Chapter 1: What are GLP-1 drugs and why are they popular?
Our greatest living athlete is hawking GLP-1s. I'm on rope, 34 pounds down on GLP-1s. She wasn't alone. Just about all the major players for these weight loss drugs had commercials during the Super Bowl.
Weight loss treatments that can be micro-dosed to fit your goals. Big news, America. Well, Gobi now comes in a pill. So adults with obesity can lose weight and keep it off, along with diet and exercise. Yes, thank you, DJ Khaled. Another one.
And most of those ads, including Serena's, were for companies that offer knockoff versions of the popular drugs. So how is that legal exactly? I'm Jonquan Hill sitting in today. The sort of sketchy world of compound pharmacies and the GLP-1 symptom that people didn't see coming. That's coming up on Today Explained from Vox.
Chapter 2: How do GLP-1 drugs impact weight loss and health?
And another one and another one.
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Today Explained.
My name is Sydney Lepkin, and I am the pharmaceuticals correspondent at NPR.
Okay, Sydney, I don't know if you watched the Super Bowl, but I did, and it seems like drug companies really want us all to get on GLP-1s. Has the industry continued to grow, or have we reached peak GLP-1 consumer?
Yeah.
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Chapter 3: What are the legal implications of compounded GLP-1 drugs?
Oh, I don't think that we've reached the peak of GLP-1s by a long shot. And when you say, like, does the industry want us to be taking them? I mean, yeah, sure, they do. Because when we take those drugs, we pay for those drugs. But also, I mean, as someone who's talked to hundreds of patients who have taken both brand name and compounded GLP-1s, like, they want to be taking them.
You know, I've I've talked to people who have said, you know, I have struggled to lose weight my entire life and this changed my life. And like, you know, there's we can talk about stigma and whatnot, which is not gone yet. But, you know, they'll say, like, this is a tool and it's really helped me. Mm hmm.
Okay, I'm also a woman in my 30s with the internet, and so I've been just told so many different ways to hate my body. And this also means that I get a ton of ads from companies like hers and Rowe telling me that they have cheap GLP-1s ready and available for me whenever I want them.
The quality of your health care shouldn't depend on where you live, what you do, or whether you have insurance. It should be personalized to your unique needs. That's why we created Weight Loss by Hims.
That's why we created Weight Loss by Hers.
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Chapter 4: How are compounded GLP-1 drugs different from brand-name versions?
With Rowe, get the online coaching and care you need to lose 15% of your body weight.
Charles Barkley wants to lose 65 pounds with GLP-1s.
Are these companies legit? What's going on with that? That is a great question. I think I'm going to back into this answer and tell you that, you know, when we're seeing these competitor GLP-1s, the assumption, because this is the way things have always been, is that they're offering generic drugs. And that's actually not what's happening here. Basically, this is not a generic.
This is what is called a compounded drug, which means that the drug is made instead of in a manufacturing drug company's facility by a drug company going through FDA approval. It is made by a special kind of pharmacist, a compounding pharmacist. Their sort of bread and butter is that they make custom drugs for people that need them.
So the example is like, okay, you need a pill, but the brand name commercial version has a preservative in it that you're actually allergic to, but you still need that pill. So you would go to a compounding pharmacist and then they would... custom prepare the version for you that you are not allergic to because you obviously need that. And it's a crucial part of health care.
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Chapter 5: What psychological effects do GLP-1 drugs have on users?
They're generally not supposed to make what are called, quote, essentially copies. And I'm using air quotes for those who can't see me. Essentially copies of existing commercial brand name drugs. But there's an exception. The exception is when that brand name drug is in shortage. Then the compounding pharmacies can pitch in.
Now, these GLP-1s that we've been talking about their popularity, in fact, they were so, so, so popular that the drug companies didn't make enough supply.
Accessing semi-glutide injections is challenging for thousands of people who live with diabetes.
And the demand for the drug is high as people around the world have turned to it for weight loss. These weight loss drugs, they've exploded in popularity so much so that these drug makers simply can't keep up with the demand.
And all of a sudden, you know, compounders were like, well, we can actually do this for cheaper than the list price for Wagovi is like $1,400 a month. So all of a sudden, people could get it for cheaper. Telehealths were helping connect them with physicians. And that's sort of where this boom is coming from. Now, the shortages have ended.
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Chapter 6: Are compounded GLP-1 drugs considered safe and effective?
The companies, it took them a couple of years to catch up on the manufacturing side, but the shortages have ended. And the thought was that the compounding would also end. But What is now happening is a lot of companies are saying, well, what we'll do is we will make you a custom version of this drug.
And then they think that there are at least some that I've spoken to have said, you know, then I think that we're working within the parameters of the law. And there's some definite debate about whether that's true. But that's sort of why we're still seeing a lot of compounding.
The other big news in GLP-1 world is that you can now get it in pill form. You know, it's been an injection up until recently. When it comes to these compounding pharmacies, are they offering the pills now, too?
So, well, as far as we know, there isn't a shortage of the pill, but we are seeing, you know, the pill is brand new. The pill came to market about a month and a week ago. So it was just approved at the end of last year by the FDA. It's now just now on the market where you can actually go to a pharmacy as of the beginning of January and pick it up if you had a prescription.
So seeing last week that HIMSS, the telehealth company and hers, were offering their own version of the compounded pill raises sort of a lot of questions like, can they do that?
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Chapter 7: What potential risks do users face when stopping GLP-1 drugs?
is sort of the question and they will say and initially they said yes we can however very quickly novo nordisk which as you know makes the brand name version of it said you know we're preparing to take legal action because that's illegal it's mass market compounding which is kind of not the you know what compounders are supposed to be doing
And, you know, we're going to we're going to take action on this. And HIMS's response was, you know, that's that's false. That's not true. Then the commissioner of the Food and Drug Administration, Marnie McCary, tweeted.
FDA will take swift action against companies mass marketing illegal copycat drugs, claiming they are similar to FDA approved products. The FDA cannot verify the quality, safety or effectiveness of non-approved drugs.
And then that was swiftly followed by an HHS general counsel saying that they were going to refer this issue to the Justice Department. So that changed things.
Wow. And HIMS's response was, Since launching the compounded synaglutide pill on our platform, we've had constructive conversations with stakeholders across the industry. As a result, we have decided to stop offering access to this treatment.
So now the compounded pill, at least for now, is no longer on the table.
Do we know if these compounded versions of GLP-1s, are they safe?
The short answer is it depends.
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Chapter 8: How might GLP-1 drugs affect societal views on weight and health?
It depends on who is making it. It depends on whether they were making it in a sterile environment, whether they're licensed. In the case of compounding, it's not, the FDA doesn't typically inspect your sort of small compounders. It'll inspect your bigger ones, but a lot of these are made and they're regulated by state boards of pharmacy.
You know, when a drug goes generic, something called a USP monograph gets made. And it's basically a recipe for like how – here's the standard for how you're supposed to make that ingredient. And because this drug hasn't gone generic, there is no recipe like that. So are they making it in a way that is – and not going to have any like extra junk that you don't know about?
And like, is there going to be a long-term side effect that we're not seeing today?
What about effectiveness?
Are the compounded versions effective? I have definitely heard from people who have said, you know, like I my insurance coverage for Ozempic went away. So I went the compounded route and it's been great for me. I've heard from a lot of people like that. But there are definitely real risks.
And most of the time what I when I hear from like emergency physicians and when I ask them about it, they'll say, you know, the issue is they either they miscalculated or perhaps it was too potent or it wasn't potent enough and it did nothing. So like that's probably not going to send you to the emergency room. But like if it's too strong and you don't know it, that can be really risky.
Do you think we're about to see a big explosion in the use of these drugs? I mean, I think if I get on Instagram, I see an ad. I watched the Super Bowl and saw ads like, yeah, I wonder, are we going to see more and more people use GLP-1s?
We're already seeing a lot of people use them. The ads, actually at one point I looked at Facebook ads over time for compounded drugs and they were only growing. But I do think we're going to see more people using them if they can get cheaper. There are still going to be a lot of people who...
can't afford a couple hundred dollars a month and don't have health insurance coverage because one of the things I'm now hearing from people is also like even if they do have coverage it's very restricted like I've heard from several people I can't get it covered for weight loss unless I have a BMI of over 40 which is interesting because a BMI of 30 is considered obese so like I've heard from people be like wait am I supposed to gain weight to get coverage are you kidding
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