Introducing The Journal: Trillion Dollar Shot

This episode delves into the development and impact of a new class of pharmaceuticals for weight loss, exemplified by drugs like Ozempic and Mounjaro.

1. New weight-loss drugs like Ozempic and Mounjaro have significantly altered the landscape of obesity treatment.
2. The drugs have sparked a mix of excitement and skepticism due to their effectiveness and high costs.
3. Pharmaceutical companies like Novo Nordisk and Eli Lilly are at the forefront of this innovation, potentially leading them to trillion-dollar valuations.
4. The episode highlights personal stories of significant weight loss and improved quality of life, reflecting the drugs' profound personal impacts.
5. Concerns remain about long-term safety, the high cost of the drugs, and their accessibility.

1: Birth of a Blockbuster

This chapter discusses the origins and development of GLP-1 based drugs like Ozempic, featuring insights from industry leaders and scientists. Key topics include the initial skepticism and the eventual breakthrough in drug development.

• Bradley Olson: "It's so easy to lose weight on the medicine; you don't really have to use any willpower."
• Jessica Mendoza: "Are these drugs a true turning point for America's struggle with obesity?"

2: The Rise of Ozempic

Exploration of Ozempic's rise to prominence, including its marketing and cultural impact, as well as the ethical considerations of its use for weight loss.

• Lars Rubin Sorensen: "We knew we had something big, potentially a game-changing drug."
• Jessica Mendoza: "Ozempic's success has not just been a clinical but also a commercial phenomenon."

1. Consult Healthcare Professionals: Always consult with a healthcare provider before considering new medications for weight loss.
2. Understand Long-Term Commitment: Be aware that these drugs may require long-term usage to maintain weight loss benefits.
3. Assess Financial Impact: Consider the financial implications, as these drugs can be expensive and may not be covered by insurance.
4. Stay Informed on Developments: Keep up-to-date with the latest research and discussions about the drug's efficacy and safety.
5. Consider Lifestyle Changes: Combine medication with lifestyle changes for a holistic approach to health and weight management.

Today we’re presenting Trillion Dollar Shot, a new series that explores the business story behind the rise of Ozempic and other blockbuster drugs being used for weight loss. The first episode focuses on the Novo Nordisk scientist who invented the compound that paved the way for Ozempic. You can find every episode on The Journal's Show Feed.

Trillion Dollar Shot is part of The Journal, which is a co-production of Spotify and the Wall Street Journal. This episode was hosted by Jessica Mendoza, with Bradley Olson. It was produced by Matt Kwong, with help from Jeevika Verma. Additional production from Adrienne Murray Nielsen. The series is edited by Katherine Brewer. Sound design and mixing by Peter Leonard. Mixing for Science Vs by Bobby Lord. Music in this episode by Peter Leonard and Bobby Lord. Theme music by So Wylie, remixed for this series by Peter Leonard. Special thanks to Maria Byrne, Stefanie Ilgenfritz, Kate Linebaugh, Peter Loftus, Sara O’Brien, Enrique Perez De La Rosa, Sarah Platt, Sune Rasumssen, Jonathan Sanders, Nathan Singhapok, Leying Tang, Rolfe Winkler, Liz Essley Whyte, and Tatiana Zamis.

People

Bradley Olson, Jessica Mendoza, Lars Rubin Sorensen, Mads Krogsgaard Thompson

Companies

Novo Nordisk, Eli Lilly

Content Warnings:

None

Wendy Zuckerman
Hi, I'm Wendy Zuckerman from science versus today. We've got something a little different for you. We are sharing an episode from the journal about the rise of Ozempic and other blockbuster drugs that are being used for weight loss. And this episode is part of a series that the journal is doing called trillion dollar shot. Now, if you listen to science versus a lot, thank you.

But you'll know that we've covered these kinds of drugs a bit, and we've talked about how they work and what their potential side effects are. But in this episode today, you're going to hear the details, details of how these medications first got made and how for a moment there, it looked like Big Pharma was going to stop their development. Trillion dollar shot is coming up just after the break.

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Jessica Mendoza
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Bradley Olson
I admit to a slight bit of syringe anxiety. I'm not happy to admit that. But, you know, that is something that I've dealt with. So whenever I back in January, I hopped on a video call with my colleague Bradley Olson, who's out in San Francisco. Brad was about to give himself a dose of a drug he'd been taking for weight loss.

Jessica Mendoza
It was an unusual and personal moment for a coworker to share. Whenever I would get it, like, the first couple times, I would like, just breathe in, breathe out, you know? And then it would feel like, ridiculous because it's like a very small pin prick that you barely feel, you know? Brad has struggled with his weight for more than 20 years, and he said this medication made it easier than it had ever been for him to lose weight. In five months, Brad had lost about 40 pounds.

Bradley Olson
You know the thing that was in the beginning, like a revelation. I know that sounds crazy, but like, without medicine, when I would eat well, when I would kind of follow a good course, I would just feel very hungry and it wouldn't be a good hungry. It would just be annoying. Annoying and disruptive and frustrating when you're on the medicine. It was just great.

Those voices, which I came to really hate, were just silent.

Jessica Mendoza
This medicine is part of a new class of pharmaceuticals that has exploded in popularity over the last few years. The most well known is Ozempic. Brad was taking one called mounjaro. Anyway, so I'm gonna take my syringe out of the box. It's five milligrams and you know this, it's refrigerated so it feels vaguely cold.

Bradley Olson
You can put the injection in your upper thigh or in your like, belly or stomach. I have never done the belly just because I don't want a syringe in my belly. And so the thigh was always kind of where I put it.

Jessica Mendoza
That day. That dose was Brad's last shot. He had decided to stop taking the medication. So without further ado, here we go. Here's the last hurrah of Brad's time with mounjaro.

Bradley Olson
All right, there we go.

Jessica Mendoza
How do you feel, Brad?

Bradley Olson
It's done. I think I feel good. I feel a little bit of anxiety. Yeah, because it's, when you're on the medicine, it's so easy to lose weight that you don't really have to use any willpower or plan or anything. It just is going to happen and you know it's going to happen.

Jessica Mendoza
Brad documented his journey on and off the medication because his time on the medicine and his decision to stop taking it stirred up a lot of feelings. Surprise, anger, uncertainty. It was a lot. So after Brad took his last shot, he and I decided to report on the impact of these drugs. We set out to understand, are they a true turning point for americas struggle with obesity?

And if so, are we ready for everything? That would mean. Because people who've taken these medications told us the same things over and over again. All of a sudden just the weight starts falling off, you know, eight pounds the first month, I felt like it was a miracle. Three pounds the second month, life changing for sure.

Ten pounds the third month, that's how powerful this medication is. Then it just was like, how is this happening? I could tell it was working and I could tell that it was changing my relationship with food. And I liked that. This type of success has meant huge windfalls for drug makers.

Lars Rubin Sorensen
We said, oh, Jesus, this can become a big, big drug. It's been a boon. There's no denying that, you know, the. Demand is higher than what we can deliver to people today. And that demand for these drugs is reverberating across society.

Lotta Bier Knutson
And I thought, well, I'll stay on. This for life because it's so helpful. And then I realized what it was gonna cost me. They're just bank breakers. Okay.

Bradley Olson
If I can't get the drug, what can I take instead? What's close? There are so many people even selling bathtub ozempic. There was a lot of excitement, there. Was a lot of skepticism.

Dave Moore
And I can imagine a future where life expectancies are actually increasing because of this class of drugs. Whether you think these drugs are a myriad or you're skeptical of what they promise, they're changing how we approach one of the most intractable issues in our society. Obesity. And it's just the beginning.

Jessica Mendoza
From the journal. This is trillion dollar shot. I'm Jessica Mendoza. And I'm Bradley Olsen.

This is episode one, birth of a blockbuster.

So why did you want to lose weight?

Bradley Olson
I'm trying to be as honest as I can. As I think about it, it's a hard question. Yeah. And I wanted to look better. You know, I know that some people will say it was for my kids, and it was.

I wish that I had some noble reason. I'm just being honest, you know, the noble reason is like, I've got kids and I want to run with them and I would think about that, but I would run with them and I would think about other things. But in the end, I felt like Im not supposed to be like this, you know, this isnt me. Brads story is familiar to millions of Americans. For decades, obesity has been on the rise.

Jessica Mendoza
The CDC says one in three adults in the US is obese. The condition is linked to shorter life expectancy, to diabetes, heart disease, and to some cancers, not to mention larger health care bills. And billions have been poured into addressing the issue. But nothing's been able to bring the numbers down. What most doctors recommend, diet and exercise.

They don't work long term for most people. And short of surgery, the great minds of industry, technology, and medicine just haven't been able to find an effective treatment until this new class of drugs. Every doctor interaction that you have when it's about weight loss is always the doctor's like, I'm telling you things that you're not going to do. They don't say that, but it's just the subtext is basically like this conversation of, I'm telling you things to do and I don't think you're going to do them. It was like we were performing in a play.

Bradley Olson
He was pretending to be a doctor that believed he was giving good advice, and I was pretending to be a patient that was listening and was really going to make a change. Neither was true. And the difference with this conversation was like, this is going to work. There was no doubt about whether or not it was going to work. And that was such a difference.

Jessica Mendoza
And how did it go? How quickly did you start to lose weight? What were your reactions? I was just shocked. I had heard people talk about being on the medicine and how it really zapped their cravings.

Bradley Olson
You know, I had read that, but to experience it is another thing entirely. Brad's going to share more of his own story throughout this series, but first we want to go back to where it all started. Ozempic was developed by a danish pharmaceutical company called Novo Nordisk. The story starts in the 1990s with a woman named Lara Bier Knutson. I did a lot of work in the laboratory.

Lotta Bier Knutson
I was the lab rat. Lotta was a young scientist at Novo Nordisk. When she was just starting her career, she was focused on what most scientists at Novo were there to do, develop drugs for treating diabetes. I always wanted to work for this company, and I was very set on wanted to make product related research. I never wanted to be an academic researcher.

I just knew that I wanted to make products that could somehow be useful for human beings. And Lara had a bit of a reputation. I won't say that I have a temper, maybe some people would say that about me, but I'm very dedicated and energy. I had ideas. I wasn't really shy, and I didn't not give up too easily.

Jessica Mendoza
And so what was it that you were working on? We had all kinds of ideas. You know, at that point in time in pharma for diabetes, there was a big desire to do something new, you know, and then GLP one was just one of those ideas that were around in the community at that time.

GLP one, it stands for glucagon, like peptide. It's a gut hormone, and it's the basis for this new class of drugs. When Latta started working on it, there was research that showed that the GLP one hormone lowered blood sugar levels, which is important for treating diabetes. But no one had figured out how to make GLP one work as an effective treatment. It didnt hold up in the human body for long.

Lotta Bier Knutson
It was gone in two minutes. That was really the problem to be solved, was to make GLP one long acting. So when you say gone in two minutes or making it long acting, does that mean it breaks down in the body as soon as it appears? Yeah. There are several ways that things can disappear from the body.

One is that metabolic enzymes can degrade it, and also things can be taken out via the kidneys. Lotto worked with a team to try to solve this puzzle, to try to get this powerful hormone to stay in the body long enough to work. But then she went on maternity leave, and when she came back in 1994, Novo had gone through some restructuring. Most of the people I work with, they were gone. So I was kind of like the only one that knew anything about those projects.

And the new leadership said to me, you know, you are the one that kind of knows this biology, so you figure out what we should do. What did you do? Did you freak out? Not so that anyone can see it, right. But it was a little bit of a lonely time, right.

Because the people that I considered my closest work friends, they were gone, right. So I still had a group of laboratory technicians that were working with me and doing cool things in a lab. But this thing about figuring out how to lead the project, which idea to focus on, I was completely alone with that. So I was basically sitting in my office for a couple of months, kind of staring at the walls.

Jessica Mendoza
Lotto is now leading the GLP one team, but they weren't making much headway towards a functional drug, and leaders at Novo started to get antsy. Leaders like this guy? Yeah. My name is Lars Rubin Sorensen. I used to be the CEO of Novo Nordisk.

GLP one research was not the company's priority. So Lars was like, why were they even messing around with this hormone? Well, I have to admit, at the time, I thought it was a strange idea. We were primarily selling insulin, right, and competition in the area of insulins were. Were quite fierce.

Lars Rubin Sorensen
This GLP one compound was very, very short lived, and really, it was difficult to create a drug out of it. Quite frankly, I was worried that we were spreading our resources too thinly. We were a small company, so I knew everybody, and they would come into my office and ask for more resources. I asked Lars if Lada was one of those people. Oh, yeah.

All the time. I could not meet Laura without her really getting on my case to prioritize her projects. Better. Lauder Knudsen is a person that's very, very difficult to say no to.

Jessica Mendoza
Even with Lara pushing the project, Lars considered canning the whole thing. I do recall that we did give him twelve months to say, you gotta come up with something which is more convincing. And my recollection is it was extraordinarily slow developing at the time. And I'm sure a lot of people say this is because we had no resources. But anyway, because of their stubbornness and their skills and their professionalism, they eventually were able to create a molecule that was protracted.

Lars Rubin Sorensen
So it became a real drug that we could start to make clinical trials on. Lada and her team had met the deadline. By then, it was 1997. All told, it had taken about four years for them to create a compound that mimicked the effects of glp one and didn't immediately break down in the body. They called this compound liraglutide, and it stayed in the body for 24 hours.

Jessica Mendoza
Think of it as a precursor to Ozempic. Same scientific idea, just not as powerful. The next step was to test liraglutide on patients. But inside Novo Nordisk, Latta's team still had to fight for limited resources. And that problem fell to Latta's boss.

Mads Krogsgaard Thompson
As a very young lad, I had big hair, big, curly hair, lots of hair. Not anymore. And so I look like a typical young, nerdy scientist. That's Mads Krogsgaard Thompson, a former senior vice president at the company and a big champion of Lattas. And he wasn't afraid to get creative to keep her project going.

Well, the first stumbling block was that we were a little bit behind in production capacity for insulin. So we literally had no utilization of any production facility in the company. So I had to give the team money to go to Belgium to ask another functional company to produce it for us. And so you had to do it basically off campus to get this stuff. Done in a competing company.

Already in a competing company, another company. Eventually, they did get enough medicine for human trials, but at first, it produced a really nasty side effect. The people in the phase one trial, they vomited. Wow. So they literally felt sick.

And this, of course, didn't convince management that this was very exciting at all. Right. They were like this. I don't know what you guys are doing over there, but it doesn't seem to be working. No.

So there was actually a feeling of, okay, is this the end stage for this GLP one project? And then there was a concern about cancer. We saw tumors in rats and mice up here in the thyroid gland. And suddenly, these tumors seem to be happening dose dependently over time in rodents. Luckily, we didn't see them in rabbits.

We didn't see them in dogs, we didn't see them in monkeys. But the regulators, FDA, and so on were not happy with seeing tumors in two species.

Jessica Mendoza
The team did more testing, and ultimately they concluded that the tumors they saw in rodents were not relevant in humans. But it would take years before the FDA was satisfied that Novo's liraglutide was safe for people. Inovo Nordisk still advises against taking GLP one drugs if you have a history of thyroid cancer. So the FDA approved liraglutide in 2010. Do you remember the moment you heard about it?

Mads Krogsgaard Thompson
My wife and kids had gone to bed, and then I actually. I get a phone call at, like, 1130 in the evening mass. We've got it. We've got an approval. Wow.

And, you know, you just shout out loud, and I just got extremely excited so much that my family woke up and was really annoyed with me. They're like, why are you so excited? It's the middle of the night. Yeah, yeah. I had to apologize.

So I took a good McAllen whiskey, took a good shot of that, and celebrated over the phone with the colleagues. Yes, I was in my bed, but the minute I saw the number on my phone, I knew we got this. I felt a great sense of accomplishment. It was more than ten years in the making, and, you know, and if we hadn't gotten that us approval, maybe it would have been just not going anywhere. That would have been a great shame for the people who need this kind of medicines.

Jessica Mendoza
Liraglutide went on sale under the brand name Victoza. It was approved to treat type two diabetes, and it was a modest success. More importantly, though, it was a proof of concept. Lada's GLP one research had led to an effective drug, and the next drug, a new invention building off liraglutide, was already in the pipeline.

It would be a blockbuster, one that would turn Novo Nordisk into a company that was known for more than diabetes. Because here's the thing. Since almost the beginning of Latta's research, she knew that GLP one had another weight loss. Did that surprise you that. That it was weight loss, really, that made these drugs kind of soar to the top and make it kind of a household name at this point?

Lotta Bier Knutson
Yes and no, because I remember I've heard it for such a long time, ever since back to the early two thousands when I was first lucky enough to be able to actually hear from some patients. They had tears in their eyes and they said, you know, I've been hungry for 20 years now. I can manage to have a normal life. So how did a diabetes drug turn into a weight loss phenomenon? That's after the break.

Bradley Olson
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Thank you. Welcome to what we call the factory of the future within Novo Nordisk. At the drug company Novo Nordisk they're very serious about how you wear your socks. When you put your socks on, it would be something like this. Put them on.

Jessica Mendoza
Don't put your foot. Novo Nordisk is based near Copenhagen, Denmark. The factory there is a hive of activity. All right, just keep an eye out. Now we're in the area with a little bit more robot traffic.

On an assembly line, a machine places vials of clear liquid into blue syringes. You can see the pens clattering out.

What's on the line there? Semaglutide.

Semaglutide or semaglutide. Semaglutide. Semaglutide. Semaglutide. Semaglutide.

We've been saying semaglutide. Is that right? That is so correct. Okay. Cause you hear, like, semaglutide, or so that's incorrect.

Mads Krogsgaard Thompson
It is. It's symmetricide, for the record. Thank you. However you say it, semaglutide is Novo's successor to liraglutide. It came with some side effects, nausea, vomiting, gastrointestinal issues.

Jessica Mendoza
But semaglutide is a more effective glp one compound, and you only need to take it once a week instead of once a day. It's also the key ingredient in Ozempic.

In 2017, the FDA approved Ozempic specifically to treat type two diabetes. That year, Novo Nordisk geared up for a big us campaign. Did people inside Novo realize they had a hit or a blockbuster in Ozempic around the time of the launch? So there was a lot of excitement and preparation. We thought this could be one of the most important products that the company had brought to market.

Dave Moore
Today. That's Dave Moore. He was in charge of sales and marketing when Ozempic launched in the US in 2018 with a possible hit on their hands. Dave says the company started to get the word out. They promoted the drugs ability to lower blood sugar levels to specialists and doctors, and they spent a lot of money on branding and marketing.

Jessica Mendoza
But you probably know that already because of this catchy tune. Oh, oh, oh. People with type two diabetes are excited about the potential of once weekly Ozempic. Who came up with the idea for the jingle? We test these, and there was a really, you know, strong recall, which is important in any of these campaigns.

Like, did you like this song? Did it resonate with you? I did know the song, and I can actually tell you the first time I heard it, and I'll date myself, but I was roller skating back when I was in school in 75, and, you know, it was a hit, right? I don't know if you'll healers. Oh, it's magic, you know, never believe it's not.

Dave Moore
So.

David Payton
There you go. That's incredible. My name's David Peyton. I'm the singer songwriter with the band pilot, and I wrote the song Magic being used by ozempic extensively. David Payton wrote magic 50 years ago.

Jessica Mendoza
He didn't think too much of the fact that it was recently picked up for a drug adjustment, not even when he saw the company Novo Nordisk on his royalty statement. David figured magic had been used many times before. When it first came out in 74, Coca Cola got in touch with me and they yeah, it's been used extensively for a long time. And even Selena Gomez, you might know she had a pretty big hit with it in the States around about 2009 or thereabouts. I've heard lots of hip hop versions, which are very strange because, you know, there's a lot of rapping going on and then the chorus is used.

David Payton
Flo Rida did a version of magic. But something about this version seemed to land differently. About a year after Ozempic hit the market, David was at home in Scotland when he got a call from a. Friend and he phoned me up, really excited, and said, david, do you realize your song is on television here in the states? And he said, it must be every 20 minutes I'm hearing your song.

And I said to him, well, I knew it was being used, but I didn't realize it was that much coverage that was going on in the States. Ozempic was really starting to pick up steam, except the hype wasn't because it was a drug for diabetes. People were talking about it for weight loss. It's known as Hollywood's worst kept secret as celebrities dropped noticeable amounts of weight quickly. I mean, I cannot scroll through my social media without someone mentioning the ozempic diet.

Bradley Olson
By the way, you've been working on your body and on your health. No, that's Ozempic the topic. Ozempic has over 300 million views. When I look around this room, I can't help but wonder, is Ozempic right for me?

Jessica Mendoza
Now, companies cant promote their medicines for off label use, but its not unusual or necessarily unethical for doctors to prescribe a drug for something it isnt FDA approved for. I asked Dave Moore about all this. Hes the guy who led the launch of Ozempic in the US. As you know, today, a lot of people dont necessarily associate ozempic with diabetes. They associate it with obesity treatment and weight loss.

How did that happen? And when did people at Novo start realizing that it was being prescribed off label for weight loss? Yeah, im glad you asked that question. Ill start with the first part. Its really important.

Dave Moore
And id love to stress to your listeners that Ozempic is for type two diabetes. And I would ask everyone to really think about the uses of these medicines based on what they're intended. For. The second part, to your question, we knew that there was a need for a new medicine for people living with obesity, and we were studying higher doses of semaglutide for chronic weight management. And that was in clinical trials while Ozempic, of course, was being launched into the market as a type two diabetes medication.

Jessica Mendoza
I totally understand what you're saying. However, it did happen that doctors prescribed Ozempic off label. I mean, they were making jokes about it at the oscars, like, what do you do in a moment like that? Yeah, you know, I think what we have to do is play our role and do our part to ensure that we try to correct, you know, anytime that happens. We of course, you know, are not denying that those, those things happen.

Dave Moore
Right. We're not, we're not being shy. We see the media and ultimately clinicians make the choice, right. And our position is firm and clear. We don't want Ozempic used off label and we only want it to be used as it's intended.

Jessica Mendoza
As Dave mentioned, Novo was doing research into their GLP one drugs and weight loss. But for a long time it wasnt the priority. Diabetes was because drugs to treat obesity looked like a risky proposition. Heres Lars Rabian Sorensen, the former novo CEO. I was not against that.

Lars Rubin Sorensen
I actually thought it was a good idea. However, I was a little bit cautious about expressing this publicly because at the time, almost all, without exception, weight lowering drugs have failed, some even so badly that companies were sued. So I knew that if we started talking too much about the obesity effect of GLP one, we might taint a very good diabetes drug. There was a quote that's been circulating the Internet a little bit that is attributed to you from 2005, where you say that obesity is primarily a social and cultural problem. It should be solved by means of a radical restructuring of society.

Jessica Mendoza
There's no business for Novo Nordisk in that area. Do you remember saying that? I remember that and I believed that at the time. Yeah, I was not aware at that time of the great difficulty number of people with severe overweight. I have absolutely no doubt that I said this.

What ultimately changed your mind about developing GLP? Ones for obesity treatment. First of all, you get in contact with these individuals that are struggling with this for their entire life. That has an enormous impact on you as an individual. Then there's also a.

Lars Rubin Sorensen
A commercial motive in this. This is a huge potential commercial market for the company. So it was composite of patient consideration, but also pursuing a commercial opportunity for the company. So Novo Nordisk released Wigovi in 2021, a higher dose of semaglutide approved specifically for weight loss. In one major trial, patients lost an average of about 15% of their body weight in just over a year.

Jessica Mendoza
And it wasn't just Novo. Another pharmaceutical giant, Eli Lilly, had also been working on GLP one s for years. And in 2022, they were hot on Novo's heels. Eli Lilly answered Novo's semaglutide with their own compound, trizepatide. Trizepatide mimics two gut hormones, GLP one and another one called gIp, that made terzepatide even more effective.

In the spring of 2022, Eli Lilly released Manjaro, which was approved for type two diabetes. I started taking Mangyro, and I've lost 65 pounds. Last year, they came out with zep bound for weight loss. Zep bound, made by Eli Lilly, potentially more effective for losing weight than any other drug on the market. And GLP one medications also got a huge endorsement from one of the most trusted voices in America.

Bradley Olson
For 25 years, making fun of my. Weight was national sport Oprah. In my lifetime, I never dreamed that. We would be talking about medicines that. Are providing hope for people like me, who have struggled for years with being overweight or with obesity.

Jessica Mendoza
Suddenly, Novo Nordisk and Eli Lilly were leading a booming market. Novo is now the most valuable company in Europe. It's locked in a race with Lilly to become the first trillion dollar pharmaceutical company by market cap. And demand for these drugs has gotten so high that Novo and Lilly cannot keep up. The FDA put semaglutide on an official shortage list in 2022.

Terzepatide followed just months later. Here's Novo's Mads Thompson again. Did you ever dream that it could be this big? Ultimately, my dream, but that was just a dream, was that one day it could be the number one drug class in the world. And right now, this year, the latest forecast is that the GOP one class is actually going to be the number one drug class in the world.

Mads Krogsgaard Thompson
But it's gone surprisingly fast, to the extent that neither we nor our peers at Eli Lilly can deliver enough product to satisfy the market.

Jessica Mendoza
Thank you for calling Walgreens pharmacy, how. Can I help you? Rory. Pharmacy, how may I help you? Go.

Pharmacy, how can I help you? Pharmacists can't stock the stuff fast enough. My colleague Brad Olson, you heard from him? At the start of the episode. He and I called a bunch of pharmacies all over the country.

Bradley Olson
I'm just calling to see if you have any GLP one drugs in stock, like Ozempic or Mountjaro. No, we don't. No, unfortunately, we do not. We haven't gotten it in the past few months. No, it's not available.

Lotta Bier Knutson
I think next month is going to be available. Literally, like every injection right now is so hard to get. We're out of stock on it. On all of it. Yeah.

Jessica Mendoza
Today, theres no doubt Americans want these drugs, but almost everyone we spoke to for the series, from patients to doctors to lawmakers, pointed to the same big price. These drugs are very expensive, about $1,000 a month out of pocket in the US. Insurance often wont cover them for weight loss, and it's recommended that the medicine be taken for life or else studies show people gain the weight back. My colleague Brad also ran into the affordability issue. And so you did stop taking Manjaro after about five months.

Why? I would say it's mainly cost. I just can't afford, you know, that expense over the course of my lifetime out of pocket. And so for me, starting without insurance is sort of like a choice where you know in the end that the jig is up. Like, you're not gonna be able to keep taking it.

Mm hmm. So how long after your last dose before you started to feel the cravings come back? It was probably three weeks. Okay. It became hard because it became like, you're kind of without a net.

Bradley Olson
You know, in the circus, you're on the tightrope and there's no net under you. And the medicine was like having the net. You're like, oh, I can fall off this tightrope. No big deal. That's what it feels like.

Jessica Mendoza
Yeah. Brad decided to go without a net. But as we reported the series, he and I talked to people who weren't so willing to give up a drug that they felt changed their lives, even if it was more than they could afford. Okay, if I can't get the drug, what can I take instead? What's, what's close?

And so they resorted to riskier measures. What I received in the mail was a tiny vial filled with white powder. Okay. Which could, honest to God, be anything. Cause, like, who knows?

That's next time on trillion dollar shot.

Trillion dollar shot is part of the journal, which is a co production of Spotify and the Wall Street Journal. This episode was hosted by me, Jessica Mendoza with Bradley Olson. It was produced by Matt Kwong with help from Jivica Verma, additional production from Adrienne Murray Nielsen. This series is edited by Katherine Bruce. Fact checking by Sophie Hurwitz series art by Pete Ryan sound design and mixing by Peter Leonard.

Music in this episode by Peter Leonard and Bobby Lord. Our theme music is by so Wiley, remixed for the series by Peter Leonard.

Special thanks to Maria Byrne, Stephanie Ilgenfritz, Kate Linebaugh, Peter Loftus, Sarah Obrien, Enrique Perez de los la Rosa, Sarah Platt, Suna Rasmussen, Jonathan Sanders, Nathan Singapoc, laying Tang, Rolf Winkler, Liz Esli White, and Tatiana Zamis. Thanks for listening. Episode two drops next Sunday, May 19.

Wendy Zuckerman
Hey Wendy, here again. So that was episode one of trillion dollar shot from the journal. You can listen to the series by finding the journal wherever you get podcasts, we'll be back in your ears with an episode of science versus in just a couple of days. And we are diving into the science of protein. How much do you really need to get jacked or to, you know, just be healthy?

It's a really, really fun episode. I can't wait to share it with you. I'm Wendy's looking back to you in a couple of days.