The Journal. - Trillion Dollar Shot, Episode 2: Bank Breakers

Episode Date: May 19, 2024

As demand for the new class of GLP-1 weight-loss drugs skyrockets, one thing has stood in the way of many people trying to access them: cost. With a price tag around $1,000 a month for U.S. patients and many insurance companies refusing to cover these drugs for weight loss, patients are often turning to alternatives. In episode two of “Trillion Dollar Shot,” we look at the roadblocks to making these drugs more affordable, concerns that their high cost will negatively impact U.S. insurance systems, and the sometimes risk-laden options people are turning to in desperation. Listen: Trillion Dollar Shot, Episode 1: Birth of a Blockbuster   Learn more about your ad choices. Visit megaphone.fm/adchoices

Hey, this is episode two of our new series on weight loss drugs, like Ozempic. If you haven't listened to episode one, it's in your feed, and you can find a link to it in the show notes. Hey, Brad. Hey, Jess. I'm so excited that you're hosting this episode with me. Me too. I'm so happy to be here.

So, Brad, in our last episode, we talked about this new class of drugs. Ozempic and Wigovi by Novo Nordisk and Mount Jaro and Zepbound by Eli Lilly. And we talked about how they've become these huge blockbusters. Yes, I mean, everyone wants them. The demand is wild, even though they're really expensive. You know, when I was on Mount Jaro, I used money from a healthcare savings account,

which made it a little easier for me to afford. But the total I was paying, you know, with that included, was just over $1,000 a month. And it changed a little month to month, but eventually I had to stop taking it, even though it was working so well, because I just couldn't afford to keep paying that amount after the health savings account ran out. Right. The list price of Ozempic is about $970 a month. And granted, there are some pharmaceutical drugs that are like 10 times this amount.

It's just that they're usually covered by insurance. But if you're paying out of pocket, like a lot of people are on these drugs for weight loss, $1,000 a month is a chunk of change. Yes, and affordability is something that we heard about from almost everyone we talked to for this series. And one woman I spoke to, her story really stuck out to me. Her name is Lori Ciccatello. She's 53, and she lives in Colorado. So Lori was put on Ozempic by her doctor a few years ago for her type 2 diabetes.

It helped a lot and it also helped her lose weight. I could tell it was working and I could tell that it was changing my relationship with food. And I liked that. Because I just hadn't really had that kind of aha moment when I was trying to eat keto or whatever. Do anything else, really. Because I'm 6'2 and 400 pounds. And it's just, I'm a big person. So people are just like, well, just go exercise. Like, it's just, I'm a big person. So, you know, people are just like, well, just go exercise.

Like it's nothing, but it's, when I move, it hurts. How much weight did you wind up losing on a Zympic that first time? At that point, I had gotten up to 450 pounds. I could barely move because I just hurt so much. But yeah, I went from 450 and I went down to 350. So I lost 100 pounds. Now my thing is, of course, well, you can't really see it because 350 pounds on a six foot two frame is still a lot.

But 100 pounds off of me was better. And I felt like I was more motivated to get out of bed. And, you know, yes, I was in pain, but I could just move better. Why did you have to stop taking Zempik ultimately? Because it got too expensive. Ugh, every time I hear that, it's just so hard to hear, you know. I know, it really is. And Lori's insurance is Medicare because she has a disability,

and it did cover Ozempic at first, but she says after a certain point, it stopped. But Lori didn't want to stop taking Ozempic. She started feeling pretty desperate, and that's when a friend told her about another option. She'd found a way to order online what's called research-grade semaglutide. Now, semaglutide, that's the active ingredient in Ozempic. Exactly. So, Lori gets a package delivered to her house, but this package was not from a regular pharmacy.

What I received in the mail was a tiny vial filled with white powder. Okay. Which could, honest to God, be anything because, like, who knows? And then there was a little vial of, and I'm going to say the word wrong, bacteriostatic water that you would then add to the vial with the powder in it. And you shake it up. And then the white powder just dissolves. So it just looks like a clear fluid in there.

And you have to do that mixing yourself. You do that mixing yourself. And I don't know how much back to asteriac water do we add into this. I don't know. There's no instructions? There's not really instructions for it. My friend goes, just watch on YouTube. There's YouTube videos on how to do this. I'm like, are you kidding me?

So you will get your peptides in a dried version, and you'll get some bacteriostatic water to mix the peptides with so that they're usable. And then this company that sent me these products also sent me like four or five diabetes needles. And so you fill these syringes up and then you have to tap them to get the air bubbles out. And I'm sitting there and I'm flicking the little syringes, like doing the tip, tap, tap, tap, tap, you know, on this, trying to get the air bubbles out. Did I get enough out? Is this okay? Do I have enough product in here? Oh, yeah. Don't think that would work for me. I mean, I already don't like needles. So, you know, that gives me the heebie-jeebies for sure.

Yeah. I mean, Lori was pretty sketched out as well. She was doing this medical thing without any real medical guidance. But being willing to try an unregulated online product like this that claims to be the same active ingredient as Ozempic, it kind of gets at the lengths to which people are willing to go to get these drugs at an affordable price. Yeah, and that's what we're talking about today on the show. Exactly. Why are these drugs so expensive?

Why doesn't insurance always cover them for weight loss? And where are desperate patients going instead? From the Journal, this is Trillion Dollar Shot. How a new class of drugs is transforming bodies, fortunes, and industries. I'm Jessica Mendoza. And I'm

Bradley Olson. This is Episode 2, Bank Breakers. We'll see you next time. You'll love it so much you'll want to extend your stay beyond the matches. Get the ball rolling on your soccer getaway. Head to visittheusa.com. Whether you're practicing your morning breath work, waiting for your favorite artist to come on stage, or running errands at the perfect pace, liquid IV powder helps you turn ordinary water into extraordinary hydration so you can live a more extraordinary life. Live more with Liquid IV

Hydration Multiplier. Available in refreshing lemon, lime, passion fruit, and strawberry flavors. Buy a stick in store at Costco, Walmart, Amazon, and other Canadian retailers. When it comes to accessing these drugs, cost and insurance came up a lot. Would you, if it came down to it, pay this out of pocket? Unfortunately, I don't have excess cash. I thought, well, I'll stay on this for life. And then I realized what it was going to cost me. I knew that I was not going to be able to get it covered through insurance, so I was going to have to pay out of pocket. I'm worried that my insurance is not going to cover it forever. My insurance did not cover it. Insurance typically covers these drugs for type 2 diabetes, but it's a lot harder to get

them covered for obesity. When we talked to our colleague Liz Esley-White about this, she walked us through why these drugs are a big financial issue for insurance companies. These drugs are so expensive, they're a complex problem for any insurer to solve. What's the rationale for the insurance companies? They're just bank breakers. They cost a lot of money. Everybody's going to want them. And especially if you have a big chunk of your people that you're covering, you know, you end up with budget-busting numbers that you can't sustain. And the insurance system that we have in the U.S. is like struggling with the cost of them. And how can we help all these people that probably could use this and still stay in business? And Jess, there was that

paper from the New England Journal of Medicine last year that said that Medicare could really be strained if it started covering these drugs for weight loss. And Medicare is the largest insurer in America. Yeah, and we actually spoke to the lead author of that paper, and she said that if Medicare covered obesity medicine for every adult in the U.S. who is eligible for it, it would cost more than Medicare's whole budget for prescription drug coverage.

Okay, so I guess the question now is, why do these drugs cost so much? Yeah, especially because recently there was also a study published in the Journal of the American Medical Association, and that estimated that a relatively low dose of semaglutide costs less than $5 to make. NovoNordisk declined to say how much it costs to manufacture their semaglutide drugs, but what they have said about this is that they spent billions of dollars on research and development last year and are making investments on production and discounts on the drugs. And I also brought this up in an interview with the CEO of Eli Lilly, Dave Ricks. He said something

similar about the price of Lilly's drugs, whose active ingredient, if you recall, is trisepatide. And Ricks also had some thoughts about the findings of that JAMA study. I don't think it's well done. I don't think it's even asking the relevant question. It sort of looked at what's the marginal input cost to make a drug. That's not an interesting question because it's ignoring, first, all the research and development. And then they're very complicated to make. So the manufacturing costs are high. If we look,

you know, last year's income statement for the company, about 20% of our revenue we spend on making drugs. And these, I would say, are at the high end of that. But 27% of our revenue we spend researching drugs. So our biggest cost is actually R&D, and our biggest area for research and development right now is Terzepatide. How much does it cost to make Terzepatide? Well, we started looking at Terzepatide in 2010, so that's 14 years ago. We've been spending money at risk ever since, so people need to get a return on that money.

And then since we launched Gersipitide, we've announced $11 billion in capital. We haven't sold $11 billion yet of the drug. So we're deeply underwater here in a cash flow sense so far in the life cycle. We'll make money in the end, and I think we should because it's a useful invention. What he's saying is sort of the same thing, right? These drugs cost what they do because there's a lot of R&D and manufacturing that goes into them. And that even despite the demand, the company hasn't sold enough of the drug to make that money back. Yeah, but they are very likely to make that money back. This is actually quite common in many industries where there may be a very high upfront investment, but it pays off spectacularly in the end. And in this case, analysts have already said that terzepatide drugs could become the highest-grossing pharmaceutical of all time.

So, beyond the price, have pharma companies said anything about making the drugs more affordable or accessible? Yes. So both Lilly and Novo do offer discounts to patients who qualify. Novo said that 75% of its gross U.S. sales goes to rebates and discounts. And Lilly is lobbying insurance companies, employers, and the government to try to get more coverage. Ricks also said that the patents won't last forever, which means there will come a time when the price drops. What happens at the end of the cycle,

which is usually after 12 or 13 years, our patent expires and drugs get super cheap, and that will happen here. And we'll make money because it's useful, we should get rewarded, but eventually, trucepidide will get cheap and go generic. But that patent doesn't expire until 2036.

Which is a long time. So right now, the main way these drugs are going to become more affordable for most people is if more insurance starts covering them for weight loss. But it's hard, right? Like in Medicare's case, it's not just that it can't afford these drugs. Liz told us it legally can't cover them. Medicare can't cover any weight loss drugs. Medicare has a rule that dates back to 2003 that says they don't cover any drugs for weight loss. And at the time, obesity as a disease wasn't as entrenched an idea. And so weight loss drugs were really viewed as a cosmetic thing versus a health thing.

And so they tacked on to some legislation a rule that said you can't cover weight loss drugs under Medicare. But there's been an effort on the Hill to try to change that to get these drugs covered for obesity. And that bill is called the Treat and Reduce Obesity Act, commonly known as TROA on the Hill. I wanted to know more about this bill, so I talked to this guy. Yeah, I'm Senator Bill Cassidy, and importantly for this, I'm also a medical doctor.

Do you ever still get called Dr. Cassidy, or do you prefer Senator now? No, no, no, no. Frankly, doctors get more respect than senators, but someone says, what should you, I'm also a gastroenterologist. So they said, should I call you a doctor or a senator? And I said, you want a bill passed or a colonoscopy? And so most people say senator. Cassidy's the lead Republican sponsor of the Troa bill in the Senate. There have been efforts in Washington over the years to allow Medicare to cover weight loss drugs, but they've never gone anywhere. I asked the senator why he's trying to revive the bill now. Because these pharmaceutical agencies, these drugs are so good. This has the potential to help control healthcare costs by controlling obesity, which in turn will decrease our incidence of kidney failure,

heart failure, diabetes, hypertension, et cetera. And just so people understand this, when I used to teach medical students, I would compare obesity to the Greek monster, the hydra. Recall the hydra had multiple heads. You're nodding your head yes, so I remember that correctly. And so sure, you have obesity, but one of the terrible heads that comes out of that would be the diabetes. And one of the terrible heads would be heart failure.

And one of the terrible heads would be fatty infiltration of the liver. And another one would be kidney failure. And I could keep going down. And so if you, you could slop off each head as I, which I think Hercules did, or you can kill the body. In this case, we're healing the body. We're healing the body by addressing the obesity, which decreases your predilection to all these other conditions. So it's very exciting. Okay, so by reducing obesity and all the risks associated with it, all the heads that pop out of the hydra, you know, cut one head off and two appear, maybe that means less money is spent in the future on stents and heart disease medicine, that kind of thing.

That's the theory. But even Cassidy says he's not sure the math will work out. As a U.S. senator, what are the biggest policy questions these new drugs raise for you? Well, can society afford them? There's a cost-benefit ratio. We have an unofficial, preliminary, no details involved with it, estimate from the Congressional Budget Office that if we offer this to patients in the Medicare population, the excess cost would be $40 billion over 10 years. Masa menos.

So clearly the cost of the medication is a major factor. If we are preventing diabetes and hypertension and all these other things, if despite that we still is costing 40 billion dollars, that's going to be obviously an obstacle. What chance does this bill have of passing? Well, obviously, if you can get the price tag down to where it saves money, it's going to absolutely pass. And if it's kind of, OK, break even, it'll absolutely pass.

So we're looking for that threshold where we can get it to where it gives the maximal benefit with the maximal amount of coverage in a price range that our appropriators feel like we can afford. And did he talk about how he's planning to get to that threshold? He gave a couple different scenarios, like maybe Medicare can cover the drugs just for higher-risk populations, or we'd put limits on how long people can be covered. There are a couple things I want to mention about Cassidy. One is his relationship with the pharmaceutical industry. In the last election cycle, Novo Nordisk donated more than $15,000 to the senator and his PAC, according to a research group that tracks campaign funds. In total, Cassidy has also received almost $800,000 from pharmaceutical and health product companies.

That's about 5% of his total contributions from that period. I asked Cassidy about getting funding from pharma companies. And there's no perceived, you don't perceive any conflict of interest there? You know, not at all. When I say, you know, I always am like Ronald Reagan. Ronald Reagan said that when people donate to me, they sign up for my agenda, I don't sign up for theirs. And so, and I really think the people

who are having the most influence upon me were the people who I used to treat in a public hospital for the uninsured. And if you look at poor people, they are disproportionately affected by obesity. That's what influences me. The echo of my patients who would have benefited from this, but who died in the absence of it. Another thing about Cassidy is that he's against letting Medicare negotiate lower prices with drug companies.

He said publicly that doing that would hurt funding for research and development for life-saving treatments. Now, some of his colleagues across the aisle, like Bernie Sanders, have long argued that allowing Medicare to negotiate drug prices is one of the fastest ways to get these drugs to cost less. Yeah, a lot of other countries do that, and that's one of the reasons why their drug prices are lower.

Medicare just started negotiating prices on some drugs, but as of right now, the drugs we're talking about aren't on the list. Right. For example, one analysis from last year found that the sticker price for a month's supply for a certain dose of Ozempic was $147 in Canada. In Australia, it was only $87. That's compared to, as we've said, more than $900 in the U.S. for the same dose. One thing to note is, even since we started reporting this series, insurance coverage has started getting better.

Even since we started reporting this series, insurance coverage has started getting better. Earlier this year, Medicare approved coverage of Novo's weight loss drug, Wegovi, if patients also have heart disease. Because there are studies that show these drugs also help improve heart health, which is something we'll talk about later in the series. Yes, and maybe long-term, other diseases will be the way people get coverage if insurers remain resistant to weight loss coverage. Right, but that isn't happening quickly enough for a lot of people. Which brings us back to those alternatives we talked about at the start of the show. People are looking to get their hands on these drugs, and some routes they're taking are potentially riskier than others. That's next. Breeze through security. Meeting friends a world away? You can use your travel credit.

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carefully brushes Benjamin Moore Regal Select down the seam of the wall. It's like poetry in motion. Benjamin Moore, See the Love. Jess, we've been talking about how expensive these drugs are, how they're hard to find because demand is so high, but there's one thing that didn't make sense to me. It's all the ads. I've been getting so many ads

selling me ozempic-like drugs or semaglutide. I mean, same, Brad. Having trouble finding semaglutide or truzepatide without it costing a fortune, especially with insurance not covering them. You can get semaglutide delivered directly to your doorstep. And we're now offering treatment with GLP-1, the revolutionary weight loss medication everyone is talking about. And these ads, they're often from a telehealth startup that I've never heard of. And they're generally offering it for a lower, more affordable price, like a few hundred dollars a month. So I was like, how are they able to do that? Right. That was one of my big questions at the start of this series.

And what we learned is that a lot of these companies, they're often not getting brand name Ozempic or Wegovi or Zepbound. Instead, they're getting their drugs from places called compounding pharmacies. And they can do this in part because of an interesting loophole around the Eli Lilly and Novo Nordisk patents. If you remember, we talked last episode about how there's been an ongoing shortage of these drugs. Here's our colleague Liz again. Whenever there's a drug shortage in the United States

that's recognized by FDA as a shortage, which some of glutides in shortage, terzapatides in shortage, that means that legally compounders can make it. So to be clear, compounding pharmacies are like the main legal way that drugs can be manufactured and accessed by patients during an FDA-declared shortage. Yeah, that's right.

Because the pharmaceutical companies have not been able to manufacture these drugs fast enough, that's opened up a big opportunity for compounders. And business is booming. I talked to Scott Bruner. He's the CEO of the Alliance for Pharmacy Compounding, which represents about 600 compounders across the country. Here's how Scott characterized this moment for the industry. I would say it's highly unusual. And I would tell you, the compounders I've talked with say they've never seen a situation with the demand for the drug as big as

it is. I mean, this is, I mean, we're talking about a drug on the same scale as some of the HIV drugs in the 1990s, birth control in the 1950s, 1960s. This is a drug of that caliber. And so we're in strange territory. Do these compounded drugs work the same way as, say, ozempic or Wigovy? Are they the same drug? Well, they were made with the same active pharmaceutical ingredient. So when we talk about essentially a copy, again, the guy just doesn't say it's an exact copy. It says it's essentially a copy.

Scott also wanted to point out that this is legal, but because of these drugs' popularity, compounders are getting conflated with the less regulated online marketplaces. We are in a universe right now where there is absolutely sale of illicit substances purporting to be semaglutide or terzapatide. And consumers are able to get that without a prescription. I'm sorry, that ain't compounding and that ain't pharmacy. It is illegal and patients, I believe, take their lives into their own hands when they do that. That's right. Compounders are different from the gray market for these drugs. But Liz did flag some issues around compounding pharmacies for us.

There are some caveats. The compounding of semaglutide really took off. A lot of places were offering it online, and the FDA came out with this warning, and it said, listen, we can't verify what's in a lot of these compounded things that are being offered. These are not the same as a prescription brand-name drug. Prescription brand-name drug makers have to follow all kinds of manufacturing practices. They have to prove through data the safety and effectiveness. Like, this is not the same level of careful oversight. And then also Novo Nordisk and Eli Lilly have sued different compounders. And they're

saying in their lawsuits, we don't know how you're making this, but it's not what we make. And Novo Nordisk has even said, like, your product is impure, where it's not up to the same potency. So the drug makers and the FDA are kind of warning people about compounding. Now, some of the compounders sued by Novo have denied the allegations and say they've been complying with the law. That's right. And compounding pharmacies also pushed back against the broad characterization that what they do is not safe. And compounders right now are a way people can get a version of these drugs at a cheaper price. We talked to one woman who never even considered getting name brand Wigovir Zepbound.

She got her prescription and medication from a wellness clinic. That clinic gets semaglutide to its patients from compounding pharmacies. And she's totally happy to be getting her semaglutide from there. She told us she's going to do this as long as she can. But right now, compounding is still a big point of tension for the pharmaceutical companies. Novo and Lilly said that they'll continue to take legal action against compounders that they believe are participating in trademark infringement. But we also know that people have turned to other methods to access these drugs,

including crossing the border. My name is Concha Gonzalez, actually Concepcion, really. I am from La Villa, Texas, about 30 minutes north of the border in deep south Texas. Concha is an educator, she's in her 50s, and she and, Joe, have both been trying to lose weight for a really long time. Why did you want to lose weight? I think it's my feet hurt all the time. I'd wake up hurting. I'd go to sleep and they were throbbing.

Like 24-7 my feet were hurting. My back was always hurting. I'd go to sleep and they were throbbing. Like 24-7 my feet were hurting. My back was always hurting. I was always in a constant state of fatigue. We'd go to the park, we'd walk and we were huffing and puffing and all of those factors combined has always been provoking me to lose weight. Unfortunately, I lose the weight, 40 pounds, and up they came, 30 pounds, and it's just been a constant yo-yo. Conja's doctor put her on Mount Jaro for weight loss, but it was off-label and not covered by her insurance

because she doesn't have diabetes. How much weight did you lose while you were on Mount Jaro? 90 pounds. How did that make you feel? I think GOP1 medications became my life. And because of the weight loss, I'm able to walk very well now. And for long periods of time, I no longer huff and puff. And so I feel a lot healthier. Concha and her husband Joe both got on the medicine

and it was all working really great. But they were paying for it out of pocket. At the beginning, they were able to get a coupon from Eli Lilly, which actually helped them get a big discount. But the discount ran out.

So she and Joe came up with a backup plan, and they've documented it on TikTok. Hi, everyone. This is Concha and Joe on our Manjaro journey. Come along with us as our journey takes us to Mexico for GOP One updates on our backup plan. This is not intended as medical... Where in Mexico do you go? I go to a very quaint town, Nuevo Progreso, also known as Las Flores. It's south of Wasaco, Texas.

Take a look at that bright yellow building. This is where you find the disco store and there's a ginormous pharmacy in there. This is block two. There's also a pharmacy again. You know, this border town or this Mexican town that we go to, I want to say hundreds of pharmacies, one back to back to back to back. Yeah. It's a tourist center where people from all over the United States go to get medication.

So is it typically cheaper for you to get medications from Mexico? Oh, definitely, definitely cheaper without question. Some of the drugs Concha saw in Mexico were around a third to half the price that they are here, depending on the brand. Concha says this is the only way she and her husband can really afford these drugs, especially since they feel like they have to stay on them long term to keep the weight off. It's not something that we can afford, especially with two of us being on the medication. You're talking, I'm an educator, we don't get paid enough to supplement something like that. Do you worry about being able to afford it, like long-term? I do. As a matter of fact, I do. But we're in it for the long haul.

I want to be able to breathe. I want to be able to walk. I don't want to be in pain. I don't want to be chronically fatigued. If it benefits me, then I'm going to continue. And by the way, we've confirmed that it is legal to cross the border with small amounts of medication for personal use. Okay, so compounding and border crossings are some alternate ways to access these drugs right now. And they definitely have some issues, but overall, they're pretty safe

and regulated. Right. And these drugs are meant for human use. But there's another world of drugs that's much murkier. Yeah. And our colleagues Rolf Winkler and Sarah Ashley O'Brien, they did a big investigation into this. And they found more than 50 websites selling semaglutide and terzepatide. Almost all of them had a disclaimer that said that the substance was, quote, not for human consumption. Here's Liz again.

In some cases, they're like shipping the syringe with the little thing that you inject, you know, with it. So it kind of clearly is for human consumption. I mean, these websites are not asking for a prescription, but they'll sell it to you for a month's supply for like $100. And so that can be really tempting for people. What makes it a gray market instead of like a black market? In practical terms, no one is going to go to jail for buying, you know, semi-glutide knockoff Ozempic from these websites. But the FDA has sent warning letters to a lot of them, these gray market websites to say, hey, what you're doing is not cool.

As questionable as these sites are, though, some people still risk it because they feel like it's their only option. Remember Lori from the top of the episode? She was the one who got that vial and syringe from one of those websites. She was the one who got that vial and syringe from one of those websites. For her, being on Ozempic was so transformative for her weight and her overall health that after her insurance stopped covering it, she became desperate to find a way to stay on anything like it. It's so frustrating because, like, I just want to be healthy. So one of my friends says to me, well, there are these companies that have research-grade

semiglutide peptides. What are you thinking when she reaches out to you with this? I mean, okay, if I can't get the drug, what can I take instead? What's close? That kind of got me thinking like, well, you know, maybe this is okay to do the research grade, semi-glutides and see what happens. Maybe that's just as well. And again, when she says research grade, what that means is that it's not being sold for human use and it's not FDA regulated. In fact, it's not regulated at all. So we don't know for sure what's in those vials without getting it tested by a third party. Right. And I've talked to someone who says she tried research-grade semaglutide and experienced severe side effects, including stomach paralysis that led to frequent vomiting. She can't know for sure if the symptoms were due to the drugs,

but she stopped taking it within a few weeks. Lori didn't have those side effects, but she also says she didn't think what she was taking was working at all. And like she said, she was bothered by the fact that she had to mix it herself. So after a month, she quit. I told my friend, I said, you know what, I don't know if I feel any different on this. I don't know if it's doing what it's supposed to. I don't know if I feel any different on this. I don't know if it's doing what it's supposed to. What I do know is that I'm very uncomfortable with the whole process. At that point, I was like, you know what,

I'm just going to go off of the Ozempic and everything altogether just because I didn't really have the financial resources at the time to get some huge pharmacy bill for this. And so you stopped taking the research grade stuff. You stopped a Zempik. Like, how did you feel? Did it feel like, like, I don't know, that you were sort of out of options? Yeah, because like, I was like, what am I supposed to do next? Apparently the universe is not, does not want me to be on this.

It's very frustrating. Sorry. No, it's okay. Your frustration is just like really, it's really coming through and I... I don't know what to do, but everything I have tried, I feel like a total failure.

Sorry, Lori. I just, you know, and then I finally find a drug that works for me and it's like Lucy and Charlie Brown. As soon as you find something that works for you, they go, no, we're going to take it away because you don't have enough money for it. Oh, my gosh. I'm totally crying now. Sorry.

I'm sorry, Lori. Sorry. Anyway. This is just, it's just an ongoing battle that, what am I supposed to do? And it's just, the way that I get treated in this country is abysmal. Absolutely abysmal. The way that we treat people who are disabled,

and especially people of size who are disabled, it's bad. I really, really feel for her. You know, she's getting at something important here. She captures how obesity isn't just a medical or health issue. It's also a societal issue. It's in our culture. I've definitely felt fat chain before. I've been made to feel like being overweight was my fault. Sometimes you just feel the hate or judgment, and it can be almost paralyzing. And we talk about weight. It has a lot of baggage.

And Brad, you know I love hearing about your thoughts on this issue, but I don't want to give too much of the next episode away because that's when we're going to dig deeper into your story and also look at why price is just one of the problems some people have with these drugs. We have not gotten rid of the software or the psychology that bigger bodies are worse and smaller bodies are better. These medicines are a band-aid for the problem

because they're not really addressing the actual problem of what's going on in obesity, which is the food. Do you want to close it out, Brad? Yes, I do. That's next time on Trillion Dollar Shot. Trillion Dollar Shot is part of the journal Thank you. Matt Kwong. The series is edited by Catherine Brewer. 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 Nathan Singapak. Our theme music is by So Wiley. Remix for the series by Peter Leonard. Special thanks to Maria Byrne, Pia Gadkari, Stephanie Ilgenfritz, Kate Leinbaugh, Peter Loftus, Sarah O'Brien, Sarah Platt, Jonathan Rockoff, Jonathan Sanders, Alex Stuckey, Leying Tang, Lisa Wang, and Rolf Winkler. Thanks for listening. The next episode of Trillion Dollar Shot will drop in two weeks on June 2nd.

See you then.