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Brian Lehrer: It's The Brian Lehrer Show on WNYC. Good morning again, everyone. Now we'll revisit a rapidly evolving topic that continues to get so much attention culturally, medically, and financially. The technical term is GLP-1 agonist medications, but they're more commonly known by the brand names Ozempic, Wegovy, or Mounjaro, or by the active ingredient, Semaglutide, a class of medication created to treat diabetes, but they carry a socially desirable side effect, easy weight loss.

These drugs are seemingly everywhere, as I don't have to tell you, yet incredibly elusive in a certain way. Maybe you've seen them advertised in subway cars, in speculative conversations about celebrities, or you've personally discussed the pros and cons of using these drugs with your doctor or used them yourselves on-label or off. Perhaps you've come across headlines describing revolutionary impacts like, "Can weight loss drugs such as Ozempic also treat addiction and dementia?" From The Guardian, we talked about that one, or, "Will the Ozempic era change how we think about being fat and being thin?" From The New Yorker. We had the writer of that article on.

There's a The New York Times story just today about their potential for treating kidney disease. While the discussion is endless, the supply is not. Limited supply and growing demand have made the brand name GLP-1 medications difficult to come by even if you can afford what is frequently a $1,000 dollars sticker price. With all of this hype and demand and exclusivity, it shouldn't come as a shock that companies providing semaglutide medications have become the darlings of Wall Street.

Earlier this week, did you see this, the telehealth company, Hims & Hers, saw stock prices shoot up over 27% after announcing the addition of semaglutide injectables to their offerings, but questions remain about the safety and efficacy of off-brand Ozempic, including should we really be able to access these drugs without seeing a doctor in person, just on telehealth.

Joining us now to talk about the weight loss drug market and the evolving societal impact of these medications is Melissa Lee, host of CNBC's Fast Money. Do you watch her on TV? She also has a CNBC documentary out on the rise of weight loss medications called Big Shot: The Ozempic Revolution. Melissa, thanks for some time today. Welcome to WNYC.

Melissa Lee: Great to be here, Brian.

Brian Lehrer: Listeners who has an Ozempic on-label or off-label, in person or a telehealth prescribed story you want to tell us, 212-433-WNYC, or a question, 212-433-9692, call or text. I see that just this week you interviewed the senior vice president of Hims & Hers Weight Management, Dr. Craig Primack, on CNBC after the company announced that they'll be offering semaglutide injections on their website. For those who aren't familiar with Hims & Hers, what is that company?

Melissa Lee: It's a telehealth company. You can basically connect with the doctor online. You never have to see them in person. They'll take your information and based on your criteria, they will recommend that you get this version. I want to say version, not even off-brand, this version of semaglutide. I say version because these are compounded medications, Brian, and so what does compounded mean? It means that you're going to a [unintelligible 00:03:52] making up a formulation of their version of Ozempic. They're using what's known as semaglutide base, they're mixing it with other things, and they're putting it in a vial instead of a pen for you to then inject into yourself. We'll get into it, but there are very important things that people need to know when they're taking this version versus the name-brand drugs, which are patented and, of course, FDA-reviewed.

Brian Lehrer: We'll come back and talk about those differences. A big headline on this story that we shouldn't leave out before doing that is that Hims & Hers is saying they'll be offering this Ozempic-like medication for $199 a month, which is so much less than Novo Nordisk's original name-brand product, right?

Melissa Lee: Right. If you're talking about no insurance and no coupons because these manufacturers are now offering coupons to make these drugs more affordable and accessible to more people, you're talking about $1,000 a month out of pocket for a drug that you potentially would have to take forever in order to keep the weight loss off. With coupons, these drugs can be had for about $500 a month and on insurance, some of the copays are as low as $25. It just depends on your access and what sorts of plans you have. Of course, even if you compare with the coupons $500 a month versus $200 a month, it seems like you're getting a bargain, but I guess like everything in life, you get what you pay for.

Brian Lehrer: Right. For a lot of people, another $300 a month is really, really meaningful.

Melissa Lee: It's a lot of money.

Brian Lehrer: Again, the perennial divide between the insured and the uninsured in this country. Let's go back to these different versions. Again, you made a distinction between a different version or a different-- I don't know. Can you go back to that and say what are we talking about here with what you can get on Hims & Hers compared to actual Ozempic?

Melissa Lee: For Hims & Hers specifically, what you're getting is what's known as the compounded version of semaglutide. For Hims & Hers, they're going out to this specific pharmacy, which is, in fact, FDA-inspected. It's part of a class of pharmacies called 503B compounding pharmacies. There's another class called 503A compounding pharmacies. The only thing that you need to know is that B is better. B is inspected by the FDA. 503A pharmacies are just inspected by the states so the regulations are much looser.

Hims is using this more strictly regulated FDA-inspected facility for these compounded drugs. They take semaglutide base, which is a copycat molecule of semaglutide, which is the patent and molecule that Novo Nordisk had discovered, and they're mixing with various things. It could be water, it could be various different things. They're putting it into a vial and they're going to ship it to you. What you usually get through telehealth sites is you get a little vial with a little top where you can put the syringe in and you pull up the medicine and you inject yourself every week. You put the vial back into the fridge, you wait till the next week, you get a new syringe, and you do it over again.

A couple of points here in terms of the potential points of danger, points of infection, points of it not being sterile. First of all, you have to rely on the practices of the compounding pharmacy that they're doing everything right, that the product that you're getting when you go in and out of that one vial because one vial could have many weeks of injections that you're not then introducing bacteria into the vial, which can then grow.

There are a lot of reasons why medical professionals and the FDA are warning that compounded versions of these medications are not in fact the same. In fact, the actual compounded versions, they are not FDA-tested. While the facility is inspected by the FDA, the drug itself in terms of safety and efficacy is not.

Brian Lehrer: The reason companies like Hims & Hers can compound these drugs at all as I understand it, is because there's a shortage. Do you see that shortage being mitigated soon? What would that mean for these compounders?

Melissa Lee: That's the problem with this business model for Hims & Hers and other telehealth companies that are depending on compounded versions. Tirzepatide, which is the active ingredient developed by Eli Lilly and semaglutide, or the active ingredient by Novo Nordisk, they're both on the shortage list. Each manufacturer is working overtime spending billions of dollars to increase their manufacturing capacity because they don't have enough to even fulfill prescriptions for the name-brand drugs out there that cost a whole lot more money.

Over time, that will though abate. Things will improve. The supply chain will get better. All these manufacturing facilities will go online and eventually, starting in 2032, that's when semaglutide goes off-patent. Generics will come on the market. It's a finite amount of time, but for right now it's an amazing business model because there's such demand and so you have to think about this as this amazing class of drugs which can promise tremendous results in a fairly effective way, safe way.

There's this frenzy for them, this desperation for them, there's not enough of them, and then there's the rise of social media and telehealth, the internet side of things, which is making it a whole lot easier for the cottage industry of the telehealth companies to come and take advantage of this market opportunity.

Brian Lehrer: Let's take a call. Kata in Maplewood, you're on WNYC. Hi Kata.

Kata: Hi Brian. Thank you for taking my call and it's really great to talk to you. I'm a big fan. I was just listening to what you were saying about it being an amazing business model. While I agree with that from a business perspective, I just wanted to share that my mom is 75 years old, she has type 2 diabetes. She is on Medicare. She currently takes Mounjaro, but just this last month beginning in April, she wasn't able to get it because of the supply issue, so she had to wait three weeks. Then finally she got a notification from her CVS that it was available, but it was $400. My mother doesn't work. She's retired. I need $400 for someone like my mother it's too much. I don't really think that anybody is thinking anymore about the people that actually need it for medical reasons, like diagnosed with type 2 diabetes, has had it for years, really needs it to prolong her life and it's really had a positive effect for her. Just wondering--

Brian Lehrer: Medicare doesn't cover that? Medicare prescription--

Kata: Pardon me?

Brian Lehrer: Medicare prescription drug insurance doesn't cover that.

Kata: No. It's weird with it. It isn't covering it for some reason. Every time she goes back into the pharmacy too, it's always like a different cost. This last time it was $400. Just trying to figure out. We've looked at GoodRx. GoodRx is $1000. I don't really know what's going on there. Maybe your guests might have some more insight.

Brian Lehrer: Melissa, can you help Kata and her mom or have you heard stories like this before?

Melissa Lee: Medicare Part D plans to cover it. I'm not an expert on Medicare, but it's in the works at the very least because for Medicare Part D it will be one of these drugs that will be covered. Perhaps this is just a matter of time before the drug will come down in price.

Brian Lehrer: Kata, thank you for your call. Good luck with your mom and I'm sorry it sounds like we can't give you a better answer. I don't know more to tell you either. I'll just follow up by asking, even though you're not a Medicare expert when you say plans to cover, these drugs have been around for a while and we know the dramatic results that apparently they're having for people on diabetes. Why wouldn't they be covered already?

Melissa Lee: Well, there are many other ways to treat diabetes, various other instances. These drugs come in the version for weight loss and for insulin. The insulin versions are covered by Medicare, should be covered by Medicare. For the weight loss side, it's just coming under Medicare coverage. That's the difference. There are other insulin products as well in addition to the ones that are part of this GLP-1 class.

Brian Lehrer: You're a business reporter, not a doctor, just to be clear and not take you out of your depth, but is there any way, as an expert on markets that you could help Kata and her mom? I'm still thinking about, what Kata was describing about the cost seeming to fluctuate on different trips to the same pharmacy. Any tips for making it as affordable as possible under the current circumstances?

Melissa Lee: I would try reaching out to the manufacturers, Eli Lilly, for instance. They created a telehealth site by themselves, LillyDirect and they're offering they will meet with patients and also potentially prescribe. They may also have various coupons which could help offset the costs. They might have other coupons for older patients. It's worth reaching out directly because these manufacturers understand that these access issues are problem, and especially for diabetics, you need a constant supply of these drugs in order to maintain your blood sugar levels. They might have some solutions for you.

Brian Lehrer: The demand is only going to get more intense to have Medicare and any other kind of insurance cover these drugs. Here's The New York Times headline from today that I referred to in the intro, Ozempic Cuts Risk of Chronic Kidney Disease Complications Study Finds. A major clinical trial showed such promising results that the drugs maker halted it early. If that's new news in the last 24 hours, are we going to see another spike in the stock prices for places that sell Ozempic or Ozempic-like drugs?

Melissa Lee: That's a tricky question from a stock move perspective, because a lot of these studies have been underway. At various points in time, if you're talking about a phase three data, that's obviously great because you're very close to the FDA approval, but phase two might've been amazing. Investors start to factor in these new use cases, these new potential markets, potential revenues earlier on in the cycle. Right now I think what Wall Street, in particular, is grappling with is the valuation of these companies. How much is being factored in because it's not just kidney disease, such as the latest headline for today, but it's also how these drugs help with offsetting cardiovascular events. They will help prevent cardiovascular events like heart attack and stroke, for instance.

There have been very positive readouts on that. There are promising trials underway for Alzheimer's, for instance, for addiction. There's so many potential use cases, and so how much do you factor in terms of, do you assume that Novo Nordisk is going to have a successful drug readout in terms of these trials? Do you assume that and think, okay, well that means X amount of revenues and you factor that into the stock valuation, so the stock should go higher? Do you say, you know what, at some point it may not work, maybe it's too much. Maybe there's overlap in these populations, maybe obese people and have the cardiovascular events and so you're talking about the same group of people. Those are the things that are being sorted out right now on Wall Street.

Brian Lehrer: Melissa Lee with us for another few minutes, host of CNBC's Fast Money, and she has the CNBC documentary on the rise of weight loss medications like Ozempic and Mounjaro, the one that Kata's mom is on called Big Shot: The Ozempic Revolution. Brian in Springfield, New Jersey, you're on WNYC. Hi Brian.

Brian: Hi. Thanks for taking my call.

Brian Lehrer: Happy to.

Brian: Actually, my doctor encouraged me to get on it. I do have diabetes and we tried the pill form of some of the medications and I was having a lot of side effects, digestive side effects, and I just said, I really can't stay on this stuff. I had just read an article on CNN in the last week that a lot of people start on it, but then don't stay on it because they also, for various reasons, but for me it was the side effects. I couldn't stay on it.

Brian Lehrer: Did you move to the--

Melissa Lee: Brian what pillar are you on? I'm sorry to interrupt.

Brian Lehrer: Go ahead.

Melissa Lee: What pill are you on?

Brian: I think it was Rybelsus that I was on, but she had suggested one of the injectables too. We started with Rybelsus and it was the lower dose, the starter dose before it ramps up. I was having the side effects on the lower dose. I just said I can't do this.

Brian Lehrer: Did you transition to an injectable form or would that presumably according to your doctor, have the same side effects?

Brian: Probably would've had the same side effects, so we're trying some different alternatives, but I reacted very badly to the GLP-1 formulation.

Brian Lehrer: Thank you for telling us that, Brian. We appreciate it. Does this bring us back, Melissa, to the premise at the beginning of the conversation that it's now easier to get these kinds of medications with just a telehealth appointment as opposed to actually going to see a doctor, your doctor, if you have a doctor, as opposed to going to websites like Hims & Hers and hers and getting it that way.

Melissa Lee: You can pull up, Brian, if you did a Google search, how do I get semaglutide? 100 sites will come up. It's super easy to get these things, but you just don't know what you're getting, and that's the issue. You can go to your doctor and get a prescription. The problem there is access and the manufacturers are feverishly working on that side of things, but there is a gap. There's just not enough being made for the demand that is out there for even the brand name drugs that you could possibly afford or your insurance will cover. We're in this gap period where it's just consumers might be pushed to say, "You know what? I will accept these compounded versions." I interviewed a young lady who couldn't get her hand-- it's just not affordable for her to take the brand-name drugs. She didn't have insurance. She said, "What do I have to lose?" Well, [laughs] it is your health. [laughs]

Brian Lehrer: Right. I guess these websites, even if they have a telehealth screen with an MD, they don't offer a follow-up I'm guessing.

Melissa Lee: Oh no. Oftentimes you don't even have to meet a criteria to get compounded semaglutide. This is not like a prescription process for many of these sites. I was able to get it. I do not fit the criteria for being obese and I was easily able to get semaglutide, that's part of the investigation that we did in my documentary. It was a little bit too easy.

Brian Lehrer: One more follow-up from Brian's call then we're going to run out of time. He mentioned taking the oral version of one of the medications and I'm sure anybody would rather take a pill than have to keep injecting themselves. I see that Hims & Hers already offers oral weight loss medications and other telehealth companies are heavily advertising similar orally ingested semaglutide drugs. If these drugs are available orally, why hasn't Novo Nordisk or Eli Lilly which created the actual Ozempic or Mounjaro created an oral version?

Melissa Lee: They're working on it. The trick with oral is that it has to be like a time release. If you think about an injectable you're taking that injection once a week. If you take a pill you have to think about you need this hormone regulation in a steady pace over the course of a day, two days, and a week. They have to work on that and then they have to put it through all of the tests to make sure it's safe and effective. They have to pass FDA standards. These sites do not, and that's the huge difference between using a compounding pharmacy and going through brand-name drugs in a manufacturer.

The brand names have the safety standards and the compounded do not. There are no FDA trials for compounded oral semaglutide for semaglutide pill, they don't exist. When you're ingesting it, one what are you ingesting and is it going to be effective? Those are the two main questions that you have to have.

Brian Lehrer: We didn't even address as we did in a whole other segment, and I don't know if your documentary gets into this, the off-label uses. We heard from callers who had diabetes but there's a whole cultural critique about people being drawn to these kinds of drugs just because they're brainwashed by thin culture and you have to look a certain way in order to be socially acceptable. I imagine a real MD would screen for that before giving you a prescription.

Melissa Lee: If you think about how far we've come in terms of body image. More and more these days you'll see a large model. Not all models fit into this one stereotype, so when you go into a clothing site you have large sizes and that's not uncommon these days. The question is when you introduce this class of drugs and it's "easy" to be thin then are you taking a step back in time in terms of this body positivity movement?

Brian Lehrer: Which is not to downplay the medical risk of obesity but there's a line there.

Melissa Lee: Right. Exactly. The positive side though is that I think that in this country for a long time, it was always obesity was always perceived as the person's problem. The person's inability to control themselves. The person's inability to stick to an exercise regimen. Obesity is a disease. It was recognized as a disease by the American Medical Association a decade ago. I think having medications that treat a disease, the disease being obesity has changed the way Americans are thinking about obesity. It's not blaming the person who's affected by obesity. It's recognizing it as a medical problem.

Brian Lehrer: Melissa Lee, Host of CNBC's Fast Money, and she's got the documentary now on NBC's business channel called Big Shot: The Ozempic Revolution. Thanks so much for sharing this with us.

Melissa Lee: Thank you.

Brian Lehrer: Brian Lehrer, on WNYC more in a minute.

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