You can buy pharmacy compounded semaglutide through online portals, e.g. Ro

It's $450/month out of pocket (no insurance coverage)

Therefor, there will actually be price competition and we should see pretty cheap prices in the coming years.

I'm not sure exactly why pharmacies are free to compound it independently. I guess whatever patents exist on Ozempic/Wegovy etc aren't sufficient to squash competition.

The $1000/month for Ozempic is purely a name brand markup. I'd guess we'll see prices closer to $100/month for the compounded variants within a few years

There are dangers/risks to buying pharmacy compounded semaglutide -- not really a great thing to recommend widely. It's hard to depend on whatever pharmacy people might be able to find locally or through some hopefully trustworthy portal.

That said, with China and more notably India entering the GLP1 RA race, there will be much cheaper options very soon, hopefully!

Relevant supporting FDA article: https://www.fda.gov/drugs/human-drug-compounding/compounding...

Can you articulate those dangers? Compounding is a well developed means of sourcing drugs and GLP has been around for decades. What specifically should people be mindful of?

Well quality of the compounder/pharmacy is the real issue here -- of course it's not that the process itself is flawed, more that it's basically impossible for a layman consumer to inspect/assess quality/safety.

How does the layman consumer inspect/assess the quality/safety of other drugs or really any other substance that they ingest?

That's a fair question - they obviously can't inspect pharmaceutical factories. That said, the FDA has much more power to regulate drug manufacturers than pharmacists and most drugs are manufactured in a few locations that are much easier to inspect. They only have to make sure one or two locations are set up correctly and a significant chunk of the application for clinical trials is quality control procedures.

There are shady online compounding pharmacies based in other countries and you don’t know what you’re getting, as with any prescription drug. I’m guessing that was he meant.

But from a reputable one regulated by an industrialized nation, it would not be fitting to call them dangerous.

I have bought generics from India but can we really say GLP1 generics in India are better than compounded GLP1 in the US? It seems inconsistent to recommend one over the other.

Well I'm more looking for GLP1 generics developed whole-cloth in India.

India is quite good at pharmaceuticals -- their generics basically serve the rest of the world that are priced out of US-made products IIRC.

Ex. their generic version of Paxlovid:

https://www.reuters.com/business/healthcare-pharmaceuticals/...

Basically, with the expiring patents coming up on a bunch of these drugs:

https://www.biospace.com/article/9-drugs-losing-patents-or-e...

We're going to be in interesting waters soon.

> Therefor, there will actually be price competition and we should see pretty cheap prices in the coming years.

Considering how man times pharmaceutical companies have been lightly taken to task for doing the exact opposite, this seems extremely optimistic.

Currently they cannot manufacture enough to cover demand at $1000/ month. Why would the price come down before they can supply current demand?

> Why would the price come down before they can supply current demand?

Because in exchange they could unlock a bulk order from e.g. the U.S. government. That in turn could unlock economies of scale that let them price competitors out of the market.

They are literally buying up as many factories as they are allowed to do. Money is not the issue - getting access to production lines is.

> Money is not the issue - getting access to production lines is

You don’t think having the heft of the U.S. government behind one of those parties will help with that access?

What I'm trying to say is that the supply is constrained, not the demand. And the supply of factories themselves are constrained as well. So they need to build more factories, which they are doing at an impressive pace. And for building factories it's similarly not the land or the money or the red tape that's the issue. It's the time to build a factory that's the limiting factor.

I interviewed for a contractor involved in building factories for Novo Nordisk. The timelines sounded insanely ambitious.

Do you see the US government wanting to disrupt these industries, many of which are political donors?

> Do you see the US government wanting to disrupt these industries, many of which are political donors?

When the one being disrupted is a European pharma? Yes.

The article is about disrupting big tobacco, candy companies, etc. being disrupted by a European pharma. Why would the US gov’t make a massive order to bring down costs to disrupt homegrown companies?

> Why would the US gov’t make a massive order to bring down costs to disrupt homegrown companies?

Have you been around our lawmaking institutions, or lawmakers? The idea that we'd sandbag something like Ozempic, which by the way is being negotiated for mass deployment through Medicare [1], to save the likes of Frito-Lay is nuts. Even if we reduce American politics to the lobbyist-conspiracy model, which isn't terribly predictive but whatever, you're pitting big pharma against chips and fast food.

[1] https://qz.com/wegovy-ozempic-weight-loss-drugs-medicare-rul...

Don't they have a patent which makes competition non-existent for the near future?

There are numerous compounding pharmacies selling generic ozempic (Semaglutide)

There is competition, I see ads on Facebook and Instagram for it all the time, there are clinics all over where I live advertising Semaglutide treatment for weight loss.

Additionally, "Ozempic" (semaglutide) has become the blanket word to describe an entire class of drugs (GLP-1 Agonists) that all kind of do the same thing. Some of which have already been proven in clinical trials to be even more effective than Ozempic (ex. Tirzepatide)

It's like when COVID hit and somehow "Zoom" became the shorthand for online video meetings even though there were (and still are) a ton of options for that functionality on the market.

There are multiple formulations, e.g. Ozempic vs Wegovy.

Ozempic is for diabetics, wegovy is for weight loss

Both Ozempic and Wegovy are manufactured by Novo Nordisk. That’s not competition. It is market segmentation as they are marketed for different uses.

Oh, didn’t know that. Doesn’t Eli Lilly have a competitor?

They do. It's called Mounjaro.

The govt has already subsidized production through investing in research they've leveraged.

I mean sort of, maybe. It's a danish company, that's already the largest contributor to research, also from a grant perspective. The Novo Nordisk Foundation is supplying research grants at like 5 times of the size of the danish government. And that's without taking into account the grants and research done by Novo Nordisk, the company itself.

> price competitors out of the market

Are there competitors or are they under patent protection?

Isn't the US Gov'mnt required to buy prescription drugs at market value? One of the Medicare Prescription Drug Expansions from the GW Bush era.

They're not buying generics, and even at a 20% discount will get hosed compared to the $7 generics

Are you suggesting they shouldn’t manufacture more?

No, they certainly should, and according to them they are trying to. There is currently an unknown level of demand at the current price point, all we know is that it is probably far more than current supply. There's every reason to believe that they will increase production as fast as possible and still only meet demand over a year from now.

Once demand is met, there starts to be an argument for lowering the price and growing the market. Getting the price down to half the current price is when we start to see health benefits that outweigh the cost of treatment and an obvious win for insurance companies to start covering it for everyone.

But until there is supply, lowering cost just means more people fighting over the same supply, not more people getting access.

Money to be made. Competitors will enter the market. Oral options will be come eventually. Prices will drop. Don’t distort the natural market with price controls. You’ll get less product options and higher costs. With all the obesity, this is going to be a gravy train.

> Prices will drop

This seems incredibly optimistic considering all of pharmaceutical history in the united states.

In worst case, Ozempic patents expire in 2031, which is not that far.

The worst case is worse than that: in addition to composition of matter patents there are dosage patents that can be invoked.

https://www.fiercepharma.com/pharma/novo-nordisk-patent-sema...

I am not familiar with pharma patents. Are you saying, for example, a 300ml dose could have a patent with different expiry than a 400ml dose?

I could see patenting mechanism of delivery, like injections versus oral, but not the example above.

Pharma is notorious for changing the formulation just enough to acquire a new patent to restart the clock. I wouldn't be surprised if the dosage was a factor in the process.

That doesn’t mean the existing drug can’t be sold as a generic.

Sometimes it means exactly that: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4968089/

Of course you could still sell the same drug if you get it approved with a different dosage but that is a long and costly process.

That still presupposes a new patent with new dosage.

In this case, is there a dosage patent on ozempic’s current dosage? If manufacturers tweak ozempic’s current dose and get a patent, what’s to stop the existing dosage from being made by generics?

I really don't think you're being skeptical enough.

https://www.nbcnews.com/health/health-news/gaming-us-patent-...

Rybelsus is an oral version of semaglutide which has good efficacy.

Ozempic is the injectable version of semaglutide. Rybelsus is the orally administered form. It has been available for several years but isn’t as effective as the injection.

Eli Lilly who makes the Ozempic rival Mounjaro is in late stages of clinical trials for their oral GLP-1 medication.

There’s a pill form called Rybelsus that works similarly, but has some gotchas. Namely you need to take with water when you wake up and eat nothing for 30m.

From a lifetime value perspective, I think it’s priced cheap. This drug is a miracle drug and is going to eliminate a lot of suffering and healthcare costs.

That sounds pretty great! I adopted intermittent fasting this year, so I skip breakfast anyway.

Plenty of ongoing research into orally active analogs and cheaper variants. Give it a year or two.

> As Chairman of the Senate Committee on Health, Education, Labor, and Pensions (HELP), I am calling on Novo Nordisk to lower the list price of Ozempic – and the related drug Wegovy – in America to no more than what they charge for this drug in Canada.

I'm not aware of how legislation works in US but I feel like a senator should have more power than just "calling on" a company?

He would if he had broader congressional support, but opposing forces are strong (lobbies, pro-market ideology, etc)

He is asking them, using the official power of his office, to do the right thing so legislation doesn't need to be drafted. Either they choose to do the right thing today and not be subject to regulations, or they can get punished with regulations at some point in the future.

If you think things happen differently in Canada, you don't understand how the sausage is made.

They do, they can propose and vote on legislation. And some budgetary and people nominating powers.

1000 a month per patients will handily fund an awful lot of high priced lobbyists. Such congressional proclamations are arguably just a clarion call to K Street

that seems unconstitutional and also terrible precedent to set. why do any research if you can just piggyback on others?

Eh, calling on a company to do a thing is some mix between public fact finding and threat here.

It allows the public to comment and maybe the senator will like the public support they are getting. Alternatively a pharma lobbyist will show up and toss them a few hundred thousand in campaign contribution promises. And they'll weight the relative value of those things. Depending on how that goes they (or another senator seeing this play out) will actually make an issue of it and it will start the more formal processes.

If obesity is an “epidemic”, and the US just forced TikTok to sell based on national security concerns, what’s stopping Uncle Sam commandeering Novo to either sell off its Ozempic ownership as a subsidiary to force a lower general sales price, or forcing to nullify its patents?

I’m speaking legally rather than economically. If the US Gov did this, big pharma would stop investing in research (even though I wouldn’t be surprised if USG pays for the private research in the first place) and cause worldwide slowdown in new medicines all in the name of profits

>and the US just forced TikTok to sell based on national security concerns

First, worth noting that this is very much TBD. There are grave 1st Amendment concerns with the government's efforts there and it is very much an open question for now whether the effort will actually hold up in court. That said:

>what’s stopping Uncle Sam commandeering Novo to either sell off its Ozempic ownership as a subsidiary to force a lower general sales price, or forcing to nullify its patents? I’m speaking legally rather than economically.

So as a practical matter, and as with TikTok, Novo Nordisk is not a domestic company it's a foreign one. But unlike TikTok where China is a geopolitical opponent, Novo is Danish and thus part of a close ally. Second the people pushing the TikTok thing are fine with TikTok going away entirely in the US, that's the stick. The US has zero power jurisdiction over China just as the reverse is true, but can police its own market and thus say "comply or lose access to our market". Same as how the EU is pushing stuff like the DMA. Since the US market is valuable that's a sizable stick, but TikTok very likely even if they lose will tell the USG to pound sand and just leave, but Congress/WH wouldn't mind that.

But here the whole point is that people desperately want this product. So if Novo said "no, and we're ceasing all sales in the US" they'd take a major financial hit sure, but there'd also be massive blow back in domestic and international politics. It would definitely be questioned on various US/EU trade agreements which would have messy legal implications, and invite tit-for-tat. Nationalizing foreign IP would implicate a bunch of treaties and US itself pushed hard and benefits from.

But putting all that aside and pretending it was all domestic (or going specifically after domestic components), there is still the Takings Clause of the 5th Amendment. The government could legally seize it using eminent domain powers, though it'd no doubt face as good a legal fight as the highest paid law firms could put on. But I don't think there's any doubt this would be a clear case of public use and courts have approved vastly more dubious and worse takings.

However, there's no dispute government would then have to pay the entire fair market value for it, whatever anyone else would have to pay to buy the whole shebang right now. Novo as traded on the NYSE has a market cap of over $430 billion, and a sizable chunk of that is from this product which has sold well enough to measurably boost the entire Danish economy. The stock has nearly tripled in just the last year and half or so. Even if the US part of that one component was "only" 25%, $100b is not nothing, not even for the USG. And FMV might well be double or more.

There would be other legal avenues to explore but that's a big one, and in turn it's not actually clear it'd save the US any money which is kind of the point, eminent domain isn't supposed to be used that way but for some critical greater good. You can gain control but you have to pay for it.

Zepbound is $550/mo with the manufacturer coupon without insurance.

Rybelsus is available in tablets and costs €130 in Spain.

$947 in the US, LOL.

This reasoning is valid if the first pill costs $10B

I’m reminded of the bit in 1984 where they’re trying to remove the pleasure from orgasms. I don’t entirely disagree that this would be good to make accessible but removing the joy from eating is so bleak

It doesn't remove the joy, just the need. The first thing I noticed after starting is I wasn't hungry all the time. That constant sense of hunger made me eat when I didn't need to. Now I can eat a nice meal, but much of the time I don't feel a need to eat, so I don't.

Edit just to add that in 10 months I've lost 40lbs and halved my insulin usage. That insulin is the pricy synthetic stuff (Tresiba and Novolog), so the cost of the mounjaro is probably close to paid for by that decrease.

You get the same effect when you go zero carbs

Is that really true? Everyone I’ve talked to has suggested they don’t really enjoy high reward food anymore and so they end up eating healthier. In part because nutritious food tastes comparatively better.

Ozempic doesn’t remove the joy from eating. It just makes you eat much less. If anything it leads to eating less of really amazing food.

Think enjoying tasting menus instead of double baconators.

only while administered. this is a feature, not a bug

some people need the kick start to experience the effects of a healthy living

People will pay for it even if it was a sharp-ended, spiked suppository made out of powdered Carolina Reaper. Because they believe it makes you look "good".

The fact that its $1000/month only increases its anti-consumption effects because people will have that much less each month to spend on alcholol/candy/cigarettes....