Business Wars: Ozempic Wars | The Next Injection | Episode 2 (November 26, 2025)

Episode Overview

This episode of Business Wars delves deep into the fierce and rapidly evolving battle between Eli Lilly and Novo Nordisk over the future of GLP-1 weight loss drugs, especially Ozempic (Novo Nordisk), Wegovy (Novo Nordisk), and Zepbound (Eli Lilly). Host David Brown guides listeners through pivotal moves, unexpected pivots, government scrutiny, and the race for innovation, market share, and patient trust—ultimately showing how this pharma rivalry is reshaping the business, medical, and public policy landscape.

Key Discussion Points & Insights

1. Eli Lilly's Game-Changing Approval and Launches

• Zepbound FDA Approval (00:09)

  • November 8, 2023: Eli Lilly CEO David Ricks announces FDA approval for Zepbound, their weekly weight management drug.
  • Quote, David Ricks: “Zepbound has the highest efficacy we've seen in an approved drug so far.” (00:44)
  • Studies show Zepbound leads to ~20% body weight loss vs. ~13% on Wegovy—a critical, market-shifting difference.
  • Zepbound’s active ingredient, tirzepatide, targets two hormones (GLP-1 and GIP), giving it a “dual pronged approach” and efficacy edge.

• Pricing War and D2C Model (04:20)

  • Zepbound launches at ~$1,000/month, about $300 cheaper than Wegovy.
  • Lilly introduces an innovative direct-to-consumer (D2C) platform, allowing online consultations and home delivery—bypassing traditional intermediaries.
    • Insight, David Brown: “Sometimes how you sell can matter more than what you sell... sometimes the best strategy isn’t a new product, but a new path to the same product.” (05:30)
  • August 2024: Lilly offers lower-dose Zepbound in vials, cutting monthly cost to ~$500 and directly competing with compounded (off-label, pharmacy-mixed) versions.

• Financial Impact

  • Eli Lilly projects a 30% jump in annual revenue, reaching ~$45 billion for 2024.

2. Regulatory and Political Pressures on Novo Nordisk

• Senate Scrutiny – Price Disparities (09:35)

  • September 2024: Novo Nordisk CEO Lars Fruergaard Jørgensen testifies before a Senate committee led by Bernie Sanders.
  • Sanders highlights massive differences in Wegovy pricing: $1,300 in the US vs. $92 in the UK.
    • Quote, Bernie Sanders: “Stop ripping us off.” (10:42)
  • Novo CEO blames US system and Pharmacy Benefit Managers (PBMs), but Sanders counters, brandishing PBM commitments not to restrict coverage even if list prices drop.

• PBMs and Pricing Narrative

  • Jørgensen claims that PBMs and insurance, not Novo, dictate patient pricing.
    • Quote, Jørgensen: “We don’t decide the price for patients. That’s set by the insurance companies.” (11:20)
  • Sanders exposes these claims, arguing the onus is on Novo Nordisk.

3. Market Disruption: Compounding Pharmacies and Supply Shortages

• FDA’s Role, Supply & Legal Maneuvers (16:47)

  • October 2024: FDA removes tirzepatide from the official shortage list, barring pharmacies from making their own (compounded) versions of Zepbound.
  • Meanwhile, Novo Nordisk struggles to keep up with semaglutide (Wegovy/Ozempic) demand due to ongoing shortages and billion-dollar investments in new factories.

• Legal & PR Strategies

  • Novo Nordisk seeks FDA support to ban compounded semaglutide, citing safety concerns, but faces criticism for “desperation” tactics. (18:33)
  • Off-brand GLP-1 drugs, often priced between $250–450, eat into brand market share.

4. Innovation Race: Next-Gen and Oral GLP-1 Drugs

• R&D Setbacks and Investor Reaction

  • December 2024: Novo Nordisk’s next-gen drug CagriSema (semaglutide + cagrilintide) misses ambitious weight loss expectations (23% vs. 25%), triggering a 22% share price plunge.
    • Insight: “Investors aren't buying science, they're buying momentum.” (22:30)

• Lilly’s “Triple G” Therapy

  • Eli Lilly’s retatrutide, targeting three hormone receptors, shows even greater efficacy (24% weight loss). Trials continue as the innovation one-upmanship intensifies.

• D2C Escalation and Startup Disruption

  • Telehealth startups (e.g., Hims & Hers Health) aggressively market cheap compounded semaglutide—advertising a $199 monthly injection during the Super Bowl, dwarfing Big Pharma’s presence.

5. Competitive and Leadership Upheaval at Novo Nordisk

• Direct-to-Consumer Catch-Up

  • March 2025: Novo Nordisk copies Lilly’s D2C model (NovoCare Pharmacy) and slashes Wegovy price to $499, but fails to recapture mass consumer attention.

• Partnership & Fallout with Hims & Hers

  • April 2025: Novo Nordisk partners with Hims & Hers to distribute Wegovy, attempting to co-opt startup's marketing muscle.
  • June 2025: Partnership sourly ends amid mutual accusations of unsafe practices and deceptive marketing.
    • Quote, Dave Moore (Novo EVP): “When we didn’t see that [focus on approved meds] we had to make a choice on behalf of patients.” (28:48)
    • Quote, Andrew Dudum (Hims & Hers CEO): “Novo Nordisk is misleading the public... refuses to be strong-armed...” (29:10)

• CEO Shakeup

  • May 2025: Jørgensen is ousted as CEO—surprised, hurt, and replaced by company veteran Mike Dustar amid 53% share price drop and mounting copycat pressures.
    • Quote, Mike Dustar: “The competitive landscape has completely changed. Two years ago we were alone. Now everyone wants to play in obesity and diabetes. This means we need to move faster, focus harder...” (30:13)

• Mass Layoffs and Strategy Reset

  • September 2025: Dustar slashes 9,000 jobs (11% global workforce), saving ~$1.3B; short-term stock bump follows.
    • Insight: “Pruning gets you headlines, but long-term growth can get you a legacy.” (32:44)

6. M&A, Pipeline Bets, and Political Deals

• Acquisitions and Competitive Bidding

  • October 2025: Novo Nordisk makes big bets—acquires Acero Therapeutics ($5.2B) and bids for Metsera (up to $9B), targeting new obesity and liver-disease therapies.

• Policy Breakthrough: Trump Administration Deals

  • November 2025: Both Novo Nordisk and Lilly broker deals with President Trump to lower GLP-1 drug prices to $245/month, with Medicare patient copays capped at $50.
    • Insight: “In exchange, the companies will avoid pharmaceutical tariffs for three years.” (38:15)
  • Oral GLP-1s (pending 2026 FDA approvals) will be available for $149/month under these deals.

7. Future Prospects and Public Health Questions

• Beyond Obesity: New Indications

  • Novo Nordisk expands into Alzheimer’s treatment trials (Evoke/Evoke Plus) using semaglutide, with results expected late 2026.

• Safety, Efficacy, and Long-Term Use

  • Studies show two-thirds of weight is regained after stopping GLP-1s, and ~20% of patients see no benefit.
    • Insight, Dr. Sadia Khan: “It might actually be healthier to just maintain their current weight than to keep riding the GLP-1 roller coaster.” (40:56)
  • Concerns about cardiovascular risk linked to “weight cycling” and high discontinuation rates could impact future market dynamics.

• Market Forecast

  • By 2030, up to 30 million people might be on GLP-1 drugs annually, with the race wide open for new blockbusters and broader disease applications.

    • Closing Insight, David Brown: “Whether the next breakthrough comes from Novo Nordisk, Eli Lilly, or a yet unknown challenger, the battle for the body definitely isn’t over.” (41:50)

Notable Quotes & Memorable Moments

• On Zepbound’s Impact
  • David Ricks: “Zepbound has the highest efficacy we've seen in an approved drug so far.” (00:44)
• Sen. Bernie Sanders’ Rebuke
  • “Stop ripping us off.” (10:42)
• Market Reality Check
  • Host: “Investors aren't buying science, they're buying momentum... you promise them the moon and you’re punished for reaching the stratosphere.” (22:30)
• On Partnership Risks
  • Host: “If the partner defines the brand louder than you do... you just rented out your credibility.” (27:55)
• Novo’s New CEO, Mike Dustar
  • “Two years ago we were alone. Now everyone wants to play in obesity and diabetes.” (30:13)
• Caution on GLP-1 Weight Cycling
  • Dr. Sadia Khan: “It might actually be healthier to just maintain their current weight than to keep riding the GLP-1 roller coaster.” (40:56)

Timestamps for Key Segments

| Timestamp | Segment Description | |-----------|------------------------------------------------------------------------------------------------------| | 00:09 | Zepbound FDA approval and Eli Lilly’s strategy | | 04:20 | D2C sales innovation & Zepbound pricing war | | 09:35 | Congressional hearing: Bernie Sanders vs. Novo Nordisk on pricing | | 16:47 | FDA ends tirzepatide shortage; Novo Nordisk's struggles with supply, compounding pharmacies | | 18:33 | Novo Nordisk legal action against compounding pharmacies | | 22:30 | Novo’s next-gen trial fails to impress, market reacts | | 27:25 | Hims & Hers Super Bowl ad shakes up public perception | | 29:50 | Leadership shake-up: Jørgensen out, Dustar in at Novo Nordisk | | 32:33 | Mass layoffs and strategic refocus at Novo Nordisk | | 35:00 | M&A spree: Novo Nordisk’s new acquisitions for its obesity pipeline | | 38:00 | Trump administration negotiation: market-changing pricing and access deals | | 39:10 | Expansion into Alzheimer's/dementia; critical look at GLP-1 market sustainability | | 41:50 | Episode conclusion: The race continues |

Conclusion

This episode paints a dynamic picture of two pharma titans locked in a struggle for innovation, patient reach, and public goodwill, all while facing political, legal, and disruptive startup headwinds. The GLP-1 market's future hinges not just on science, but on public policy, pricing, perception, and patient outcomes—with huge dollars, lives, and reputations on the line.

Episode hosted by David Brown. Story by Aaron Land. Sound design by Kyle Randall. Produced by Wondery.

Recommended Reading:

• Reuters and Fortune Magazine in-depth GLP-1 industry reporting.