A global cultural, pharmaceutical phenomenon
The explosion in usage of GLP-1 - a diabetic drug - started during the pandemic, primarily driven by its initially off-label use for weight loss. GLP-1 is a hormone the body produces to control appetite.
The last 3 years have seen the transformation of a diabetes medication into a global cultural and pharmaceutical phenomenon. This surge is mainly fueled by social media trends, celebrity endorsements, and the drug’s significant weight-loss effects. TikTok saw videos tagged #Ozempic garnering over one billion views by 2022.
Initially, Novo Nordisk and Eli Lilly (in 2022, the primary manufacturers of the GLP-1 drugs) could not keep up with the demand. These production difficulties and a reluctance from insurance companies to cover weight-loss medication threatened to throttle its newfound potential.
In turn, the shortages and the high price end users were charged, meant compounding pharmacies saw an opportunity. They started buying the ingredients and make their customized versions creating a thriving 2nd marketplace.
By 2025, the GLP-1 landscape in the US includes FDA approval for several GLP-1RAs for specific uses: semaglutide (Ozempic for diabetes, Wegovy for weight loss), liraglutide (Victoza for diabetes, Saxenda for weight loss) and tirzepatide (Mounjaro for diabetes, Zepbound for weight loss). In addition to the original two manufacturers, giants like Pfizer and Roche are getting in on the act, with high profit expectations.
A drug for the rest of your life
The drug has a half-life of about one week, meaning it takes roughly one week for the concentration in the body to decrease by half, and it is generally cleared from the system within five to seven weeks.
When I meet Alan, he is in good shape. Thanks to a regular intake of semaglutide he has lost a lot of weight and managed to shed his daily alcohol usage habit.
But the thing about GLP-1 medication is that you need to take it for the rest of your life or have to confront a high likelihood that its positive effects will be reverted. Back to square one.
When his insurance told him that he was now healthy enough and thus that they would no longer pay for the drug, Alan decided not to take the risk associated with no longer taking the medication. After all there’s a high chance he would fall back to his old behavior, gain back the weight and worse.
The official drugs are expensive, in the range of $1,000 to $1,400 per month in the US. The compound pharmacy versions are cheaper, but still in the $200 to $500 per month range. What an end user actually pays depends primarily on the insurance coverage you can get.
A third marketplace
Alan shows me a package he just received from an overseas manufacturer of raw drug ingredients. A small vial of 30mg of semaglutide, bought online for $55.
While 30mg may not seem like a lot, it is actually enough for him for 5 months. The typical starting dose is 0.25mg weekly for the first 4 weeks, then increased to 0.5mg for the next 4 weeks, and then on to a steady 1mg to 2mg per week. Wegovy, for example, is sold in pens containing 2.4mg. Other variations may have to be taken daily and/or with different dosage.
So, once a week he takes the vial out, mixes approximately 1.5mg semaglutide, a tiny amount, with a special kind of water, also bought online. It is sterile bacteriostatic water, specifically intended for reconstituting medications. Once mixed, the vial goes back to the fridge.
He then uses a syringe to inject the stuff in his abdomen.
Alan has considered the risks and decided the likelihood of serious harm is low and given the choice between no drug or this drug, he assures me his current practice is the right answer for him.
Meanwhile, Novo Nordisk is keen to put in their advertisements: Only Novo Nordisk manufactures FDA-approved semaglutide medicines, like Ozempic®.