Weight loss brings health benefits at any age, but is difficult for many to achieve and sustain.
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In every news cycle, there’s at least one story about GLP-1 drugs such as Ozempic, Wegovy and Zepbound. Although some extol the drugs’ health benefits, most focus on economics, including the drugs’ high cost, the growing reluctance of private and public insurance plans to cover the expense and the resulting affordability crisis for patients. With a dose of common sense, we can solve these problems.
American healthcare is too expensive. This is particularly true of brand-name drugs. Although our nation accounts for 4.2% of the world’s population, we consume 13% of the world’s prescription drugs and pay half of the world’s costs for these products. GLP-1 drugs are a case in point.
Americans Fund Much Of The Basic Science Research That Leads To New Drugs
Federal labs and grant-funded university research produced many insights that led to new treatments. The discovery of glucagon-like peptide-1 receptor agonists (GLP-1RAs) grew out of National Institutes of Health and Veterans Administration research in the 1980s and ’90s. The recent cuts to federal labs and university-based research programs may change this going forward.
When A Discovery Is Made, Pharmaceutical Companies Step In
Building on this early work, Novo Nordisk developed, patented and secured FDA approval for two GLP-1 drugs to treat Type 2 diabetes: liraglutide and, a few years later, semaglutide. When semaglutide was approved to treat Type 2 diabestes in 2017, Novo named it Ozempic. Four years later, the FDA approved semaglutide at higher doses to treat obesity. Novo named the higher-dose version Wegovy.
In 2022, Eli Lilly secured FDA approval of tirzepatide, its GLP-1 drug, to treat diabetes. It named the medication Mounjaro. The following year, the FDA approved higher doses of tirzepatide to treat obesity. Lilly named its higher-dose version Zepbound.
When A Winner Is Found, Drug Companies Try To Make As Much Money As Possible For As Long As Possible
Drug companies need FDA approval before they can market a newly patented drug. Unlike other countries, the FDA can’t consider a new medication’s price or the existence of equally effective, lower-cost alternatives in reaching its decision.
Once FDA approval is secured, Medicare typically covers the the drug’s cost because it is not allowed to negotiate with drug companies as other countries do. This policy was modified during the Biden administration, but only for a few brand-name drugs. It’s the main reason the U.S. pays far higher prices than other countries.
When a company brings a new product to market, it relies on patent law to protect its exclusivity. Although patents generally expire after 20 years, drug companies like Novo and Lilly use a variety of strategies to extend the lifespan of their patents or add secondary ones, according to Time magazine. Insulin was developed almost 100 years ago but Novo, Lilly and Sanofi still control 90% of the global insulin market. Novo has already extended its original patent on semaglutide to 2031. Lilly’s patent on tirzepatide will not expire until 2036 (if then).
An employee works on the production line at the Novo Nordisk factory in Hilleroed on September 26, … More 2023. (Photo by SERGEI GAPON/AFP via Getty Images)
AFP via Getty Images
When GLP-1 Drugs Were Introduced, Demand Exceeded Supply
When Novo and Lilly rolled out their new weight loss drugs, demand quickly outpaced production. This opened a regulatory door for federally licensed 503B compounding pharmacies to make products containing semaglutide or tirzepatide, the same active ingredients brand-name GLP-1 drugs. Their versions were not only more affordable; they offered flexible, individualized dosing. At the shortage’s peak, 2 million Americans were using compounded GLP-1 drugs, according to Kaiser Health News.
Despite this competition, Novo reaped a bonanza. U.S. spending on Ozempic and Wegovy surged to $38 billion in 2023 and reached $65 billion in 2024. Both companies poured billions into expanding their production as quickly as possible. In February 2025, the FDA declared the shortage was over. Soon thereafter, it notified compounders to wind down production.
Americans Face An Affordability Crisis
By restricting compounders, the FDA has transformed a production shortage into an affordability shortage. Medicare does not cover Wegovy or Zepbound for weight loss — only selected weight-related health problems after they develop. Private insurers are dropping coverage, or capping costs by erecting complex hurdles before they’ll consider covering a GLP-1 drug. This year, 4.9 million people lost coverage of Zepbound in 2025, and 1.1 million lost coverage of Wegovy, according to GoodRx. If Medicaid is cut, the few states that currently cover GLP-1 drugs will probably stop.
Policy Options
The administration and Congress could turn a blind eye to this problem, but voter patience is wearing thin. Fortunately, with one or two tweaks to policy, affordable weight-loss drugs are within reach.
- FDA Commissioner Makary could affirm that state-licensed 503A compounding pharmacies can fill personalized prescriptions as long as the compounder doesn’t duplicate the patented doses and auto-injectors used by brand-name drugs. Alternatively, President Trump could issue an executive order to this effect. Compounders assert that they already have this right but an administration order could short-circuit years of industry litigation.
- The administration could revoke Novo’s patent extension. In April 2024, the Federal Trade Commission announced that it was expanding its campaign “against pharmaceutical manufacturers’ improper or inaccurate listing of patents in the Food and Drug Administration’s (FDA) Orange Book, disputing junk patent listings for diabetes, weight loss, asthma, and COPD drugs, including Novo Nordisk Inc.’s blockbuster weight-loss drug, Ozempic.” If the administration revoked Novo’s extension, patent protection for semaglutide will expire in 2026 as it is scheduled to do in many other countries. This would open the door to generic competition and personalized compounding, both of which could trigger a drop in prices.
How To Assure Safety
Although news articles about compounded GLP-1 drugs often refer to them using terms such as “copycat,” “cut-rate” or “cheap,” reputable compounders test the semaglutide and tirzepatide they use in their products to assure its quality and safety. Similar care is not always taken by importers of FDA-approved generic drugs. To address this concern, the FDA could urge, if not require, that all generic and compounded medications be independently tested to assure their quality and safety.
The FDA or NIH should also conduct post-market surveillance of patients taking compounded GLP-1 drugs and compare their outcomes to those of patients taking brand-name products. This might reveal that the “go low, go slow” approach that compounding allows reduces side effects, improves sustainment and achieves better results.
The Bottom Line
Public and private health insurance is expensive because our healthcare system is hugely expensive. Rather than bankrupt the federal treasury or, alternatively, pass the costs on to states and tens of millions of American families, Congress should focus on lowering costs and improving the value of American healthcare. Overpriced GLP-1 drugs are a great place to start.
My views are my own, and do not neccessarily reflect those of any current or past employer.