WRFH/Radio Free Hillsdale 101.7 FM - Satya Marar: How Cheap GLP-1s Could Save Lives — AND Kill Pharma Innovation

Episode Date: November 21, 2025

The era of GLP-1 weight-loss therapies has erupted into a high-stakes showdown: major drugmakers are slashing sticker prices while regulators grapple with mounting safety and access concerns. Just recently, Wegovy and Ozempic manufacturers announced a 30% cash-price reduction for uninsured Americans. Simultaneously, three new independent reviews warn of long-term unknowns and major equity gaps in who actually benefits. With regulators scrambling to assess safety, equity, and access amid skyrocketing demand, Young Voices Contributor Satya Marar brings a crucial, nonpartisan lens from his latest article on how this policy shift reshapes innovation, affordability, and the long-term sustainability of America’s health-care system. He joins Samantha Mandel on WRFH to discuss.

This is Radio Free Hillsdale 101.7 FM, and I'm Samantha Mandel. With me today is Satya Marr, a research fellow at the Marquita Center at George Mason University and a young voices contributor. His recent essay can be found at truth on the market.com. Thanks for joining us. For listeners who haven't followed this story, can you briefly explain what this new Trump administration deal is on GLP-1 drugs? Yeah, sure. So the Trump administration is trying to have a series of deals with pharmaceutical companies

to lower the price of drugs because Americans are frustrated about high cost of health care. And what he's doing is he's basically threatening all these drug companies that own the IP for the drugs with massive tariffs, threats of lawsuits, revoking approvals for their drugs, and other targeted penalties that they don't lower their prices. So basically a kind of form of price control. Basically, the idea that these companies charge lower prices to insurers overseas than they do in the U.S. market.

So the U.S. is kind of subsidizing, you could say, medicine for the rest of the world. And, you know, while this is well-intentioned, you know, price controls ultimately lead things like shortages. They reduce the incentive to invest in researching and developing new drugs. And, you know, in the long run, you know, the costs are going to likely outweigh the benefits. So what he's done with the GLP-1 drugs, which, you know, are, of course, extremely popular right now.

Many Americans are trying to get access to them. He's managed to negotiate a deal where in exchange for exempting certain companies, like Eli Lilly and Novo Nordis who make these drugs from tariffs, they're going to lower their prices. So right now they're sold out-of-pocket if you're not covered by. insurance, you pay about $500 a month or so for the lowest dosage. That would come down by about $200 or $300 over two years on the Trump RX website. He'll also plan to expand Medicare coverage of the drugs to include about 10% of Medicare beneficiaries. So right now, the drugs are only covered for people on Medicare who have sleep apnea, diabetes. This would expand that to include

with seniors with severe obesity, as well as people with conditions like peri diabetes and so on, and various cardiovascular illnesses, so about 10% Medicare vent fisheries. And he's also promised to expedite the FDA approval process to bring GLP oral pills into the market quicker, and those will be available for about 150 bucks. But in the long run, though, the drug will still remain probably prohibitively expensive for most Americans, I would say, given that a third of Americans will abandon their prescription if they have to pay more than even $100 for over-the-counter drugs.

We also don't know how the deal will affect higher dosages of these drugs, so people usually start off in a low dosage, and that keeps increasing. But, you know, it will make the drugs more affordable for a number of people trying to access them, which is good for them. In the long run, though, it will probably lower the expected revenues from these drugs. In many cases, the patents on these drugs are expiring anyway in the next year or 10 years or so. So the long-run impact might not be that much because it will eventually have competition from generics, which will lower the prices. But still, you know, when these sorts of price controls are generally imposed, it leads to a massive decline in the expected future revenue for new drugs.

And it takes billions and billions of dollars to invest in researching, developing, seeking FDA approval, bringing these drugs to market. So, you know, in the long run, this might not necessarily be a good thing. With that being said, weight loss is really an important thing. And as things stand, it's very hard to get these drugs for weight loss alone. And we know that for people who have BMI above 35, every additional point of BMI or, you know, their weight going up is linked to serious illnesses that can increase the cost of future hospitalization. So we could in the net in the long run have savings and more people being on these drugs because that way they're less likely

end up in hospital much later on. But with that being said, expanding publicly funded health care coverage for these drugs, generally that's a thing which leads to higher prices in the long run. So these are the many things that we want to be careful about

when we go down this road. Gotcha. And to backtrack a little bit, what exactly are GLP drugs and how do they work in the body? Sure. So GLP refers to glucogen-like peptide. So glucagon, not glucagon, glucon is this hormone that basically stimulates the body to help control, to respond to insulin, the blood sugar going up to moderate the blood sugar levels. So what the GLP1, which is the peptide, what it triggers a pancreas release insulin at times of high blood sugar. and that prevents, the basal reduces your appetite, it slows down the movement of food in your body,

and makes you feel more full. And so since they have become commonplace, already the US obesity rate has dropped from 39.9% to about 37%. And how do you think they moved from being diabetes treatments to being seen as weight loss drugs, impossibly much more? So that's the interesting thing. And this is kind of a thing you see with all, sorts of medications in the past two, where they originally developed with one purpose in

mind, tested for that purpose, are sold, you know, to treat that particular purpose or that condition. And over time, people realize, wait, hold on, this can be used for different things. This has kind of side effects are actually kind of positive, you could say. And so people kind of noticed, and, you know, also in the trial data and so on, they kind of realized, okay, one of the things this drug could be used for is weight loss, but then the issue is, well, how do we do that responsibly, right? How do we, we don't know the long-term side effects of these drugs, but now we kind of have a slightly better idea. We know that, for example, in some cases, there can be nausea and diarrhea, some people who have a genetic predisposition to kinds of thyroid cancer, they can be susceptible to that. But really the best thing we can do to make these drugs more accessible for people who want to try the amount.

out. You know, they're not addictive drugs. So even if there are side effects, it's not something like, you know, making, let's say, Adderall or Ritalin freely available over the counter. But if we made this drug available over the counter without a prescription, that would actually free up a lot of healthcare resources and put downward pressure, competitive pressure on the price. This is Radio Free Hillsdale 101.7 FM. I'm Samantha Mandel, and I'm currently talking with Young Voices contributor, Satya Marar. Can you walk us through with the key parts of this deal, like pricing, Medicare, and Medicaid access and the promised FDA fast tracking? And especially what surprised you most about the structure of the deal?

Sure. So we don't actually, a lot of this is reliant on statements from the White House and statements from pharma companies themselves. A number of the specific details are still being ironed out at this time. What we do know is that the drugs will be sold, the injectable form of the drug, which is currently approved by the FDA, will be sold through Trump's RX portal for about between 250 and 350 a month, which is $150 to $250, less than the current price that they're often going for over the counter. The list price is about $1,000 a month, but in practice, that's rarely actually paid. That's more of a starting point to negotiate with insurers. It's unclear how this deal will affect private insurance plans, but, you know, given that the over-the-counter prices are going to drop and given that the drug, given that basically the, the former companies that promise to sell the drug to Medicare for around the same, like much lower price than they currently would be sold, we would expect that private insurers will start demanding the lower prices that the companies are offering to the government. So it'll put downward pressure on the private market, too. For the 10% of Medicare beneficiaries who will be,

administration says, will be eligible for this, to get this drug on their public coverage, they'll be able to access it for $50 a month, a copay. Now, all of this is for the lowest dosages of the drug. So we actually have no idea what the pricing structure will be for higher dosages of the drug. We do know that once someone is on the drug, typically their dosage will be amped up until it reaches, level is appropriate for their needs. We also don't quite know how long this will play out,

how long this will may enforce, whether it will be renewed. On the expedited approval side, again, we don't have a lot of detail there. We know the administ promised to speed up the approvals process. But keep in mind, I mean, there's no guarantee these drugs will even be approved. Or, you know, there's no guarantee that some issue won't come up during that process. But, He's promised to expedite them. And I frankly think, rather than simply doing this as a way to negotiate lower prices, he should do it across the board. Why don't we have expedited, streamlined approvals processes for all sorts of drugs that society would like to see in the future?

There's no force to competition lead to more drugs that people want coming to market and really just benefit the public and the public health. Who do you think the administration primarily has in mind with this policy? Like, is it for people with obesity, chronic diseases, low-income Americans, or someone else? I mean, it's hard to tell what they're really thinking, right? I can't necessarily read their minds. But I would say these are very popular drugs. Middle-class Americans are really trying to access and get at them as best as they can. The idea of expanding a Medicare coverage that is also designed to help people who are poorer

and more likely to rely on public health coverage. We know that poor Americans are more likely to struggle with their weight and a struggle with lifestyle illnesses than people who are wealthier, more affluent. So expanding the coverage to include lower-income Americans is good, although it's very difficult to do because the more that taxpayer-funded public health care plans cover a drug, the more upward pricing pressure generally puts on that drug.

Now, in this case, they have negotiated price control. But in the long run, if we say, okay, public health plans have to cover this drug, even after, let's say, these price controls expire, that will naturally drive up the price because when a drug is not covered by insurance, a fewer insurance plans cover it, people tend to shop around to try to get it, you know, pay in cash for it. And that leads to more competition, lower prices. But then if more people on insurance are buying the drug, then, you know, the pharma company can basically jack the price up. and because they know that the cost to be passed on to the insurance plan and so people don't actually end up around that much. So that's what we are expecting. So then overall, who do you think will benefit most from this deal? The biggest beneficiaries will be middle class and affluent Americans. I mean, if you're willing to pay up to, you know, $500 a month for a low dose of this drug,

and now that price drops down by, you know, $250 a dollar. so a month, those are real savings. And, you know, America does still have a pretty large middle class. And I'm sure they'll be happy about this deal. But the key thing that keep in mind is, you know, even with that happening, given that the patents on most of these drugs, you know, the GLP1 itself, oh, sorry, not the GLB1, the semaglite, which is one of the key active ingredients, the patent on that expires an XTO. And then a number of other patents on the formulation, the dosage, and other aspects expire in the next 10 or 15 years. So when that does happen, these drugs are going to become massively more affordable.

So, you know, it'll be great to be able to have them for a little bit cheaper. And we know that more private health plans are planning to cover the drug now. But the question is, in the long run, how much of a difference will this deal make? And I would say, well, if you're willing to wait a number of years, the market is going to basically sort that out through competition. Gotcha. And when we talk about lowering prices today, I know you mentioned some of the less obvious or hidden trade-offs for pharmaceutical innovation that you think the public doesn't see. But what do you see as the most serious long-term risk for this kind of policy?

So the most serious long-term risk would be if, well, all two things. So firstly, price controls more broadly, leading to reduced incentive to invest in highly uncertain commerce school research, which is very expensive. So the congressional budget offers has found that, you know, in order to generate a profit on 64% of their assets, the pharma company needs to make an absolute killing on about 4%. And the reason why is most of the trials they do to find new drugs either end up failing or when they produce something meaningful, it may not be commercially. viable. So they really have to make massive revenues on their blockbuster medications if they want to have enough funding to experiment and to come up with the next generation of treatments that we all need. You know, human beings are living longer and we're dying do things like lifestyle illnesses, the number of cancers that we're still trying to find

cures for. And we know that in the long run, even though it can be expensive for health plans to cover new drugs, if that can prevent people from being stuck in the hospital in the future and improve their health and vitality, that could be actually net saving for taxpayers. So it's not necessarily clear that having these price controls will be, you know, we'll just make things more affordable and reduce overall costs to the healthcare system. So the reduction in innovation and research for new cures, that's a huge issue. The other issue is the more that taxpayer-funded coverage for a drug expands, the more pressure there is for states and the federal government to mandate that health plans, whether the

public or private, cover a broader range of conditions, a broader range of drugs. And when that happens, premium send a skyrocket. It's been one of the major driving factors behind American healthcare ACA plans. You know, the premium is increasing massively since that act was first passed. So these are things we need to keep in mind. This is Radio Free Hillsdale 101.7 FM. I'm Samantha Mandel. And I'm talking with Young Voices contributor, Satya Marar. Is there a specific example in the past insider outside healthcare that you think illustrates these benefits and risks? It's kind of hard to say because, you know, healthcare is so unique with the massive amounts of upfront costs for research and developing things.

And then you basically do that expecting most of your revenue to come, not from private health. plans or patients, but it's actually come from government purchases. So healthcare is a highly distorted sector because we as a society have decided that, okay, it's the government's job to ensure that a certain amount of the population have access to health care. And that's a good thing. I think one of the things that people probably don't know enough about is that in other countries, they basically negotiated down the prices that they pay for drugs with pharma companies. so that puts massive downward pressure on the drugs. And the pharma companies are willing to accept this because, you know, the biggest buyers of drugs in those markets are the public health insurers.

The U.S. is the only major country that doesn't do this. In the U.S., the prices that Medicaid and Medicaid pays are pegged, generally speaking, to the U.S. private insurance market. Either the lowest price or the average price of the private insurer pays, what this does is it actually, on one hand, it leads to far greater revenues in the U.S. market, which means that, Americans have access to latest and new and most drugs before other countries do. So that's a good thing, but also creates a perverse incentive to distort the prices. So the pharma company knows that if it charges a very high price on the private market to insurers, even if it sells fewer drugs and will make less revenue in the private market, it can make back all that revenue because for each drug itself there, it makes that much more money of each drug that the promise people company, sorry, that the, uh, Medicare and Medicaid buys, and Medicare slash Medicaid are by far the biggest purchasers of drugs. More generally speaking, in terms of what we see in the real world, you know, price controls and their ill effects aren't anything new. We know that in the long run, we prevent firms from charging a price based on the market demand. It leads to a glutton the supply. And so over time,

it leads to reduce access. The estimate that with these sorts of price control type of policies, it can lead to up to 300 fewer newly approved drugs a year, which will be a massive ban, I think, for public health and for innovation. We know that many rural healthcare providers rely on reimbursements for these drugs as source of revenue. So in the long run, we could see these places close down. Already people are having trouble accessing health care in these places. So, you know, price controls might feel good at first, but we know certainly from every sector with the same.

have been tried that it leads to our shortages and inadvertent consequences that aren't good. This is Radio Free Hillsdale 101.7 FM. I'm Samantha Mandel, and I'm talking with Young Voices contributor, Satya Marar. What are the long-term effects of GLP-1s? We actually don't know. And the truth is, we often don't know all of the long-term effects of the number of things that are, you know, widely available, including things that aren't even pharmaceutical drugs. We do know some of the short-term effects. We know that it's linked to nausea and diarrhea. And some people, they have that as a side effect. In other cases, it aggravates certain forms of thyroid cancer. But we still don't know the fully long-term

effects. But what I will say is for other drugs in the past, things like ibuprofen, for example, so just 10 years after ibuprofen was approved by the FDA, and knowing that it had a number of side effects, including ulcers and, you know, cardiovascular ailments and so on in some people, it was allowed to be sold over the counter. The government basically made the decision that, look, you know, you are an adult, you have a label informing you about unknown risks, and you can now make an informed choice as to whether you want to try this drug out or not, see how it works for you. Obviously, if you have those side effects, then you should stop taking it. And I think it makes sense to apply the same rationale with GLP-1s. So we've seen

some early research that shows that GLP-1 has potential going well beyond just reducing people's weight or treating, helping with diabetes. GLP ones can also potentially help control addictive behaviors, and everything from addictions to cocaine, methamphetamine, alcohol, tobacco, cannabis, all the way to mitigating compulsive behavior like gambling. So,

you know, a good idea might be to say, well, if someone is, you know, as more research comes out, if someone is struggling

with one of these behaviors, maybe they want to try out GLP 1, maybe it'll help that. Maybe it won't. But let them try it out, let them get it over the counter without necessarily even needing,

let's say, a substance abuse diagnosis, which can be very embarrassing and time-consuming and have all sorts of implications And if it works for them and they don't end up seeing these side effects, and that could be a net improvement for them. And then over time, as we know more about the unknowns,

we can adjust our policies accordingly. So those are things to keep in mind. Perfect. We're pretty much out of time. Our guest has been Satya Marrar, a research fellow at the Marquitas Center at George Mason University and a young voice's contributor. His recent essay can be found at Truth on the Marketer. and I'm Samantha Mandel on Radio Freehillsdale 101.7 FM. Thank you.