Novo Nordisk facing pressure as study finds $1k drug can be made for $5 | Hacker News Reader

Novo Nordisk facing pressure as study finds $1k drug can be made for $5

fortune.com

126 pointspaulpauper206 comments

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Producing it is not the hard part.

Researching it is... And you are not paid for your research "up front". It's added to the cost afterwards.

#DingDingDing

In general, mono-dimensional arguments merit an extra dose of skepticism from the audience.

On top of research, FDA approval doesn’t come for free either.

Are the downvotes expression of disapproval with the FDA process or disagreement with the assertion that it's become slow and expensive enough to pose an ethical problem (e.g. for people with diseases for which a cure exists but is still waiting for approval)?

Or does anybody actually believe FDA approval is very easy and cheap to come by these days?

I'm not Pharma industry expert but ... I'm pretty sure it's much the same as venture capital.

That is to say that's it's not that expensive to R&D it, certainly compared to the eventual sale price, but it's carrying the cost of the hundred potential drugs that never made it to market that's the killer.

It takes $300m to $2B to get a drug approved.

And the approval rate is less than 12%.

The crazy pricing is to compensate for the failed projects.

Also, it's not like you can bootstrap yourself or grow organically like Startups.

You have to wait for like 10 - 15 years. To actually start selling it.

[1]: https://www.google.com/amp/s/www.policymed.com/amp/2014/12/a...

> Also, it's not like you can bootstrap yourself or grow organically like Startups.

So if they have a effectively built monopoly, chopping down the maximum they can charge via regulation would seem sensible wouldn’t it?

there is also a lot of problems with pharma not wanting to invest in cures for smaller diseases because the payback seems unlikely to happen or not be great enough to warrant the risk, so this seems like a pretty good vote getting maneuver that might have unintended consequences.

I think that's difficult to implement. There's a risk that companies might end up not launching new products on the US market

There's several factors that impact US drug prices. For instance FDA approvals are significantly more costly than EMA ones and the bargaining power of healthcare providers is worse compared to a single payer system

I have no knowledge of US laws, but I wouldn't be surprised if there's some kind of law preventing government interference with "the free market"

No such law here in the states, just a political atmosphere where some people adore the idea of socialism and others see it as the coming of the end of times. Combine that with a highly complex industry structure that’s been entrenched for decades, and you end up in a situation where it’s near impossible to pass laws that actually structurally change our system.

(It’s almost the opposite, in fact, where our courts have expanded the Commerce Clause over time to allow the federal government the ability to regulate close to any economic activity.)

Thanks for the clarification! :)

Regulation has hit insulin pricing. https://www.whitehouse.gov/briefing-room/statements-releases...

No it’s also ludicrously expensive to R&D a drug, even if you just count the costs of the successful program. You’d be looking at easily $50-$150MM just in clinical trial costs, not to mention the years or decades of preclinical work.

Factor in the failed programs and you’re looking at about $2B of spend in order to bring a drug to market.

If I remember correctly that cost is also only the price of developing a successful drug

Several drug developments are halted before they reach market. Novo for instance lost a lot of money on their bet to develop inhalable insulin 15 years ago

That cost also has to be recouped when finally hitting the jackpot

Of the top 10 pharma companies, 5 are American, and three of them rank 8th, 9th and 10th for R&D investment.

So the whole "American big pharma needs to make a billion dollars a week in profit to recoup their R&D" is nothing but marketing fluff.

Does it matter that only some of them are headquartered in the US? Presumably those other companies also sell drugs in the US?

I would think any company - regardless of where it’s headquartered - would seek to recoup R&D costs in a huge market like the US where prices aren’t capped by the government.

I… am not following this. Novo Nordisk for example is a Danish company.

I haven’t seen anyone say American pharma companies in particular need to make a ton of money.

The American-specific topic is that American consumers pay a ton more for drugs. That can be chalked up to lack of single-payer making American consumers incredibly easy to bully/negotiate against + all the rent-seekers who sit at various points along the care delivery system.

It’s even riskier than VC, because the capital requirements in pharma per venture are _significantly_ higher.

There's not a single drug company on the market that stops charging a high price for a drug as soon its covered its research expenditure.

you also need to cover the cost of the 100 drugs that failed at various stages of the pipeline.

Not saying that it's not a screwed up industry, but stories like these distort the problem as well

Are the people running drug companies barely scraping by?

Not nearly as much as they claim they are. The system is basically rigged in their favor. Just compare the financial statements of companies like Ford and Boeing to Eli Lilly and Novo Nordisk. Pharma does very good business.

Obviously not, but my general experience with conversations like these is that people never do the math.

If we split the profits across all of the people that "deserve reimbursement" you usually end up with a few dollars per person. Definitely, not enough to make a meaningful impact.

Additionally, the American consumer subsidizes R&D and costs for the rest of the world. America routinely pays 5x-20x more for drugs than other countries and American grants account for >50% of worldwide medical research funding (caveat: the last time I checked). Yup, even Europe is a fraction of what America pays.

I would encourage you to actually do the math and decide for yourself rather than taking (or anyone else's) word for it.

Should they not profit on that capital invested for that research? Do landlords drop rents when the loan is paid off? Of course not, they’re going to price rents what the market supports. Competition is what makes markets work. Invent a drug? And someone else invents a similar drug? Prices will go down.

There's no free market for lifesaving drugs. Just extortion.

Is it ethical for a doctor to accept payment for life-saving services, then?

A much more interesting discussion could be had around who pays for it (and how, and how the prices come to be as high etc.) – because somebody ultimately does.

Nope it's not. They can get paid a wage from gov and charge nothing. Private Healthcare in its entirety is unethical. Shouldnt exist. Full stop.

That's exactly the more interesting discussion I meant. Who pays the doctor, nurse, pharmaceutical companies, how are wages and prices negotiated etc.

But I hope you agree that in all of these models, the doctor does in the end get paid, i.e. accepts payment? I never said that the patient should be the one paying them directly. But if nobody does, there will be no doctor.

Have the entire healthcare system gov run. Need funds for it? Write em up out of thin air. Keep wages pegged above avg labor market because having a healthy society is more productive than an unhealthy one. To the extent where all other industries come 2nd as they are basically useless without healthcare keeping their workforce alive. Can't run a company if all your workers can't get well once they get sick. Literal unnecessary waste of human resources all because we want to prop up a few folks profits? The jobs and demand for the work will still be there if it's gov run, you just don't have a swathe of investors profiting off it. Zero loss. Go invest elsewhere.

One of the arguments against this is inflation from creating money out of thin air to fund it. Its a lie. The service is required and you don't get inflation from paying folks a wage to do a job. You do get it by propping up profits of private companies which essentually through the fattening of their bank accounts devalues money. Remember if you have a large number of folks competing for a good or service and they are all on similar playing fields (e.g wages near market avg), competition is high, the value of each dollar earned remains high.

If you have a handful of companies with buying power that far outweighs that of others allowing them to capture more than their share of a service or good because they can literally just throw more money at it than the majority of us can. This drives Inflation. It devalues money creating a new norm of your dollars being worth less.

Tldr: The benefit from entirely gov funded healthcare far outweighs that of a privatized system.

That sounds noble but... What do you propose? Free drugs for everyone? If nobody is allowed to profit on researching drugs, nobody has a reason to sponsor drug development - which is very expensive.

Of course I agree this market should be regulated - like we regulate it in Europe - but at the end some company is investing into drug research in order to make a profit.

Rental markets rooted where I am. Fails to provide for society the purpose it exists for. So yeah if your saying big pharma is the same sure I'm on board.

Profit enough to survive. But don't take more than your worth. Tbh profiting off medicine is about as low as profiting off weapons manufacturing. You literally make money out of the misery of others.

Thank f#@k I live in a country that has free healthcare. The concept of privatizing the health of your citizens and letting a select few profit from that is absolutely batshit insane.

Free healthcare is not really free. And it is good until you hit the point where the next available appointment date is 12+ months ahead.

Or when your country decides the benefit of treating you with the new treatment doesn't justify the cost. I understand this is quite common in Europe with some cancer treatments.

There is an awful lot of sympathy for the drug company in this thread. You are correct, research and approval is expensive. But at some point there is a limit.

Things like insulin are long paid off, and the pricing there has generated controversy. People have been charged $1000 a month for it [1].

What’s fair? They are screaming out to be regulated when they behave so badly, and that’s what’s happened with insulin.

[1] https://www.thelancet.com/journals/landia/article/PIIS2213-8...

Insulin isn't a single product.

If you're not distinguishing between insulin extracted from a horse circa 1922 and a modern synthetic analog, well that's just not being honest.

There's good arguments that the modern synthetic analogs are overpriced, but that's a more subtle argument.

The situation described in that Lancet article doesn’t seem very subtle.

And if the US is able to impose maximum pricing that is so much lower, it would seem likely that price gouging was occurring.

The lancet 'article' doesn't actually say anything. It's just a political hack job.

When people complain about being forced to pay thousands a month for insulin, they're talking about the newest synthetic insulins that were developed very recently at substantial costs.

They could take the older insulins for $50 a month, no one is stopping them. It's just that those older products are less convenient.

So why is older insulin more expensive in the US than elsewhere, by a large margin?

https://www.visualcapitalist.com/cost-of-insulin-by-country/

https://www.rand.org/pubs/research_reports/RRA788-2.html

https://worldpopulationreview.com/country-rankings/cost-of-i...

Only the last one makes the distinction between modern synthetics and basic insulin.

Frankly the US pays for the cost of the research while the rest of the world just pays for the cost of production.

If you want to fix the cost of insulin products (and many other drugs) in the US you need to figure out how to make everybody else pay for the true costs.

Edit: also your last source there doesn't even know what it's talking about Novolin is a generic brand name for 3 distinct products that have distinct pricing.

The argument that the US is paying for everyone else’s drugs is often made in defence of big pharma, but their profits make it hard to swallow. In recent times the US hasn’t really shown any other other signs of chasing socialist policy where it subsidises the rest of the world.

perhaps most of the research would not be incentivized in a socialist society? it's not like the talent doesn't exist elsewhere, but US embrace of capitalism is a factor in the research development research.

> Frankly the US pays for the cost of the research while the rest of the world just pays for the cost of production.

Oh come the fuck on, this has been the talking point since the early 2000's. Surely nobody still believes this horse shit. Phizer by itself raked in 50 billion last year alone.

It comes up here in NZ every few years, as there is frustration that we aren’t paying as much as the drug companies would like. The US leaned on us hard to scrap our single payer system.

This sympathy for these massive companies in this thread depressing. Big Agg and Big Tech don’t get this free pass.

It was depressing in 2008, now it's just pathetic. It's no wonder they feel so emboldened to continue fucking people raw for their medications, they have hordes of defenders in government and otherwise ready to offer page upon page of apologia for their rampant profiteering.

Pfizer's world wide net income was $2.12bn USD in 2023.

I guarantee you 100% of that came from the united states.

Okay? Then if the US starts changing its policy they won’t make stupid deals with the rest of the world then.

Pfizer net income for 2023 by quarter. After taking in 10s of billions in vaccine profits this certainly looks like some fun accounting.

2023-12-31 $-3,369 2023-09-30 $-2,382 2023-06-30 $2,327 2023-03-31 $5,543

https://www.macrotrends.net/stocks/charts/PFE/pfizer/net-inc...

The history of insulin shows a great deal of involvement and progress made by researchers in several countries, and the US would probably not even rank as first among them.

Eli Lilly was the first commercial producer of insulin at any significant scale.

Genentech developed biosynthetic human insulin using engineered ecoli.

Eli Lilly produced the first of the modern synthetic insulin analogs.

Literally every major breakthrough except the initial bovine extracts were done in the US.

Novo Nordisk is based in Denmark and they did a lot of research. Of course, cherry picking the stuff Eli Lilly brought first makes it seem they are the ones driving the thing forward but it only makes sense in the wider contact and when compared with what other have done first as well.

Novo piggybacked on a ton of research especially with metformin done in the US. Let's not be delusional that Denmark is a bastion of cutting edge biological research

> Novo piggybacked

Isn't this how research and science works?

> Let's not be delusional that Denmark is a bastion of cutting edge biological research

Except in this case, it is? All I read seems to point they did push the envelope a lot of times. Do you have some other reason to say this except "psht, get real, it's Denmark"

> Frankly the US pays for the cost of the research while the rest of the world just pays for the cost of production.

Top 10 pharma companies, 5/10 are US (2 UK, 2 Swiss, 1 French).

4 of the top 6 for profit margins (from 43%(!) to 19%) are US (Merck is the only outlier, 9th, at 10%).

4 of the top 5 for Sales and Marketing Spend (both on raw dollars and as a percentage of revenue) are US.

3 of the bottom 5 for R&D spend (as a percentage of revenue) are US.

Source: http://www.bbc.com/news/business-28212223

That's a 10 year old article. Although if we rank by market cap top 6 are from the US these days (by revenue 5 out 10 seem to be European) so not much has seemingly changed (besides Novo Nordisk becoming the second most valuable pharma company out of nowhere)

> That's a 10 year old article. Although [the] top 6 are from the US these days […] so not much has seemingly changed

Well, thanks for the update. Correcting a citation an out-of-date article that is - as you admit - apparently still relevant as cited was definitely worth everyone’s time.

The very specific figures from that comment are obviously not really correct. e.g. Pfizer's profit margin in 2023 was ~3.5% which isn't that great (and that's the largest pharma company by revenue).

Keep in mind that marketing is a bit complicated - very few countries allow direct to consumer marketing. I think kits just the US and New Zealand. Obviously there would still be marketing in other countries, but a heavy US presence likely skews things.

https://en.m.wikipedia.org/wiki/Direct-to-consumer_advertisi...

Fun fact: the main reason it was legalized in New Zealand was heavy US pressure and lobbying over trade agreements and there’s been substantial pressure to get rid of it since then.

Because almost nobody actually pays those prices

> One key limitation of this study is that most of our analyses used manufacturer gross prices, not manufacturer net prices after rebates and other discounts are applied.16 Given the generally competitive insulin market, rebates in the United States are substantial (Mulcahy, Schwam, et al., 2021; Dickson et al., 2023). After applying a 76 percent manufacturer gross-to-net reduction, U.S. prices were roughly twice as high as those in other countries (compared with nearly ten times as high without the discount). We caution that these results likely underestimate the magnitude of the price differential because we were unable to estimate similar gross-to-net discounts in other countries. If manufacturer net prices in at least some non-U.S. OECD countries are lower than their manufacturer gross prices, the ratio of U.S. to other-country prices would be higher. In addition, because of data limitations, we applied a single U.S. gross-to-net reduction across all insulins. Actual product-specific gross-to-net discounts likely vary along product characteristics (for example, prescription versus over the counter and timing category). As a result, our estimated ratios of U.S. to other countries’ prices for specific insulin categories likely reflect measurement error.

As far as I can tell they also aren't attempting an apples to apples comparison, they're lumping all "long lasting" insulin drugs together. There is no such drug as "insulin", or even "long-lasting insulin". There are dozens of insulin analogs being sold at an incredible range of prices, easily over 10x from the most expensive to the cheapest.

https://www.goodrx.com/healthcare-access/research/how-much-d...

My default take on this kind of analysis is that people in the US are wealthier and are therefore paying for the newer, more effective, more expensive insulin drugs than people in other countries. I'm happy to be proven wrong on this but I haven't ever seen that analysis, they always conspicuously avoid direct comparisons of the same drugs.

This falls into a greater pattern of behavior in the us that I have noticed where pricing for almost everything is completely opaque. The price on the menu for a burger is not what comes out on the bill (tax, gratuity).

The price for healthcare is beyond understanding for mortals. The price for drugs, again you and your neighbour could be paying something completely different for the same medication. The actual cost to your wallet for university? Who know, everyone seems to get different levels of subsidy and scholarship. Visa Cash App - you can make the same purchase on two different days and pay different prices, unique only to you.

I find it incredibly exhausting to visit the US and navigate all these pricing systems, I dont know how you have let this become a psychological status quo.

>> So why is older insulin more expensive in the US than elsewhere, by a large margin?

Here you go kid: https://en.wikipedia.org/wiki/Free-rider_problem

Read that, and then you can explain to me the answer to your question.

the fact that noodles cost 10x as it does in Canada? cost of labor and minimum wages

One bit of nuance here is that you cannot buy FDA approved non-human insulin in the U.S.

That’s not because of an action by the FDA, but just that the manufacturers stopped selling it between 1998 and 2006:

https://www.fda.gov/drugs/frequently-asked-questions-popular...

So your only option is to buy the modern day synthetic analogs - or illegally import the old stuff, which the FDA notes here it has the right to block, but may allow under exceptional circumstances.

That limit is the length of a patent (plus/minus some factors like extensions and time to market). That's been the deal ever since the FDA was a thing. It's nothing new.

My understanding is that the controversy is over a newer type of fast acting insulin that's not yet generic. In general insulin is really cheap, but the really nice new stuff makes life a lot easier for diabetics so everyone wants it.

Turns out many many of the drug companies have been abusing the systems. The feds created a process for handling drug patents, and companies keep filing extenuating patents on existing stuff, and they also have been submitting not just drugs but devices to the registry illegally too, to hold monopoly. No one has guarded the registry.

FTC is finally taking some charge, after all the other agencies (patent office, FDA) have failed to do any enforcement.

Really good recent write up by the usual king of company & capitalism watching, https://www.thebignewsletter.com/p/monopoly-round-up-how-ftc...

> There is an awful lot of sympathy for the drug company in this thread.

And for good reason.

> Things like insulin are long paid off, and the pricing there has generated controversy. People have been charged $1000 a month for it [1].

Humalog and NovoLog both have expired patents. There are newer, better insulins. But these drugs were state of the art just 25 years ago.

The older products are much more expensive in the US too. It’s price gouging, and that’s when regulation has been imposed.

The newer products are cheaper elsewhere in the world. The US is getting ripped off by big pharma.

First of, I think that health-care prices in the US are horrible and have terrible consequences for patients

However, the blame doesn't lie with pharmaceutical companies. They're not selling their products cheaper elsewhere because they hate the US and love other countries

They're doing it because the US has created a system that benefits corporations more than its citizens. If blame needs to be distributed it lies with the people in power who built these systems and those who gave them that power

Healthcare in Europe is cheaper because the population fought for it, sometimes literally

And they’re actively lobbying to keep it that way.

Which they can do because the US has created a system that incentivizes companies to lobby for their own interests over that of the US population

I can think of two reasons on how we got here:

1. Expensive drugs are expensive to compete again. Any new entrant will have an uphill climb. They will need a new way to solve the problem, so it doesn’t infringe on the incumbents patents.

2. Drug manufacturing is still a niche business. In many other advanced industries, the tooling has become commoditized leading to a lower bar for entry and increase in competition. Repairing phone displays and soldering memory modules is now possible at home. Pharma is still waiting for that 3D printer/indie moment.

I don’t know if it’s even possible - we’re talking about chemicals and amino acids here. Every drug will need a different set of ingredients (not that different from cooking food).

You can have selective outrage. Insulin is clearly overpriced. Semaglutide, maybe not as much.

> But at some point there is a limit.

But we are nowhere close to that point. Ozempic is going off patent in 2031. It is a new drug, and it happens to be a miracle drug. Why should the company that brought the drug to market not monetize on it?

so should they charge $1b for the first pill and then $5 thereon? what is the argument you're making?

Wonder how many of these folks are on big pharma’s payroll and feel a need to defend those profiting in the billions from patented blockbuster drugs. Thankfully Biosimilars are eating away at patented drug molecules/biologics to reduce prices.

Not only are there different types of insulin, but there are different types of delivery mechanisms. "Convenience" is continually being "innovated."

Approval of biosimilars, state laws capping price, and manufacturer out of pocket max are driving down the price over the last 4 years.

https://www.goodrx.com/healthcare-access/research/how-much-d...

Society contributed to that research in the form of education, academia, infrastructure, ...

And Novo Nordisk contributed back to society. By a lot. Large part of earnings goes to Novo Foundation, which is used to help people in Denmark and make it to a nicer country for people (even though its already amazing country).

And for that investment society now has a new drug anyone can make at cost from t+20 year till forever. I'm not seeing how society is getting screwed here in the big picture.

There was a recent story right here on HN that contradicts that narrative.

"Big Pharma spends billions more on executives and stockholders than on R&D" https://news.ycombinator.com/item?id=39405547

According to Acquired.fm, they are required to sell their products at cost in Denmark, and allowed to make up for that around the world. I am curious for feedback here on the accuracy of this information.

I can't believe that I'm sharing YouTube shorts on HN, but this is the best way to share this info at the moment:

https://www.youtube.com/shorts/IVut-PE6LCA

https://www.youtube.com/watch?v=lsCvQSNsaVk

Pharma stocks actually underperform compare to other companies. So, it's not like pharma companies are making insane profits. Research, regulation, approvals and failures are expensive

> So, it's not like pharma companies are making insane profits.

Huh.

> Gilead Sciences gross profit for the twelve months ending December 31, 2023 was $20.618B

Not insane profits, indeed.

That's GROSS profit. That's basically saying that the same as the article, they have insane margins, selling 5$ pills for 1000$. They have to pay for the other stuff. Net income was 5.6B. Still, a lot but yeah it's a big company.

GILD is down 10%+ YoY. SP500 is up 28% YoY. Or Cigna (health insurance, also 100B market cap) 43% up

Marketing spend dwarfs (dwarves?) R&D costs by multiple factors.

I believe that claim ignores the R&D that is occurring in small companies. The large companies are good at marketing, so they buy small companies that have a hit, and then market it. The large purchase price they pay for the small companies reflects all that R&D that was done by the small companies (including the ones that didn't get a hit and weren't purchased.)

I agree, someone has to pay for the research.

Stories like this seem to pretty clearly represent the hazards of private funding for drug research. Publicly funded research and possibly publicly funded drug production could eliminate this issue.

Adobe facing pressure as study finds $99 program can be made for $0

Let’s be reasonable here: CDNs aren’t free. They might be spending a couple of cents per user!

But yeah, people might not like the implementation or idea of intellectual property, but that’s what’s happening here. Pretending it’s something else makes it hard to argue about it.

you're missing the point I think. if the first pill wear charged a billion dollars, the ones after could go for $5 each. same argument for Adobe.

$60/month, but that does include 100 GB of storage that you might otherwise have to store on a $20 SD card.

Goes for any software that can be copied

It’s not quite the same, although I’m assuming that no one needs Adobe to stay alive.

how is it any different

No one needs Adobe to stay alive.

I literally laughed out loud when I read this and that actually pretty much never happens despite sending LOL in text messages.

$99 once is a little different from $1k/month.

The paper models a competitive (cheaper) and conservative (more expensive) pricing. The conservative model assumes a 50% profit for Ozempic (the competitive model assumes 10%). These are margins that cannot realistically sustain drug development in the current western regulatory regime.

At the same time, its quite clear that the cost of drugs, particularly in the US is out of control.

In that sense, focusing on the fact that a company that received the technical data package and plant for manufacturing Ozempic for free could then indefinitely sell Ozempic for $5 a month is a red herring, and not likely to lead to any fruitful change. The price differential between US pricing and say... UK pricing ($350 a month for injectable Ozempic vs ~$80 a month) is enough to hammer in on.

On a side note, what I found interesting is that while the article says a injectable Ozempic can cost ~1k a year, the actual study marks it at more like $350 a month.

why just novo nordisk?

https://www.ndtv.com/world-news/at-850-000-drug-to-treat-bli...

can be made for .1c

heck, a top of the line AMD server chip costing $10,000 only contains a few milligrams of plastic copper gold and sand.

"There are currently about 1,000 cases of people who suffer from hereditary degeneration of the retina, and 10 to 20 new cases are expected to be added each year."

I mean, let's be realistic here.

so it would be better for orzempic to cost $850,000 and limit its indication to people with MODY?

How is that realistic?

TBH I have way less a problem with pharma industry being allowed to make profits than health insurance companies. In fact the US is about the only country in the world that allows profits from health insurance.

I don't see health insurance making profit being unreasonable. That is key reason why anyone would run an insurance scheme. Now the USA model is entirely wrong. But fundamentally, to offer insurance you must get something out of it.

health insurance profit is forgone health.

every other country only allows them to exist as not-for-profits.

whereas expensive medicines just make health insurance less profitable.

This is the basic principle behind why the US spends the most in the world on healthcare to achieve among the worst outcomes (e.g. same life expectancy as most undeveloped 3rd world countries)

The target market for Ozempic is tens of millions of people taking it every week.

The blindness thing has a worldwide demand cap of about 40 doses per year - it's a single dose for life in each eye).

Are you equally surprised when a one-off bespoke PCB costs more than a stock RaspPi?

The point was the profit margin on both the blindness drug and AMD CPUs are significantly higher than for ozempic.

So why target ozempic for too high a profit margin?

Caveated with its the health insurance industry is paying that profit margin - not the people who _should_ be taking it.

There is currently a supply problem. Novo Nordisk is building more capacity, but it takes time. Meantime those who are willing to pay more for it, get it. Mostly citizens of rich countries.

Novo Nordisk is controlled by the Novo Nordisk Foundation (> 77.1% of votes, 28.1% of capital) with aim to make a positive impact on health, science, and society by generating long-term returns on the assets of the Novo Nordisk Foundation.

One of the reasons why Novo Nordisk has been so successful is because their owner takes a long term view in R&D unlike purely profit-seeking owner.

I strongly success people listen to the Aquired episode on Novo Nordisk. It's quite interesting and we'll researched.

https://www.acquired.fm/episodes/novo-nordisk-ozempic

If you don't want to listen, there is the transcript right there on the page.

In there, they mentioned "It's pretty interesting. Pharma as a whole of the medical pie only occupies about 13% of revenue."

”The administrative costs of health insurance are 8%."

"I will say, who is taking any risk in this whole ecosystem? It's only pharma. Who's taking risk to innovate and make anything better? Every other bet that a hospital makes or that an insurance company is just probably going to pay off."

Say what you will, but pharma is pushing healthcare forward so I am not against them making money. Of course, I also don't want people to have lack of healthcare access because merely money, so there is a line to tow here.

The way insurance and drug pricing works in the US is bonkers and I would not solely blame pharma for that.

So this boils down simply to cost based pricing versus value based pricing.

Novo Nordisk is applying a pricing strategy that reflects demand and what people are willing to pay.

https://en.wikipedia.org/wiki/Value-based_pricing

There are many, many MANY people in this world will to pay for this on the basis of value. Heck if I had a lazy $5,000 I'd buy 5 months worth of the stuff and I'd be extremely happy with my purchase and I would not care what it cost to make.

Losing 20 kilos is easily worth $5K to me.

The only problem is I can't get it at any price - Wegovy is simply not available here in Australia and for all I know it might take 10 years until they can make enough to supply the market.

If someone could get it for me I would pay them except I'd never trust the black market - you're unlikely to be getting the real thing.

All drug research and production should just be done with public money by the public sector. Drug companies are already deeply reliant on university produced researchers and research, and in most cases the actual drug production is trivial. Imagine the human and economic benefits if there was no profit barrier to health.

I think the complexity of the issue isn't really reflected by the article. The most obvious points that are missing are the risks associated with developing a new drug, the costs of research, and the regulatory requirements from the FDA

Since pharmaceutical companies are, for the most part, publicly traded they're beholden to stock holders to create a profit. If they stop doing that they're in trouble

If the ability to generate profit from developing new drugs are limited, they'll simply stop doing it

Personally I think this kind of profit incentive for healthcare is perverse and ultimately doesn't serve public interest, but until the systemic issues behind these prices are addressed, I find it difficult to see a solution that'll ultimately benefit the end-user

Regulating drug pricing is what has started to happen. And I’ll bet they don’t like that.

A single payer system would at least change the negotiating power that big pharma has - even in a small market, drug companies hate dealing with a single buying. Here in New Zealand the point even made it into the TPP agreement negotiations. The US wanting our (deeply imperfect) healthcare system to be a bit more like the US one is rather grim.

Completely agree. That's part of why Ozempic is cheaper in Europe. I actually worked for the company who negotiates drug purchases for all hospitals here in Denmark (Amgros), so I'm somewhat familiar with the process

There's flaws in this approach as well, but in the end it's definitely an improvement to the issues US patients are facing in regards to costs

No, publicly traded companies are beholden to act in the interests of the shareholders which in practicality is fairly vague. All companies are sort of designed to turn a profit or try to as they generally need that to continue existing but there is no legal requirement that they need to create a profit or maximize it, publicly traded or not. Obviously, companies do try to maximize profit as it makes everyone involved money but they don't have to.

Which I think aligns with what I wrote, since I specifically didn't state that they are required to maximise profits for their shareholders, only that they are beholden to said shareholders

In reality those shareholders will pretty much always demand that the company maximise their ROI, so in reality I don't think it matters whether they are required to or not

If they don't they'll be eaten by a company that does and the outcome will be the same

If the EU can fine Apple and Google, the US should be able to fine Novo.

If they have a case against them under US law, sure! Do they?

Why? EU have never gone after Apple or Google because of their prices. This isn't Apple. Novo Nordisk doesn't make medicine that only work if your other medicine is made by them or force you to use their payment card (?!?!?).

If your point is the price then the US could go after every single US medicine company.

Absolutely they should.

That point is a bit different than comparing to Apple and Google.

I didn’t raise it.

> If the EU can fine Apple and Google, the US should be able to fine Novo.

So what did you mean by that?

That's against US law. The US has innovated the laws that make NN profits possible and helped other countries to adopt them.

EU created anti trust laws that makes fining Apple and Google possible.

Citations for all of this please.

US laws prioritize corporations over people.

EU laws prioritize people over corporations.

So EU corps selling in the US can bleed their customers dry, just like the local US corps.

And US corps operating in the EU are restricted in the people's interest, just like the local EU corps.

This is the just application of the respective laws as they stand.

This is the outcome the respective populations voted for.

Although the rest of the world does wonder what the US voters were thinking ...

Of course, the marginal cost of production is low at scale. Most of the mark-up is for advertising and overhead. Also, once it goes generic that will hurt future sales too.

No, it’s for the massive upfront cost of research and regulatory approval.

The stuff basically sells itself at this point; marketing probably doesn’t even register in their budget for it.

that is what overhead is

If you can find a way to cut the overhead of researching new (safe) pharmaceuticals, please do immediately start a company!

We could have all kinds of interesting discussions around the parallels between research funding and tech VCs, sprawling regulations and delayed approval procedures etc., but even in a libertarian utopia without an FDA I think you'll find that all researches like getting paid at the end of the month consistently, and not just the few that do eventually hit the jackpot.

Over simplifying but the real questions are - How long did it take to create - How long did it take to streamline manufacturing - What were the associated costs and so on. Then what's the real cost distribution over current practices. I'm sure the answer isn't a 1000$ and certainly not 5$ - but maybe something in between or a bit less? Articles like these are too simple and lack perspective for clicks...

Ozempic is blowing up on TikTok. Celebs and young people are using it left and right. This is wildly popular and there are resellers and apps popping up everywhere to make it easy to get prescriptions.

"Ozempic face" has become a meme as people try to guess who is using it.

Several of my neighbors are admittedly using it. And they've lost 30, 40+ pounds in a matter of months. Months.

This is a diabetes drug. There has to be a biochemical catch here.

> This is a diabetes drug. There has to be a biochemical catch here.

What if there isn't a catch? Sometimes technology really does just improve the human condition with no serious downsides. Consider refrigeration or sanitary surgical techniques.

Ozempic's side effects range from frequent diarrhea to pancreatitis and vision loss. Individuals can consider whether the benefits outweigh the costs. But it isn't free. We might try a Fermi problem to estimate how many of those cheerful Ozempic influencers talk about pancreatitis.

Side effects are real but obesity kills too. Importantly, GLP-1 agonists can also inhibit addictive behaviors (alcohol and substance abuse, gambling) due to a brain chemistry mechanism. Additional harm reduction to consider.

https://ourworldindata.org/obesity

https://www.scientificamerican.com/article/could-new-weight-...

All the usable refrigerants were either flammable, toxic, or highly ozone depleting, or a combination, up until the 90s…

Pretty sure R290 is flammable and I believe being used more and more

Yes, R600 even more so, there are some very expensive exotic refrigerants that are not, but they literally didn’t exist pre 90s.

The human body is a massive system of interconnected feedback loops. Tweak one knob, and there are always cascading side effects.

I could entirely see this being a net positive for a lot of people, but I want to know what those side effects are.

Plenty of people have got digestive system paralysis, so that’s a downside. Obviously the big issue is that for people with diabetes this has made the drug unavailable for actual medical problems that don’t have other treatments.

Long term studies are also not super complete - even something known to cause cancer like smoking or asbestos takes decades to show up.

Refrigerants contribute to global warming, no?

I was wondering this. How often does it turn out that a drug has no serious downsides? I guess penicillin was, if you're not allergic. (There is microbes evolving antibiotic resistance, but that's probably not a concern for ozempic.)

Try taking strong antibiotics for 2+ weeks. The list of serious downsides will be quite long

Thyroid cancer is one catch.

They said the same about Viagra.

The Law of Equivalent Exchange can be dodged, delayed, and ignored for only so long. There may not be a biochemical catch, but we will certainly pay in some other way. Perhaps spiritual, mental, etc.

imagine if you were saying this about vaccines or antibiotics.

this drug has side effects on some people but it’s may make obesity a thing of the past. especially if generics could be made so cheaply

To be fair, some people are saying that about vaccines or antibiotics.

Fortunately they don’t regulate access to either for most people in the world.

Different people place different weights on different values and outcomes. I'm sure there are many elderly people who miss the culture of sociability with neighbors that was largely a byproduct of material scarcity. Borrowing the sugar, congregating at the neighbor's house who is the only one on the block with a TV, etc. Our loneliness and mental health crisis is largely the price we paid for vanquishing material scarcity.

If you cannot see the dysgenic effects of vaccines, antibiotics, etc I doubt I can convince you in a a single comment. Just take my word for it that the percent of the population that will have permanent defects that require lifelong treatments is continuing to rise. Sperm loads and quality are continuing to drop.

I am not implying that these trade-offs aren't worth making -- just that our collective leadership should be making them with eyes wide open and planning for the inevitable sacrifice each piece of 'progress' requires.

Edit: Just as a simple thought experiment: If these obesity drugs are really the miracles they seem to be, I can see a future in couple generations where any disruption in supply will lead every single person to balloon to the size of the fattest person you have ever seen in your life. What ever gene(s) are regulating satiation will be rendered moot and thus have zero selection pressure. The outsourcing of this function is just that -- the human organism will no longer have any method of regulating hunger, satiation, etc.

Fullmetal Alchemist isn't real life. You don't have to account for every microgram of material along the way for a drug to be useful and safe.

Except that that’s not an actual natural law. In the same way that sometimes bad things happen to good people for no reason and with no compensation whatsoever, sometimes good things happen to people as well, whether they “deserve” it or not.

Other than that, what’s the problem with a weight loss drug? That it’s “unnatural” or “cheating nature”? The weight gain and the corresponding lifestyle and nutrition that often cause it aren’t exactly nature-given either.

What I find weirder is that people chase Ozempic even though they have introduced Wegovy. Which is basically the same drug but without glycemic control and hence more suited for non-diabetics. Both are Semaglutides and Wegovy directly targets weight loss.

They are the exact same active pharmaceutical ingredient (semaglutide), only differ in dosage and the design of the pen used to inject them. Ozempic is a multi use pen while Wegovy comes in fixed dosage single use pens that max out higher than Ozempic's highest dosage.

Glycemic control wouldn't be any different between the two at the same dosage but yes, people should really be seeking out Wegovy or Zepbound (tirzepatide) since those actually have a chance of being approved by their insurance for weight loss based on their FDA indication vs Ozempic or Mounjaro.

No it’s the exact same drug. There’s no “without glycemic control” difference. The largest dose of Ozempic available is a little more than the largest Wegovy but it’s the same drug.

I’m on Ozempic and not Wegovy. Here’s why:

- Wegovy is impossible to get. I had it prescribed a year ago and it still hasn’t been filled. Multiple pharmacies too.

- In the meantime, my new insurance doesn’t cover it or Ozempic. So I’m out of pocket.

- Ozempic 2mg pens are readily available and unlike Wegovy, you dial the dose, so that 2mg pen lasts me 2 months. It’s not officially indicated and they tell you not to, but just google an Ozempic click chart to see. My doctor was the one who suggested this!

- Wegovy pens don’t have variable dosage. Only Ozempic does.

- Theres no price difference in the pen sizes for Ozempic or Wegovy near me. No matter what dose pen you get, and no matter if it’s Ozempic or Wegovy, it’s $1000 for a 4 dose equivalent of the prescribed amount.

So for me it’s a no brainer if I’m paying retail - give me the highest dose Ozempic pen and I’ll dial the smaller dose that I take. It’ll last me twice as long since I take 1mg weekly. And I can actually get it.

The fact that 0.5, 1, and 2mg dose pens all cost the same tells you how badly we’re getting worked here.

> Which is basically the same drug but without glycemic control

No... The effects are the same because they are exactly the same drug (semaglutide), the difference is the dosing schedule and max dose (wegovy is 2.4mg and ozempic is 2mg).

Pretty weird diabetics have a lower dose

Ads are all over Instagram. Every TRT company is also offering it.

>This is a diabetes drug.

It was developed as a drug that increases insulin response, but it also appears to have a substantial impact on CNS processes controlling food cravings and other types of desire.

Given that, it’s possible we’ve stumbled upon the mechanism responsible for genetic differences in how we put on weight, whether that’s appetite, metabolic differences or both.

GLP-1 medications have been hypothesized to possibly result in the loss of muscle mass and bone density. There will probably be better data in a few years.

> GLP-1 medications have been hypothesized to possibly result in the loss of muscle mass and bone density.

Yikes. I wonder if there could be long term cardiac or pulmonary health issues as a result of this.

I'm also interested if this creates long-term insulin or pancreatic dysfunction.

I'm not sure there is other model, unless we move to entirely funding drug research publicly. And then set some bidding process for manufacturing...

Biosimilars couldn’t come soon enough. These companies are profiting off these billion dollar blockbuster drugs, even the R&D scientists are getting peanuts for creating the novel molecules, yet the biopharma company blocks everyone from reproducing drugs under the broken patent system. Biosimilars benefit us all by reducing prices like generics do.

Someone correct me if I’m wrong

The world no longer has an obesity problem. It has a semaglutide access problem. We can't manufacture virtue at scale, but we can make vast amounts of a simple organic compound.

Give it away. The public health benefits will pay for themselves.

Wouldn't be better for people to simply eat better? Obesity levels are much lower in Norway than they are in the UK and US. As far as I can tell this is because in Norway we simply eat less fast and ultraprocessed food.

> Wouldn't be better for people to simply eat better?

Has a half-century of telling people to "simply eat better" worked?

I didn't say anything about telling people to eat better. Perhaps what might work would be to make good healthy food more available and affordable and the rubbish less affordable and less available.

Doesn’t the price of a drug come down only once the patent expires and other drug companies can start making it?

But the reason they have patents that last like 20 years is to allow them to recover the costs of R&D.

Novo Nordisk is now Europe’s most valuable company. Congrats to them.

Their market cap is also bigger than the GDP of their home country (Denmark)

As a Dane that's pretty terrifying to me (see Nokia and Nortel)

Apples to oranges comparison. Revenue to GDP is better.

Novo Nordisk $35 billion in revenue.

GDP of Denmark:$400 billion.

Their revenue is roughly 9% of GDP.

I think that depends on what I'm trying to illustrate

There's a lot of pensions and savings tied up in Novo stock, so a potential downturn would have a catastrophic impact on the danish citizens

The danish economy is, to a large extend, dependent on the stock price of Novo, not its revenue

Asset values should be compared against asset values.

Novo Nordisk makes 17% of Danish stock index. Vestas and DSV are both 10%

(Foreign investors' ownership of listed Danish shares is over 50%, so I assume the situation is similar to NN when you remove the foundation owned stocks)

I'm honestly not sure if you're trolling here - you seem to purposefully be missing the point and I'm honestly not sure what you're trying to achieve here

If a country's largest company based on market cap is bigger than the next 50 companies combined, is the most popular stock among the countries retail investors, and is the current sole driver of economic growth in said country, that's a significant risk

Making a comparison between the value generated in a country compared to the total price of a company is a way to illustrate how massive the company actually is - same as when making a comparison to how many years I'd need to work to have earned as much as Jeff Bezos net worth

By the same logic, all software should be free, because the cost of manufacturing the bits is zero! (Yes, I'm very aware of rms and the FSF.)

> (Yes, I'm very aware of rms and the FSF.)

rms and the FSF believe selling software is totally fine as long as you provide source code to your users.

They don't think there's any moral imperative for software to be free as in priced at $0, but software should respect its users' freedom.

this is the conundrum the US Pharma is facing. GLP1 took NN 10+ years of investment to come up. Acquired podcast has a great story about them. The middleman is what is different between the various country healthcare systems. USDOJ is trying/tried going after but one word - lobby. The regulation required is for consumer to directly buy from pharma skipping all middlemen. my 2cents.

NN didn't come up with GLP1. It's a natural peptide, and people have been taking it for a very long time. Nordisk did get it approved, yes, and that was costly, but let's not massively overstate the innovation.

Semaglutide is not GLP1, it's a bit different. But it's not the first GLP1 analog. It's not even the first to be approved : AstraZeneca was the first to get a GLP1 agonist approved, in 2005. In fact, it even is used off label for obesity.

Nordisk's big break was convincing the regulators to get it approved for obesity and not just type 2 diabetes.

I want Pharma to be incredibly profitable. I want kids to sign up for chemistry majors hoping they can work for pharmacy companies rather than sign up for computer science hoping they can work for companies serving ads.

I want there to be full employment for experts in drug design and testing.

I don’t want Pharma to be a limited profitability industry that slowly loses money and talent to other industries such as tech or entertainment.

I want kids to dream of becoming the next billionaire by develops drug that cures cancer rather than becoming a billionaire by inventing a more addictive social media app.

Talent goes where the money is. If the money gets removed, the innovation will slowly go away. And like with Boeing, it may take decades for the results to be fully realized.

Covid-19 demonstrated how important Pharma was to society. With the vaccines, Pharma yielded a consumer surplus of literally trillions of dollars (just from being able to re-open the economies).

Yes there was academia that had the basic research, but you needed companies and scientists that had years and years of experience designing, testing, productionizing, and distributing medicines and vaccines.

"I object to this obvious communism attacking defenseless megacorporations. Also, cheap insulin is killing us." - what Martin Shkreli would say

Yeah that's almost every drug so what

Wait until everyone realizes the drug does more harm than good.

I find it a bit jarring that first reaction from the American public to foreign companies finding success in the USA is think about nationalising them. You see this in this thread, but also with TikTok. It's especially strange given the usual total economic dominance of the USA over the rest of the world. Did big tech get so rich by charging low prices ? Is the rest of the world 'subsidising' the Silicon Valley ?

You know what else is cheap and helps with weight loss?

Bicycles.

Who educates these scientists through PhD programs? Oh, OK. So we are paying these people to get their PhDs so they can go and start a company to scalp people with drugs that deliver 10% lift in efficacy. What a scam model.

How much do you know about this? Novo Nordisk sponsors many universities around Denmark, they pay a lot of money for those graduates.

They made a product that people want to pay lots of money for.

I don’t see why they should not be allowed to price this product to meet the insanely high demand.

How much it costs to make is irrelevant to the discussion. This drug wouldn’t have existed without Novo Nordisk, they deserve to profit so they can continue making new drugs.

What is next, should we limit the amount of money JK Rowling can make off her books because it is essentially free to produce?

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