The Dr. Tyna Show
The Fight for Affordable GLP1s & the Truth About Big Pharma | Dave Knapp
Thu, 27 Mar 2025
On this episode I sit down with my friend Dave Knapp, an independent journalist and community leader in the world of GLP-1 receptor agonists. Living with obesity and type 2 diabetes himself, Dave has built a platform dedicated to connecting and educating people using these life-changing peptides. We break down the latest updates on the FDA’s crackdown on compounding pharmacies and what it could mean for the future of GLP-1 access. We also dive into the shady role of Pharmacy Benefit Managers (PBMs) in driving up drug prices, the realities of living with obesity, and why traditional approaches to weight loss often fall short. Dave shares insights from his personal journey, including his experiences with keto and the struggles his community has faced. Topics Discussed: What is happening with the FDA’s crackdown on compounding pharmacies and GLP-1 medications? How do Pharmacy Benefit Managers (PBMs) drive up drug prices and impact patient access? What are GLP-1 receptor agonists, and how are they changing the lives of people with obesity and type 2 diabetes? Why do traditional weight loss methods like “eat less, move more” often fail for people with metabolic disorders? What is the future of compounded GLP-1 medications, and how can patients stay informed? GLP1s Uncovered FREE 4 Part Video Series On This Episode We Cover: 00:00:00 - Introduction 00:05:17 - Dave’s background 00:11:07 - The Diabetes cycle 00:16:11 - Starting On The Pen 00:21:44 - Compound pharmacies and drug shortages 00:26:23 - Increase in compound drug use 00:29:34 – Better Accessibility 00:34:55 – PBMs & Insurance Kickbacks 00:41:31 – Copays vs. Cash Pay 00:45:29 – GLP-1 & FDA Lawsuits 00:53:14 – MAHA & Compounding Pharmacies 00:55:09 – Pharmacy Types & The Future of Compounding 00:59:47 – Confidence in Providers 01:02:13 – Bias in the MAHA Movement 01:09:19 – Lowering Medication Costs 01:11:39 – Deplatforming & Censorship 01:18:34 – “Eat Less & Move More” Show Links: GLP1s Uncovered FREE 4 Part Video Series Find A Doc Sponsored By: Nutrisense Head over to nutrisense.io/drtyna to get $125 off your program. Puori Go to Puori.com/drtyna and use code DRTYNA to get 20% off Momentous Go to livemomentous.com and try it today at 20% off with code DRTYNA, and start living on purpose. Purity Woods Go to puritywoods.com/DRTYNA or enter DRTYNA at checkout for 27% off LMNT Get your free Sample Pack with any LMNT purchase at drinkLMNT.com/drtyna Check Out Dave: Instagram https://www.onthepen.com/ Disclaimer: Information provided in this podcast is for informational purposes only. This information is NOT intended as a substitute for the advice provided by your physician or other healthcare professional, or any information contained on or in any product. Do not use the information provided in this podcast for diagnosing or treating a health problem or disease, or prescribing medication or other treatment. Always speak with your physician or other healthcare professional before taking any medication or nutritional, herbal or other supplement, or using any treatment for a health problem. Information provided in this blog/podcast and the use of any products or services related to this podcast by you does not create a doctor-patient relationship between you and Dr. Tyna Moore. Information and statements regarding dietary supplements have not been evaluated by the Food and Drug Administration and are not intended to diagnose, treat, cure, or prevent ANY disease.
Chapter 1: What is the current state of GLP-1 medication accessibility?
Most people in the United States are not paying $1,300 a month for Ozempic. In fact, Wegovy, which is the obesity medicine version of Ozempic, most people that are on this are paying less than $25 a month. 80% of the people who are on this are paying $25 a month. Is that with insurance? Yeah, that's with insurance, right?
So you have the list price at $1,300, but most people in the United States are paying, 80% are paying $25 or less.
You are tuned into The Dr. Tina Show with Dr. Tina Moore. For more, visit drtina.com. On this episode of The Dr. Tina Show, I am excited for this one. I got to sit down and have a great conversation with my buddy, Dave Knapp. Dave and I met through the online space when I was deplatformed back in September for, I believe, talking about microdosing GLP-1s.
He has built an entire platform called On The Pen. And his life's mission, he's become an independent journalist of sorts. That's not what his background was in. But he has made it his life's mission to connect people who are utilizing GLP-1 agonists. He is a man living with a disease of obesity, the disease of type 2 diabetes. And he knows this world well.
And he's built this wonderful, expansive community of like-minded people who are all utilizing these peptides with life-changing impacts. He keeps us abreast on what's happening in the news.
And so I brought him on today because, A, I wanted you guys to get an update on what's happening with the FDA versus the compounding pharmacies and those ongoing trials and what's happening there because the future of compounded GLP-1s may be in jeopardy. So I want you to get the inside scoop on that. He explains it so well.
Whether you're on GLP-1s or care about them or not, this is a conversation you need to hear. Number two, we talk about the PBMs, which are the middlemen who are gouging us all and driving up prices of medications and pharmaceuticals. So that's something you guys need to know about as well. We talk about what it's like to live with a disease of obesity and what that means and how he's gone keto.
He's done the eat less, move more, how his community lives. the struggles that they have and how these peptides have been absolutely life-changing for them, for leveling the metabolic playing field, as he calls it. And lastly, we even touch on a few things that we both agree Maha may be missing the mark on. So without further ado, let's jump in. We get right into it. This is Dave Knapp.
Did you know that nearly 94% of US adults are metabolically compromised according to 2018 data published in 2021? Even more surprising, 80% of them have no idea. Shocking, right? That's why I've been beating the drum on metabolic health for decades in my clinical practice and on this podcast since day one.
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Chapter 2: How do compounding pharmacies impact drug shortages?
But it's funny because a lot of my journey to obesity, I think can be, obviously there's the genetic components. We have lots of stories about, or not stories, but we have lots of clinical trial data that bears out the fact that obesity is, there's a genetic component. There's a very genetic component to living with obesity. And then once you sort of get to the point where you have
a lot of excess adiposity, as you talk about often, it is very hard to pull somebody back from that. And so the years that I spent in the restaurant industry and the years I spent sort of on this roller coaster of dieting was a huge contributing factor to my overweight condition and to ultimately developing type 2 diabetes.
So back in, let's say, about 2011, which I was probably about 25, 26 years old at the time, it was time to get out of the restaurant world. It was like 90 hours a week. It was horrible sleep schedules. I mean, just, you know, you'd be there at 5 o'clock in the morning some days, some nights you'd be there until 1 or 2 a.m., And I wanted to start a family with my wife.
Funny, the whole reason I got into restaurants is I was going to go into marketing and I was dating my wife at the time who has rheumatoid arthritis. And accessibility is a huge issue with the Knapp family because the one thing her parents said to me when I asked if I could marry her is they said, well, there can never be a gap. in her health insurance or she loses access to her medicine.
And at the time, this was a foreign world to me. As I said, the biologic she's on that keeps her arthritis at bay is $4,000 a month without insurance. And if there's ever any gap, she doesn't get that medication covered again. So this is all pre-Affordable Care Act when they could sort of drop you from coverage if there was any sort of gap. And so I was like, man, I really want to marry this girl.
So I better either go back to school or I better... you know, figure out a way to get good health insurance. So I went to my manager at Olive Garden. I said, hey, I'm going to go back to school. And he goes, well, do you ever think about becoming a manager at Olive Garden? And I was like, no, no, I haven't. And he's like, well, here's the deal. Here's what we pay for.
You know, at the time, it was like a $60,000 a year salary. So for somebody who was like 20 years old at the time, And then he's like, full benefits, 401k. I was like, wait, what about that full benefits? Is that health insurance too? He's like, yeah. And so I literally was like, I'll do it. And within a couple of weeks, asked her parents to marry her.
And then that set off the first eight years of our marriage. I worked in restaurants. and just bat this obesity snowball, this down 25 pounds, up 35 pounds, down 25 pounds, up 35 pounds. The fettuccine Alfredo probably wasn't a helpful contributing factor to that either. But I wanted to get off this roller coaster. My father had done video production in the community that we live in for 25 years.
And I stopped into his office one day on the way into an Olive Garden shift. And I was like, dad, you got to help me get out of this. I've got the chops to do marketing. I'm passionate about it. What's out there? So I sort of repeat this stopping into his office for a period of a couple of weeks. And he popped in one day. He's like, finally, I got something for you.
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Chapter 3: What are the roles of Pharmacy Benefit Managers (PBMs)?
Just every year, down 25, up 35, down 25, up 35, until finally, it was the year of COVID. It was 2021. And I had COVID a couple of times, a couple of positive tests from 2020 to 2021. I went into the doctor because I felt like I had long COVID. And I was just like, I'm tired every day. All I want to do is sleep. I don't know what's wrong with me. And he goes, oh, your A1C is a 7.9.
You're diabetic. I was like, what? It was like literally that was my response. I never had fasting glucose that showed that I was on the track to diabetes. So I felt like I was just punched in the gut. I knew that I was overweight. I knew that I had a family history, but I never had numbers that would indicate like, hey, you're on the fast track to type 2 diabetes.
So it was like this sudden thing. And this is coming off COVID, right? And so I'm full of all sorts of skepticism towards medicine and the medical community. And I think that probably mirrors a lot of people's story. And he goes, what do you want to do, Dave? And I said, well, I've yo-yoed on keto for like 20 years. And that was the diet that I'd always lose 25, gain 35.
He's like, well, that's the only way you can stay off medicine. I said, well, if it means staying off medicine, I'll do it. So I'd bear down, white knuckle, did keto for a full year. And I mean, I was under 20 grams of carbohydrates every day. I was lifting weights. I was doing everything humanly possible. With keto, I was able to get my A1C down from a 7.9 to a 5.3, non-diabetic, right?
Really great. But my weight went from 319 to 312. I lost seven pounds. And granted, you know, some of it was probably some body composition change. I was lifting weights, but not what you would expect to see with somebody with that much weight to lose. So super frustrated, right? And just beyond frustrated.
And the interesting thing at that time to me was that even though my A1C was under control with the diet, my insulin levels were still off the charts 12 months after being extremely strict on keto. Now I had never really like gone off the rails eating. Like I'm not a donut eater. I'm not a, I'm definitely guilty of drinking diet soda, but I'm not a, a sugary beverage drinker.
Just like not your typical who you would expect a 300-pound 37-year-old to eat, right? ate lower in carbs anyway. I was aware that those probably weren't going to be handled by my body in the best way. So we're a year into the diabetes diagnosis and he goes, you know what? I don't know.
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Chapter 4: Why do traditional weight loss methods often fail?
You're one of several people on this program out of a thousand people that have gone through this program that just haven't responded from a weight loss perspective. And I was kind of like, I could have told you that when we started. But He goes, you're probably a candidate for bariatric surgery. And I'm going, I'm 37 years old. I don't want to have my anatomy rearranged.
That's where my mental state was at the time. I'm not knocking anybody who makes that decision for themselves. In fact, I'm still considering it at 39 years old, that that actually might be the best course for me. I don't know. but still sort of wrestling with it is my point. But I didn't have coverage for it. So he goes, there's this new class of medications, right?
They're actually mimicking what happens when people have bariatric surgery. We found that there are a bunch of hormonal changes that happen like on the operating table. Once we make these changes, there's a hormonal regulation that starts to happen almost immediately. And they're starting to mimic that with this class of medications called GLP-1s. And so he goes, I'm going to put you on Manjaro.
It's expensive, but you're diabetic, so you should be able to get it covered. So I went home, again, still super skeptical of medicine in general coming off of all the shenanigans that we saw around that time. And... I'm like, I'm not going to just put this into my body. I'm going to learn everything there is to learn about this. And so I went to YouTube.
Chapter 5: What is the significance of recent FDA lawsuits?
And what I found from YouTube was a bunch of stories. Like, hey, I lost 100 pounds in six months on Ozempic. Yada, yada. And there's 100 stories out there. But I didn't find anybody talking about what they were, what they did, how they worked, what the study showed. And I thought...
You know, I'm going to go find this information, but I'm going to share it because somebody else is going to come behind me and they deserve to be able to find this information. And so that's sort of where On The Pen was born is just this desire to empower people with information. Right. And so essentially.
this sort of has evolved as, as I've been a slower responder, I've seen many people in our community. We have probably 110,000 people between we're split, spread out across the platforms, right? TikTok, YouTube, Twitter, email, Facebook, everything. Um, but I've heard such dramatic stories about, uh, just massive transformations in, in weight loss, et cetera. It's just not been my story. Um, and,
So there's been sort of a level of frustration and wanting to know what else is on the horizon, what other things that I may be able to explore to get to treat my metabolic dysfunction. And so really what we do is we effort to share the news about these medications, the trial data that comes out.
whatever's going on in the news that might be pertinent to somebody whose life is being transformed by what I always call leveling the metabolic playing field. That's really, in essence, what these medications are doing for people who are taking them for type 2 diabetes or obesity, is they're actually just giving people a fighting chance for their biology to come into alignment with
In the sense that they can kind of work with the medication and bring themselves into better, more full, complete health for themselves. And one of the things that has been just the evergreen topic within this community is just the accessibility. They're extremely expensive medications to use.
to get, unless you're diabetic, it's a little bit easier if you're diabetic, but then you have to be diabetic to get it.
Right, you have to remain diabetic to continue to get it too, right? Like you have to remain obese or diabetic to actually have it clear. And that's the crazy part. Try as I might, I still find it hard to hit my protein macro goals every day. I also want to optimize my cognition as much as possible because menopause brain is real.
Getting adequate protein in is a non-negotiable as we age, everything from protecting muscle and improving strength to protecting cognitive function. So I've been taking momentous protein powder daily to ensure that all of my bases are covered, from aiding my cognitive function to supporting my muscles and joints.
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Chapter 6: How can patients navigate the future of compounded GLP-1 medications?
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Yeah, yeah. I mean, and sure, that's the other thing that... that we've learned in the Knapp household is the insurance companies will fight you tooth and nail to not cover anything that is expensive. They're essentially practicing medicine, right? At the bureaucratic level of the insurance companies, they're just saying, yeah, there's something better here.
And so ultimately, yeah, it's very difficult to stay on the medication as well as getting treatment for obesity. Once you're below a certain BMI, unless your doctor is coding everything just so, It's very hard to stay on it because now you're not obese anymore, but you need the medication for maintenance.
Many people who are on these medications for obesity will need some level of treatment because like any chronic disease, typically when you need treatment to get it in remission, you need treatment to keep it there. And that sort of bears out in the clinical trials for these as well.
That's not to say it's going to be everybody's story, but you're leveling the metabolic playing field with a peptide that is supplanting something that's deficient or deficient in your body. And so once you remove that, you're sort of fighting an uphill battle again. So the issue of accessibility has been this evergreen topic.
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