much on it

than anyone else yet Americans still die younger than Europeans and Asians one reason behind the inefficiency of American Healthcare is the middlemen that drive up costs in every transaction and the same Dynamics exists in drugs insurance companies don't negotiate drug prices with Pharmaceuticals directly instead drug prices are negotiated through thirdparty intermediaries called Pharmacy benefit managers or pbms for short pbms negotiate drug prices on behalf of the insurance companies and manufacturers play ball because no drug gets covered by insurance by default insurance companies keep a running list of drugs that they cover every insurance plan has

its own list and these lists are typically hierarchical where every drug is assigned to one tier the lowest tier drugs are often generics with the greatest discounts and the highest tier drugs are specialty patented brand names with the lowest discounts manufacturers want to find The Sweet Spot they don't want their drug to be the cheapest unless it has to be but they also don't want to be completely cost- prohibitive insurance companies tend to recommend the drugs that are on the lower tier over those on the higher tiers and patients do the same as they value

the lower tier drugs since they save more money the profits are ultimately in frequent consumption and not one-time purchase hence the placement of a drug on the list is just as critical to sales as it is to get on the list in the first place as private middlemen pbms want their slice of the cake too they negotiate price then take a cut of that discount for themselves and finally pass on the remaining savings to the insured patients since pbms negotiate every single drug no rebate is the same pbms maximize their own profits by placing the

drugs that they earn the biggest cuts from in the more popular tiers just to push patients to buy those over others thereby earning more profit profits for themselves at the end of the day pbms manufacturers and insurance companies are all In Cahoots to make the most money possible with each party influencing the other to do what they want weight loss drugs are the first ever drug to break all these lovers For Better or Worse thanks to the unprecedented virality mainstream demand and overwhelmingly positive sentiment drug manufacturers for the first time ever hold all the cards

they don't need to burn as much money wooing doctors and educating the public since consumers are pressuring doctors for prescription itions on their own people have already convinced themselves that the benefits of these drugs outweigh the risks that higher doses only means better results faster and they eat up every bit of speculation with rose-colored glasses manufacturers now have the upperhand in negotiations people want the drugs that we're selling and if you as the pbms don't cover our drugs at the prices we want we'll make deals with your competition instead it no longer matters as much

where our drug is on your list because customers are asking for our drugs by name and lack of coverage will only hurt you as insurance company as your members will either downgrade or enroll with a different carrier that will give them what they want the biggest beneficiary to all this has been the American pharmaceutical giant Eli Lily whose share price and market cap has gone up 11 times since 2019 their experience and evolution over the past two decades have shaped their aggression and Commercial prowess while Eli Lily is synonymous with weight loss and diabetes medication

today the company 20 years ago was built on antis psychotics and oncology their business in the 2000s was carried by Zyprexa a drug for schizophrenia and bipolar disorders and supplemental Blockbusters like Gemar a chemotherapy drug insulin for the diabetic and Humalog and Humulin and Evista for bone loss prevention out of their entire portfolio these five patented Blockbusters contributed on average over half of annual revenue every year there was also the anti-depressant simala which surpassed a billion dollars in sales just 3 years after launch and dialis for erectile dysfunction which took 5 years to hit the

same Mark Zyprexa was the biggest winner and earned up to5 Billion every year but that success was tainted when Eli Lily was criminally convicted of downplaying the side effects and marketing the drug as dementia and Alzheimer's treatment without approval regardless their Blockbuster patents were expiring and Eli Lily needed new drugs to replace the future earnings loss Zyprexa and Gemar sales fell off a cliff as soon as their patents expired in 2011 and the same happened with symbol and a Vista in 2014 the company believed that its latest diabetes drug beteta would be that Ace in

the Hole it was the first ever glp1 drug the grandfather of this new class of weight loss drugs it stimulated the pancreas to release hormones just like OIC and Zep bound do today but beta's primary use case back then was managing blood sugar levels for diabetics weight loss was more of an observed yet unintended bonus it was the right direction but wrong execution bayetta had to be injected twice a day as its halflife was too short which scared off most patients for a non-critical medication reports of kidney failure pancreas failure pancreatic cancer and even deaths

on byetta float in years after launch the FDA had no choice but to slap on a black label warning on the box which scared off all future customers when an independent investigation confirmed that patients on bieta over 5 years were three times more likely to develop pancreatic cancer the writing was on the wall to prepare for the downturn the company proactively broke up its monolithic business in pursuit of diversification a they ramped up R&D spend went on a shopping spree buying up smaller labs and manufacturers and focused on Three core areas diabetes oncology and Animal

Health through the 2000s cancer was a safe bet as it was the top three leading cause of death worldwide even 20 years ago diabetes was another high value market with annual double- digit growth since the 9s and animal medication was a hedge against human medication with less regulation cheaper R&D and shorter time to Market by the early 201s Eli Lily had quadrupled the number of candidates that it had in its pipeline despite continuous billions in R&D the company still could not avoid the Topline and bottom line drop with patent expiration some drugs took longer than

expected to reach Blockbuster status like the cancer treatment almp or didn't have enough to single-handedly replicate the commercial success of the prior decade as the numbers went down Eli Lily chose to double down on insulin insulin was the only medication in the portfolio where the patient pool would be simultaneously big enough and desperate enough to pay continuously for At Any Price all the R&D had been done decades ago the other Blockbusters were limited in their scope and application Calis for instance was for bedroom performance and aypa addressed only lung cancer and was not a prerequisite

for day-to-day function and with cancer there are many alternatives for treatment Beyond chemo in contrast type 1 diabetics depend on insulin to survive and it's a matter of when and not if for type 2 diabetics as earnings went backwards in the early 2010s Eli Lily started aggressively raising prices on insulin by thousands of dollars year after year these price hikes were greater than even that of cancer drugs Eli Lily is one of the big three farmaceuticals who produces 90% of the world's insulin unsurprisingly when they raised their prices so did their competition people who depended

on insulin had no choice but to pay these prices year after year across all brands the only quote unquote cheap price was last year's when the patent for Eli Lily's primary insulin product Humalog expired in 2013 there should have been a flood of Cheaper generics to bring costs down for all patients but instead Eli Lily in collusion with its Rivals used the tried andrue tactics of cash and corporate litigation to extend its Monopoly while drug patents expire after 20 years manufacturers can get extensions if they make improvements and submit those in as secondary patents there's

no definition of what constitutes an improvement and big Pharma has learned to submit tens to hundreds of secondary junk patents to prolong their monopolies smaller manufacturers have the freedom to challenge these extensions in court or to try to navigate around the red tape but given the cost of drug R&D few if any startups are going to waste money on lawyers it's a war of attrition that big Pharma will always win this is called patent thiing and it delays competition regardless of whether or not the patent is officially extended this is why even though the patent

for Humalog officially expired in 2013 Eli Lily's insulin oligopoly has lasted another full decade and it's the same case for brandname insulin products from other manufacturers this practice is ultim not unique to insulin big Pharma has done this for arthritis painkillers and cancer drugs monopolies get extended prices go up and billions flow in by the mid-20s this strategy was paying off as long as people continue to get diabetes and if Eli Lily could get more of these people hooked on their insulin products they could apply the Playbook to reap greater monopolies and billions more than

they had ever gotten from antis psychotics and anti-depressants the company's Focus shifted from running horses in three different races to creating a portfolio of essential diabetes drugs even if patients weren't on insulin yet they could still be monetized earlier in the life cycle by 2016 Eli Lily had launched jardians and trulicity to manage blood sugar for type 2 diabetics trulicity was a new and improved glp1 drug from bieta 10 years ago it only needed to be injected once a week rather than twice a day it stimulated the pancreas but was engineered on a different strand

of gp1 bieta was first generation exenatide and trulicity was second generation dulaglutide it took jardians four years to surpass a billion dollars of sales in a single year while trulicity only needed three combined with a radical price hikes on insulin Eli Lily regained its footing on earnings and margins by the late 2010s as patients were now hooked on not just the daily insulin but also the weekly glp1 the company had noticed signs of weight loss in the clinical trials of trulicity as early as 2015 but didn't think much of it but by 2017 even the

control patients were experiencing considerable weight loss doctors had been prescribing insulin for decades as the first line of treatment for diabetes but insulin is actually counterproductive in the sense that it actually causes weight gain there was increasing evidence that gp1s not only lowered blood sugar levels but also guaranteed weight loss this made gp1s a far more promising first line of treatment for diabetics and Insulin in turn would become a last resort Eli Lily was concerned that their Rivals would disrupt diabetes with a superior glp product that it would negate insulin demand and it would crush

their three decade long Cash Cow obesity was the precursor and if Eli Lily stood around while other Pharmaceuticals cured the pre-diabetics there wouldn't be many diabetics left in the future to sell insulin to by 2018 Eli Lily had ramped up investment in a third generation glp1 even as they Rak in profits from the second gen trulicity the other angle is that weight loss was the perfect exit to escape the political pressure that had been mounting on the company public outrage over insulin price hikes and patent thiing had reached the ears of DC Eli Lily had

become a named Target of federal agencies the White House and politic itions across both aisles to avoid becoming a national punching bag during an election year Eli Lily proactively rolled back its Monopoly by launching a cheaper generic in 2019 and has since been quickly settling the price gouging lawsuits as they come in to keep the attention on weight loss drugs as a result sales for Humalog and Humulin have both been on a steady decline since 2019 by the early 2020s Eli Lily was deep into its third gen glp1 called tepati and unfazed by the expiring

patents for Calis and olymp as long as tepati could achieve greater weight loss and blood sugar reduction than trulicity the R&D would be worthwhile tepati was approved in 2023 and branded into monjaro specifically for diabetics and Zep Bound for the obese the weight loss benefit was indeed the Difference Maker as monjaro has gone from just a half a billion dollars of sales in its first year to over5 billion in its second which is more than the company ever grossed in a single year with its insulin monopolies to this day insurance companies and Medicare still don't

deem weight loss drugs is eligible for coverage as a result zet bound sales have been slower out the gate given that the only patients buying them are paying $11,000 for a month supply out of pocket it's more probable that Americans are getting their weight loss fixed from monjaro whether they're officially diabetic or not as those prescriptions are cheaper and covered by Insurance Eli Lily is already working on its fourth generation glp1 where it hopes to get up to 25% weight loss which would match conventional bariatric surgeries like gastric bypass and lipo suction there's continu hype

that this fourth gen glp1 will have even more positive side effects like curing sleep apnea and migraines which would only further improve the chances of future coverage from insurance and Medicare and since the demand from consumers has eclipsed the supply of doctors willing to write prescriptions Eli Lily has taken matters into its own hands it doesn't want to lose customers to its competitors as people are likely to stick to one brand rather than flip-flop between multiple if you want these drugs your fastest way today is to call Lily direct their newest tella Health Portal where

doctor will write you a prescription if your regular doctor won't and you can buy the drugs directly from the company to be shipped straight to your front door going direct to Consumer and cutting out the doctor is a slippery slope that's only viable when you have a drug as viral as weight loss medication while doctors and Regulators work within the parameters of Science and the Hippocratic Oath Pharmaceuticals are loyal only to the dollar their greed hasn't changed insulin was a Cash Cow of the past decade and Eli Lily is still figuring out how to best

milk glp 1's as their new Golden Goose Eli Lily's biggest rival is the Danish pharmaceutical giant Novo Nordisk while the two companies colluded over the insulin price hikes as members of the insulin cartel they were still fighting over who could take the biggest piece of pie for themselves while Eli Lily put as many irons in the fire as it could Novo had lasered in on Diabetes as early as the 2000s the Danes found it obvious that the modern Western lifestyle with its high fat high sugar foods and conveniences like television computers and cars to be

the main culprit for declining Health in the 2000s diabetes was not just appearing in the elderly but also in working adults and children around the world as even developing countries pursued this Western lifestyle for its own populations Novo went Allin on diabetes and developed entire Suite of insulin products with varying durations and storage methods so that people could find the injectables that fit their comfort level and schedule the business was built on selling as much insulin as possible and the company burned billions of dollars in pursuit of this final form the only way to get

insulin in your body is through needles Novo and Eli Lily have both tried over the years to downplay the stigma behind subcutaneous injections by bundling the needle and medication into pre-loaded pens if someone could package insulin into tablets that could be swallowed like vitamins or breathed in with inhalants it could potentially expand the total addressable market and getting more people hooked on insulin faster and earlier was the most cost- effective way for Novo to grow but when the oral and nasal insulin Ventures failed Novo pivoted they had seen Eli Lily's launch of bayetta in the

mid 2000s while bayetta struggled Novo saw potential in 2009 at the peak of beta's controversies Nova released their own glp1 drug in liraglutide and studied its weight loss performance post launch trial subjects had lost 5 to 7% of their body weight after a year on L glutide which gave Nova all the ammunition it needed to differentiate the drug and its pits to doctors and diabetics alike L glutide was branded as Victoza and pitched for lowering blood sugar as well as losing weight Victoza shut out the gate and broke over a billion dollars in sales in

its fourth year 5 years ahead of Eli Lily's trulicity the momentum of Victoza gave Novo the confidence that if they could increase weight loss and make the drug last longer that would be an even greater payday so while Victoza rigged in the cash in the 2010s the company launched Senda a weight loss variant for non-diabetics Senda became a blockbuster but the absence of insurance coverage and the internal fears of sales cannibalization kept growth slow in the mid-20s between the insulin price hikes and the glp1 drugs Novo had doubled its annual revenue in less than 6

years and with far fewer assets than Eli Lily its bottom line reached record highs with operating margins that were double than that of its main American rival it was in 2018 when Nova launched its glp1 Crown Jewel and semaglutide or more commonly known as OIC with an industry-leading 17% weight loss OIC exploded and has maintained its rocket ship streak to the state grossing more money than the company has never made in a single year from insulin Novo is the leader in both diabetes and weight loss medication and the company is already on its fourth generation

gp1 promising even greater weight loss when you're Hammer everything is a nail to lawyers every problem can be solved in court to techies every problem can be solved with software and to Pharmaceuticals every ailment can be solved with drugs in America there's a poor societal understanding of the concept of overmedication the last companies that should be trusted to handle this hype with a responsibility are the same insulin cartels that colluded to raking billions of dollars over the past 20 years in one breath these manufacturers promote balance they say that these weight loss drugs are not

lifelong medications that everyone eventually stops using them at some point and that lifestyle and diet changes are still useful but in the other breath they push greater doses they make it easy to obtain prescriptions by removing primary care physicians from the equation and they maintain public hype by teasing the potential of curing addiction once and for all for now Eli Lily and Novo are playing nice to get the insurers employers and governments on board with covering their drugs ultimately just like with insulin their goal is profits which comes down to getting as many of these

people on these drugs and consuming them as frequently as possible the price gouging that these manufacturers pulled off with insulin was so effective that there's no chance that these companies won't do the same for their latest Golden Goose from a medical standpoint these Pharmaceuticals bury news around side effects they pretend not to acknowledge the long-running unresolved issues of pancreatitis and they refuse to admit that they're not really sure why these drugs work the way they do initially the belief was that glp1 drugs simply trigger the pancreas but these days the consensus is that it's more

neurological than it is intestinal the point is not that manufacturers should have all the answers right away but rather that it's dangerous to promote only the known positives at face value while ignoring the unknowns every medicine has side effects especially when it can rewire your digestive system and trick your brain into having no appetite there's no such thing as a miracle cure as much as Eli Lily and Novo want the public to believe glp 1s are Eli Lily in particular has a terrible track record in the past two decades when it comes to acknowledging side

effects and accepting responsibility scientists and doctors have their code of ethics but it's the suits that run the show another angle is that weight loss drugs are treating obesity but obesity is more of a symptom than it is a root cause obesity in the US has much to do with the underlying American food system where profit-driven corporations freely pump essential ingredients in foods with toxins dyes additives and hormones that are banned everywhere else in the world it seems strange that the solution is to have taxpayers spend their savings on drugs to lose the weight that's

put on by the failing food and Consumer Protection Systems while opioids were inherently addictive it can be argued that the social stigma around weight creates comparable pressures and when someone is faced with a decision between guaranteed results from a weekly injection or slow incremental progress from months of consistent dieting and exercise it's obvious which will win out in the long run and at a personal level as someone who used to be overweight with a BMI of 30 it feels odd to be in an era where willpower can be medically induced rather than earned