It's not the only GLP-1 agonist out there. Victoza is another GLP-1 agonist and should be going generic in the US in a little over a year. It might already be available as a generic outside the US. There might be other GLP-1 agonists that are going generic soon as well.

Going to be huge when it goes off patent off exclusivity. I'd also expect you'll be able to get it when it's made in jurisdictions that will ignore the patent. Up to you to get it from those places, either via mail or travel runs.

They will find some way to prevent people from acquiring it and promote some other in-patent drug.

Lots of ways around jurisdictional regs. Consider how many people live near a national border.

https://www.usnews.com/news/best-states/articles/2018-11-01/...

Also, I expect CRISPR or gene therapy to be the long game wrt this.

It is not possible to stop people from getting mail order pills from China. Especially with the abortion restrictions the market already is pretty large and it will be easy for them to throw these drugs in too.

We used to believe it was not possible to stop people from getting their funny movie clips from China.

The solution to that was a $10 per month subscription via Netflix and clips for free on YouTube. Meanwhile Ozempic is around $1,000 for a month's supply. That is a margin on par with illegal hard drugs, which already have a smuggling supply chain from China to North America (eg. Fentanyl and variants).

A lot of clinics are administering the generic form and it is still very expensive.

If a drug is under a patent, the generic form still pays royalties to the patent holder, so of course it's still expensive.

not entirely true. semaglutide is a great example. the FDA allows compounding pharmacies to make semaglutide because wegovy/ozempic are sold out and therefore have limited availability. compounding pharmacies are allowed to sell their own royalty-free in this situation! wellsrx does just this (probably with chinese sourced semaglutide)

You can buy it as a "research chemical" and save money, but then the potential consequences of diy medicine and all that that entails are all on you.

Hopefully the price will come down more as it becomes more prevalent or as generics become available.

I'm not that afraid of swallowing random chemicals but self injecting is a bit hardcore for me.

FWIW, SubQ injections are pretty much completely unnoticeable in terms of pain / feeling at all. It’s more the mental barrier of doing it to yourself but once you’ve done it for the first time you soon realise it’s fine.

The actual doing it seems wild/absurd, but I don't think that would hold me back.

This is ignorant/uniformed, but, taking research chemical by ingestion feels like I have some natural barriers still. Where-as I feel like there's a much more raw exposure to risk with injection. Also there's dumb risks like infection, if I don't attend well enough to injections.

In spite of these protests, I think you are probably much closer to the truth here. Thanks for writing. These reactions I have are, I suspect, not really significant.

Counterpoint: Don’t inject yourself with stuff you found on the internet because people on the internet told you it’s ok.

Steroid users do it all the time and I haven’t heard of steroid users dealing with infections much.

I'm sure its because most people aren't going to talk about illegal drug use and when it goes wrong.

There are tons of online places where people openly discuss steroid use like r/steroids and many oldschool phpbb-style steroid forums

GLP-1 agonists are a bit more tricky since they are temperature sensitive and need to be injected. You'll really need to be careful to keep it sterile and handle it properly. Whether the "research chemical" will receive the proper care until it gets into your hands is something that you're literally gambling your health on.

You ship it as a dry/lypohilized powder, both semaglutide and tirzepatide survives long China->Europe shipping in the summer just fine, with customs delays. The testing I've seen showed 99.965% purity of semaglutide after 22 days in shipping from China to Poland during April. Tirzepatide shows 99.064% purity after 58 days of shipping in October-November.

You reconstitute it with Bacteriostatic Water which is available without a prescription in the USA and contains 0.9% benzyl alcohol to inhibit bacterial growth.

If you're particularly concerned you buy a 0.22 micrometer PVDF "syringe filter" and pump it through that to another, fresh/sealed sterile vial which you can get for like $2.00 from a medical supply company (the syringe, filter, and vials are gamma-irradiated to destroy any remnants of RNA/DNA). That size filtration will filter out any lifeforms (fungal, bacterial, viral) while allowing the peptide/drug itself to pass through. So you get a guaranteed sterile solution out of the filter.

Where do you buy it from to ship to Poland?

Anything specific would be inappropriate for this forum. But the broad answer is a chemicals distributor in China. I actually only utilize them for legal "nutritional" compounds, but others use them for pharmaceutical options, and those are independently tested frequently by a variety of stakeholders. Personally I really wish US citizens didn't feel forced to go outside of the quality protections of the FDA for their medical care.

Nutritional compounds? My understanding is that without a lot of special processing, GLP-1 agonists (semiglutide, liraglutide, tirzepatide, etc) will be degraded by stomach acids into useless fragments. There's an oral semiglutide formulation but it looks like it's quite inefficient and has some pretty strigent requirements in order to be effective.

What? No one is taking these orally. Hence the bacteriostatic water for injection.

The same distributor sells legal things to import like L-Carnitine, Epitalon, Berberine, NAD+, NACET, and vitamins at great prices so I was saying I use them for things like that.

But others use them for GLP-1 agonists and many do their own independent testing.

> That size filtration will filter out any lifeforms (fungal, bacterial, viral) while allowing the peptide/drug itself to pass through

0.22 won't filter out viruses, but time will inactivate enveloped viruses (which are usually the ones you want to avoid injecting), and source control/proper handling should take care of the rest.

You can get these wholesale from China from "reputable" gray-market wholesalers who get the chemicals made at contract manufacturing facilities. BYO QA/QC though, as with all non-FDA drugs. That's the huge catch, and it sucks for consumers. Testing just for active ingredient is >$100 and takes about a month. Testing for proper buffering agents, harmful contaminants, microbial contamination, etc is essentially unavailable at all.

Semaglutide is very, very cheap in the gray market. It's somewhat less effective than Tirzepatide and has slightly more side effects if you ramp up the dosage too quickly.

If an annual amount is purchased on the gray market, this brings the monthly cost down to:

- Semaglutide: $10/month

- Tirzepatide: $60/month

- Liraglutide: $87/month

- LY3437943: I have not yet seen this available, but it looks like distributors are notifying manufacturer of latent demand and are working to build up a supply chain.

Note that in the USA, it is legal to import certain amounts of FDA-approved drugs if you have a prescription for them. However, just because something is the exact same chemical as an FDA-approved drug does not make it an FDA-approved drug. It must be manufactured in an FDA certified facility and be the same brand/manufacturer/packaging/labeling/etc as the approved drug.

e.g. importing generic Sildenafil/Viagra is legal if you can find the Teva(tm) brand generic sildenafil in, say, Mexico or Canada for a better price. But it must be the pills manufactured by Teva in the appropriate facility with NDC #0093-5342-56[0].

If you import generic sildenafil "Cenforce" from the (very legitimate but not FDA-approved) Indian pharmaceutical manufacturer "Centurion Laboratories"...

...that would still be potentially criminal smuggling. Even if the pills you import show via laboratory test that they precisely match your medical prescription, they are not "FDA approved" and therefore not legal to import.

A lot of people do though!

0: https://ndclist.com/ndc/0093-5342/package/0093-5342-56

Interesting.

where is this grey market? apparently it's not as simple as just searching aliexpress :)

Alibaba is more likely to have b2b products

Wow this is incredible, thanks for sharing! I was quoted $800/mo after insurance for a moderately low dose of Semaglutide (Ozempic)