Dr. Oz (2:34)

Both of these gentlemen, they really are stars in the truest sense. And it's an honor to have you in the White House.

Eisha Nelson (2:40)

These are the two companies that are responsible for making the weight Loss drugs that you probably know about. So Novo Nordisk is the maker behind Ozempic. And. And then you also have Eli Lilly. They make Mounjaro and Zepp 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.

Dr. Oz (3:08)

I called the fat drug.

Eisha Nelson (3:09)

And he looks around the room and he starts asking, do you take any.

Dr. Oz (3:14)

Of this stuff, Howard?

Capital One Savor Card Advertiser (3:15)

Not yet.

Dr. Oz (3:16)

Okay, good.

Eisha Nelson (3:17)

You know who is taking this?

Natalie Kitroeff (3:19)

Oh, my God.

Dr. Oz (3:19)

We have Steve. Where's Steve? She here. Head of public relations for the White House. He's taking it.

Eisha Nelson (3:28)

This is certainly one way to reduce the taboo of taking these drugs.

Natalie Kitroeff (3:32)

Yeah, yeah, Just tell people who is. Who's on it.

Eisha Nelson (3:34)

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.

Dr. Oz (3:45)

Weight loss drugs significantly. Medicare and Medicaid will finally cover the cost of these weight loss drugs for millions of patients suffering from obesity.

Eisha Nelson (3:54)

So up until now, you couldn't get these weight loss drugs through Medicare. So you could get Ozempic, 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.

White House Official (4:09)

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.

Eisha Nelson (4:24)

RFK Jr. And Dr. Oz, they talk about President Trump being here for the forgotten man of America.

RFK Jr. (4:31)

And we are democratizing access to these medications and dealing with a moral imperative to make sure that all Americans have access to avoid.

Eisha Nelson (4:38)

And one of the things Dr. Oz says is that, Mr. President, our estimate.

RFK Jr. (4:42)

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 and save lives.

Eisha Nelson (4:51)

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 by next year. Wow, that seems pretty difficult. So I'm assuming he meant 135 million.

Natalie Kitroeff (5:09)

Which is still a lot. 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. 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.

Eisha Nelson (5:44)

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 Novo Nordisk, which is the Danish company behind the drug that I've been covering, and to some extent how they've 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 Kitroeff (6:19)

So what is that story of how we got here?

Eisha Nelson (6:23)

So Novo 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, GLP1s 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 GLP1s into a medicine is that it's just really short acting, you know, you put it into humans and it vanishes instantly. So one of the things Novo Nordisk 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.

Natalie Kitroeff (7:24)

Never heard of it.

Eisha Nelson (7:25)

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 weightless effects of it, it is still only for diabetes. Not until 20 do they have the same drug, but for weight loss. And that becomes Saxenda. Did you hear of that one?

Natalie Kitroeff (7:47)

No, but what a name.

Eisha Nelson (7:49)

I don't actually know how they come up with these names. I would maybe love to find out. 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 onto 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? 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 semaglutide, which you will know, because that is Ozempic.

Natalie Kitroeff (8:57)

Finally, Ozempic.

Eisha Nelson (8:58)

We're here. We're here at Ozempic. Ozempic is Approved in the US in 2017. It's a weekly injection for starters, so no more daily injections. And it also leads to much more weight loss, about 5, 15% in clinical trials. So it's a huge difference from this first generation of GLP1 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 Kitroeff (9:34)

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.

Eisha Nelson (9:44)

All of a sudden, oh, jokes about it.

Dr. Oz (9:47)

When I look around this room, I can't help but wonder, is Ozempic right for me?

Eisha Nelson (9:52)

Endless queries about kind of which celebrity was taking it or not, right?

Natalie Kitroeff (9:57)

Everybody lying. Everyone's like a smaller portion, like, shut the up, you're on Ozempic.

Eisha Nelson (10:03)

You know, I felt like it fed a million tabloid headlines.

Natalie Kitroeff (10:06)

My anti aging doctor just hands it.

Capital One Savor Card Advertiser (10:07)

Out to anybody, right?

Eisha Nelson (10:09)

Who was on Ozempic, who wasn't. Loads and loads of TikTok videos.

Natalie Kitroeff (10:12)

Here's everything you need to know if you are starting Ozempic.

Eisha Nelson (10:16)

People documenting their journeys on Ozempic.

Natalie Kitroeff (10:18)

I start taking Ozempic in March of this year. I am officially 52 hours past my first Ozempic injection and I just start.

Capital One Savor Card Advertiser (10:28)

Dropping pounds left and right.

Eisha Nelson (10:29)

But it's not until 2021 that they get FDA approval for the same drug, but for obesity. And that's called WeGovy. And while we're seeing it all over social media, the reason 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 Kitroeff (11:03)

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.

Eisha Nelson (11:16)

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 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. 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.

Natalie Kitroeff (11:54)

We'll be right back.

Ashley (Listener Caller) (11:59)

Hi, this is Ashley. I live in San Francisco with my boyfriend. We would love to officially share my New York Times subscription with separate logins. We both love cooking, love being in the kitchen, but I'm a 30 minute and under efficient dinner girly. I want a sheet pantry. He is very elaborate. He wants to get into the storytelling. I want to be able to save my easy meals and check off the ones that I've completed. And I think him having his own profile would be great.

White House Official (12:27)

Ashley, we heard you introducing the New York Times family subscription. You get your own login and Mr. Elaborate gets his, plus room for two others. Find out more@nytimes.com family.

Natalie Kitroeff (12:44)

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?

Eisha Nelson (12:55)

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 WeGovy, and it's wildly popular, they just don't have enough of the drugs to meet all of this demand.

Natalie Kitroeff (13:28)

A medicine used to treat Diabetes is.

Eisha Nelson (13:30)

All over the Internet as the newest way to lose weight and to lose it fast.

Capital One Savor Card Advertiser (13:35)

Now that off label use is affecting.

Natalie Kitroeff (13:37)

The supply for those who need it most.

Capital One Savor Card Advertiser (13:39)

Diabetes patients and some pharmacies say they.

Natalie Kitroeff (13:42)

Just can't get it in stock.

Eisha Nelson (13:44)

You know, Novo Nordisk, 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.

Natalie Kitroeff (13:57)

Like what?

Eisha Nelson (13:58)

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.

Natalie Kitroeff (14:12)

The Food and Drug Administration gave permission.

Eisha Nelson (14:14)

To other companies to make non brand name versions of those drugs, allowing compounding.

White House Official (14:19)

Pharmacies to essentially make generic versions of the drug.

Eisha Nelson (14:23)

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 Ozempic and Wegovy, that's called Semaglutide, and they can sell it, crucially at a lower price.

White House Official (14:49)

The cost difference between the compounded generics and the name brand can be as much as $300 a month.

Natalie Kitroeff (14:56)

Essentially, the company's losing their monopoly on making them. And you get all these knockoff versions that are allowed to be sold to people.

Eisha Nelson (15:04)

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.

Natalie Kitroeff (15:20)

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.

Eisha Nelson (15:42)

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 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 Novo Nordisk. And in the meantime, weight loss. For so long, I felt stuck. A competitor comes onto the market.

Natalie Kitroeff (16:37)

But Zepbound means change.

Capital One Savor Card Advertiser (16:39)

Zepbound is for adults with obesity to.

Eisha Nelson (16:41)

Help lose weight and keep it off. Eli Lilly's drug comes on the market in 2022. Initially they have Mounjaro, which is for diabetes, in the same way that Ozempic is for diabetes. And a year later, in 2023, they, Eli Lilly get FDA approval for Zepbound, which is an obesity drug. And this is a big change because now Novo Nordisk 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 Kitroeff (17:14)

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.

Eisha Nelson (17:23)

Absolutely. Eli Lilly's Zep band 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 Nordisk. Wegovy Another reason is that some people say they simply prefer taking Zepbound. 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. And then earlier this year, the FDA.

Natalie Kitroeff (18:03)

Says Ozempic and WeGovy, the popular GLP1 drugs for diabetes and weight loss, are no longer in short supply.

White House Official (18:11)

The FDA has ordered compounding pharmacies to largely stop selling their version of the drugs.

Eisha Nelson (18:16)

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. Now, Novo Nordisk 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 Kitroeff (18:57)

And what's the impact on the company? At this point, I imagine it's stark.

Eisha Nelson (19:02)

The fortunes of this company are completely reversed. In the summer, Novo Nordisk 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.

Natalie Kitroeff (19:20)

Whoa.

Eisha Nelson (19:20)

It wipes out 70 billion in market value.

Natalie Kitroeff (19:23)

So much money.

Eisha Nelson (19:24)

It's so much money. 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 ousted 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.

Natalie Kitroeff (19:50)

Wow.

Eisha Nelson (19:51)

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 Kitroeff (20:01)

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. Generics entering the market, Eli Lilly offering a competitor. People have more options now. And so I want. I wonder if the upshot of this story is bad news for Novo Nordisk, but good news for consumers and potentially public health.

Eisha Nelson (20:33)

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 fall. 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. We'll 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 Kitroeff (21:36)

Eisha, thank you so much.

Eisha Nelson (21:38)

You're welcome. I loved being here.

Natalie Kitroeff (21:46)

We'll be right back.

White House Official (21:52)

The New York Times app has all.

Eisha Nelson (21:54)

This stuff that you may not have seen. The way the tabs are at the top with all of the different sections, I can immediately navigate to something that matches what I'm feeling.

Natalie Kitroeff (22:02)

I go to games always doing the.

Eisha Nelson (22:04)

Mini, doing the wordle. I loved how much content it exposed me to things that I never would have thought to turn to a news app for. This app is essential.

Capital One Savor Card Advertiser (22:13)

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Natalie Kitroeff (22:25)

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 feet 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. Today's episode was produced by Ricky Novetsky, Caitlin o' Keefe and Diana Wynne. It was edited by Lisa Chow, contains music by Marian Lozano and Diane Wong, and was engineered by Alyssa Moxley. That's it for the Daily I'm Natalie Kitroweff. See you Monday.

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