The Ozempocalypse Is Nigh
40 comments
·March 15, 2025jmward01
monkburger
Profits over patients.
Pharmacies have to have crazy high prices though because PBMs reimburse at such shit rates, based on some percentage of the price given to them. Because if they buy the bottle at $30 and list the price at $60, the PBM contract will only reimburse at the adjusted wholesale price (another made up number), eg: 17% plus a $1.99 dispensing fee. This disgusting math results in getting a loss on the drug.
Even all this leaves out some of the most absurd abuses of PBMs. They set minimum drug copays, have the pharmacy collect a $15 copay for a $5 drug, and have the pharmacy pay the PMB the $10 difference. They make it a breach of contract for the pharmacy to inform the patient this is happening or to charge the $5 and bypass the insurance. The total lack of anything even approaching ethnics is absurd...
scarab92
How should this system work, in an ideal world?
deadbabe
Can someone please explain the economics of GLP-1s? How can people pay $1000/month for the rest of their life, just to keep weight off? Rent and mortgages are already insane as is, and then there’s insurance, kids, etc.
dragonwriter
> How can people pay $1000/month for the rest of their life
No one actually pays that price. The $1000 misrepresented in the article as the "usual insurance price" is actually the list price, from which insurers negotiate discounts (that is, the full price -- not just the out of pocket price charged to the insured -- for insured patients is significantly less than that $1000 price), while most people who get the drug outside of insurance get it through some program (if it is the actual, brand-name drug, run by the manufacturer) that also charges much less than the list price.
scarab92
It seems like the entire US medical system runs on prices that no one actually pays.
I don't really understand what all that extra complexity achieves?
MathMonkeyMan
It hinders individuals from making purchasing decisions that affect price. Less clarity on the actual price means that it's harder to shop around.
kashnote
The sellers can write it off as a loss. It’s a way to avoid paying taxes
oatmeal_croc
Few people actually pay 1000/month. Most get it through insurance (I pay 25/month), and most of the remaining get it through compounding pharmacies like HenryMeds which comes out to 300-400 per month.
In fact, I know a few people who get brand pills (Rybelsus) mailed from India, where it's much cheaper. This insane pricing is a US only thing.
alabastervlog
Further, as noted in TFA, it’s possible to get higher doses at the same or almost the same price, though a compounding pharmacy, because pricing is basically the same no matter the dose (the materials are dirt cheap, the drug is very cheap to make, so they sell “the drug’s effect at however much you need” not “this amount of the drug”, basically) and then stretch it by taking smaller amounts than prescribed, or split a prescription with someone else.
doctorpangloss
Rybelsus doesn’t work.
oatmeal_croc
Of course it does, it is just much less effective than the injectable versions.
alabastervlog
1) Any number of ways, they don’t pay that much. Or,
2) They’re rich. Not even that rich. I mean hell we paid $1,500/month for two kids to go to preschool, for years, and that sucked but we could still save. And we had a household income of like $130k or so at the time. Doing fine, not saying we didn’t have alright income, but not that uncommon. Now imagine a two-FAANG income like many folks on here. $1,000/month, even times two, is entirely within reach for them. Also,
3) You can go off it for periods and just go back on if the weight starts to creep up. Anyone who’s successfully maintained weight for periods in the past may be able to manage long stretches without it and not gain much. And further,
4) It’s not going to cost that much for long, in the scheme of things. The price will likely settle in the tens of dollars per month when the patents expire.
novemp
> And we had a household income of like $130k or so at the time. Doing fine, not saying we didn’t have alright income, but not that uncommon.
Americans with six-figure incomes seriously don't understand the rest of the country lives.
timewizard
> but not that uncommon
Taking in nearly double over the average household income is, by definition, uncommon.
yimby2001
I think that’s a pretty average income for a couple with two children
woleium
They don’t. If you live outside of the USA it is cheaper (e.g. 400 cad a month in Canada)
The article also mentions the grey market, where you can buy a year’s worth of power from China for a couple hundred bucks. You do need to be able mix it up properly though.
black_13
[dead]
noduerme
Knowing a couple people who've done it, they do it for a few months to lose weight, then stop taking it and try not to gain the weight back. I don't know anyone who's chosen to go on it permanently.
SkyPuncher
I'm doing essentially right now. Not big by any means, but loosing 20 to 30 pounds would be amazing for my joints.
For me, I've been at a stable weight for over a decade. I figure if I can drop down over a few months, I can stay at my target weight.
doctorpangloss
The drugs have been cheaply and widely available for a little over 17 months, and by some measures, about 1/3rd of patients prescribed semaglutide or tirzepatide are forecasted to be using either permanently.
jandrewrogers
Americans are wealthy and don’t even realize it. The median household has >$1000 left over each month after all ordinary expenses against income, per the US government’s own data and statistics. Not everyone can afford it but a large percentage can. They may value this more than many other things they can waste that excess income on.
The drugs are only going to get cheaper with time.
ergonaught
Most people I know using it were using insurance, so paying much less than that, however for many of them the insurance companies are dropping coverage for it. That had pushed some to the compounding, and thus ozempocalypse as that avenue is removed as well.
unsnap_biceps
I can afford 1k/month and will if that's what's required. My life is well over 1k/month better with a healthier weight. I preform better at work, I'm happier, and I should live longer. That's worth the money.
doctorpangloss
The status quo was pretty good for the FDA. Lily and Novo Nordisk still saw major stock price rises. Patients had super cheap drug options for something that would free up lots of money for non-medical spending in the economy. Why does an administration ruling via EO not keep the compounding loophole? It aligns with their goals. IMO, the compounders need to turn this into a media sound bite sized win for politicians. Because it certainly doesn’t make any scientific or objective medical sense to cease the compounding.
wewewedxfgdf
I'm far from convinced that some random "compounding pharmacy" produces effectively the same thing as Ozempic.
oatmeal_croc
The thing is, GLP-1 isn't that hard to make, and these compounding pharmacies make effectively the real thing.
SkyPuncher
Even further, most drugs aren't _that hard_ to manufacturer.
The hard part is discovering them and proving they're safe and effective.
unsnap_biceps
Compounding pharmacies existed before Ozempic and their entire business model is producing custom drugs at reasonable prices. For Ozempic, they order the GLP-1 peptides from a large Pharma company and then mix it to order with bacteriostatic water and any other additives. Mine includes a B-12 compound that is attempting to help with the weight loss. They are highly regulated and require trained and licensed employees. The compounding pharmacies I don't trust are the ones that only started to do Ozempic and nothing else. But I do trust my local one. They've made me medication for my animals for decades now.
wozniacki
Is there a compounding pharmacy aggregator online youve found trustworthy?
Mazy
https://www.glpwinner.com/ is a good resource for comparing compound glp-1 providers
timewizard
What do you believe is different between their process and the patent holders?
doctorpangloss
What would convince you?
This is actively improving health outcomes for millions of people so of course insurance won't cover it and it is being taken away from consumers. If the shortage is over, why does it cost $1k or even $500? Sounds like there is still a shortage to me. I guess vaccines are out but price gouging is still in in the US healthcare system.