Speaker 1: Bloomberg Audio Studios, podcasts, radio news. I am a single parent.
Speaker 1: I'm a widow.
Speaker 2: My husband was in the military and he died in
Speaker 2: the line of duty years.
Speaker 1: Ago, so it's just me.
Speaker 2: So if something happens to me, you know, I think
Speaker 2: about my kids.
Speaker 3: Lindsey Posey is a thirty eight year old living in Spartanburg,
Speaker 3: South Carolina with her two teenage kids. About a year ago,
Speaker 3: after a series of health scares, a doctor told her
Speaker 3: she needed to lose weight and offered to write her
Speaker 3: a prescription for ozembic or munjaro.
Speaker 2: I told him that I'm like, yeah, I would love to,
Speaker 2: but my insurance isn't going to cover it.
Speaker 3: But then she thought about her kids and started looking
Speaker 3: into ways to pay for the weight loss drugs, which
Speaker 3: can cost hundreds of dollars a month without insurance.
Speaker 2: So I, you know, started going on Reddit, researching different places, googling,
Speaker 2: and I came across telehealth companies.
Speaker 3: The telehealth company Lindsay found wrote her a prescription for
Speaker 3: a weight loss drug and then hooked her up with
Speaker 3: a compounding pharmacy. Compounders make copycats of drugs, often at
Speaker 3: cheaper prices, but the compounded versions aren't approved by the FDA.
Speaker 3: Lindsay says the first vile she received seemed to work,
Speaker 3: lowering her desire for food, but then the second vial
Speaker 3: seemed to have no effect.
Speaker 2: So, you know, me, not really knowing what I'm doing,
Speaker 2: I thought, Okay, well maybe that means I need to
Speaker 2: move up in dose. So I increased my dose and
Speaker 2: nothing happened.
Speaker 3: Then Lindsay opened her third fial of medicine.
Speaker 2: And you know, within a week of starting it, my
Speaker 2: face just kind of started to break out.
Speaker 1: Within two weeks, it was getting really bad. I think
Speaker 1: I did.
Speaker 2: Three weeks of that vial before I had gone through
Speaker 2: every avenue and process of elimination.
Speaker 1: Trying to figure out what is causing this.
Speaker 3: Lindsay stopped applying a new moisturizer she'd been using, she
Speaker 3: modified her diet.
Speaker 2: You know, I really I couldn't find an answer, so
Speaker 2: I thought it has to be this.
Speaker 1: So I ended up throwing the rest of that vial away.
Speaker 3: Lindsay eventually got a replacement vial from the compounding pharmacy.
Speaker 2: I started using that one and it was very strong,
Speaker 2: like I had side effects after the first shot, and
Speaker 2: I'm like, what in the world is going on? Why
Speaker 2: is every vial that I get so inconsistent?
Speaker 3: Lindsay says the experience made her wonder just where these
Speaker 3: vials were coming from.
Speaker 1: It's kind of scary. You know.
Speaker 2: They comfort you, They you know, say all of these things. Oh,
Speaker 2: you've got nothing to worry about. Everything's you know, tested
Speaker 2: and up to standards, and then you start kind of.
Speaker 1: Digging and you're like, okay, well is that the truth?
Speaker 3: Today on the show, how the skyrocketing demand for weight
Speaker 3: loss drugs like zetbound, ozempic and wgov is sending Americans
Speaker 3: into a one billion dollar shadow industry that could be
Speaker 3: putting their health in danger. I'm Sarah Holder, and this
Speaker 3: is the big take from Bloomberg News.
Speaker 4: Last year, when you would google ozembic or wagov, most
Speaker 4: of the things that would come up online were news
Speaker 4: articles or you know so and so celebrities taking ozembic.
Speaker 3: Madison Muller is a health reporter at Bloomberg. She mostly
Speaker 3: covers ozempic, wagovi and other weight loss drugs, and she
Speaker 3: says over the past year she's noticed different results starting
Speaker 3: to show up on Google.
Speaker 4: It's crazy. I mean, if you type ozembic, into Google Search,
Speaker 4: like all of the advertisements are for telehealth companies that
Speaker 4: are selling compounded drugs.
Speaker 3: You might have seen these results too for telehealth companies
Speaker 3: like Hymns and Hers or Row that sometimes advertised cheaper
Speaker 3: copycat mets. Madison got to work compiling all of the
Speaker 3: results she found for companies that said they sold these
Speaker 3: sought after weight loss drugs.
Speaker 4: I mean, I think there were like sixty companies or
Speaker 4: something at the time, and I was like, there's something
Speaker 4: going on here, and so Ike and I started looking
Speaker 4: into this.
Speaker 3: Ike Sweatltz is also a reporter at Bloomberg who focuses
Speaker 3: on the business of health and medicine. He was intrigued
Speaker 3: by what Madison found out, and he started looking into
Speaker 3: these compounding pharmacies that many telehealth companies partner with to
Speaker 3: procure weight loss drugs for their patients. To be clear,
Speaker 3: compounded drugs aren't just generic versions of brand name products.
Speaker 3: There's something else entirely.
Speaker 5: So compounding is how drugs have been made really since
Speaker 5: the beginning, you know, prior to modern manufacturing, prior to
Speaker 5: the FDA, if you needed a medicine, you went into
Speaker 5: the pharmacy and they mixed together some chemicals and you know,
Speaker 5: gave it to you and whatever sort of format you
Speaker 5: needed it. So that was that was how you got medicines.
Speaker 3: But that changed as drug making became more mechanized and automated. Eventually,
Speaker 3: the Food and Drug Administration was established and with it
Speaker 3: the regulations that required drug makers to submit medicines for
Speaker 3: approval before they could be sold.
Speaker 5: But compounders still had a role making some medicines, mostly
Speaker 5: medicines for people who might have might be allergic to
Speaker 5: one of the ingredients that's in the FDA approved version,
Speaker 5: or patients who like physically could not take the FDA
Speaker 5: approved drug.
Speaker 3: Essentially, the FDA left a loophole open for these compounders
Speaker 3: to continue making small batches of drugs if a patient
Speaker 3: needed a medicine to be slightly tweaked for some reason.
Speaker 5: The FDA you know, sort of knew that, you know, technically,
Speaker 5: on paper, this was like a violation of the federal
Speaker 5: law because the drugs had not gone through the FDA
Speaker 5: approval process. They were just choosing to, you know, exercise
Speaker 5: enforcement discretion and not enforce those laws and allow compounding
Speaker 5: to continue as long as it was regulated by the states.
Speaker 3: Ike says this worked for a while until twenty twelve,
Speaker 3: when dozens of people died from contaminated drugs made at
Speaker 3: a compounding center in Massachusetts.
Speaker 6: State officials here in Massachusetts say they found a leaking boiler,
Speaker 6: dirty floor mats, even black specs of fungus visible to
Speaker 6: the naked eye in sealed vials at the New England
Speaker 6: compounding center.
Speaker 3: That led to a national meningitis outbreak, and in twenty
Speaker 3: thirteen to the passage of a new law which laid
Speaker 3: out more clearly how compounders could operate. But even with
Speaker 3: those new rules, there was still a loophole for compounders
Speaker 3: who are making drugs that are in short supply, says Madison.
Speaker 4: So compounders got into the weight loss drug industry most
Speaker 4: likely around two ish years ago when these drugs were
Speaker 4: first falling into shortage, So hozempic would go via manjarros
Speaker 4: that bound to have gone in and out of short
Speaker 4: supply with the US Food and Drug Administration, and that
Speaker 4: sort of loophole allowed them to capitalize on this opportunity
Speaker 4: and allowed this market to really proliferate because they were
Speaker 4: allowed to do this and they were filling a need
Speaker 4: and continue to do so, because these drugs are still
Speaker 4: in shortage.
Speaker 3: Even if you've been prescribed ozepic or another some maaglutide drug,
Speaker 3: it can often be very difficult to find a pharmacy
Speaker 3: with the medicine in stock.
Speaker 4: We've seen a lot of issues between the supply shortages, affordability,
Speaker 4: insurance companies not covering weight loss drugs. That's made it
Speaker 4: really really difficult for patients who need these drugs to
Speaker 4: get them. And so what these compounding pharmacies have done is,
Speaker 4: I mean their drugs are not in shortage, and so
Speaker 4: they've made the drugs a lot more readily available. And
Speaker 4: that also helps telehealth companies and other businesses that have
Speaker 4: sort of built up a business around prescribing these drugs
Speaker 4: to patients.
Speaker 3: Are they using the same active ingredients as ozepic and
Speaker 3: we go V and manduro.
Speaker 5: So if if the compounders are doing what they're supposed
Speaker 5: to do and following the rules, then yes, they should
Speaker 5: be using the same active ingredients.
Speaker 3: But sometimes patients might be confused about exactly what drug
Speaker 3: they're getting.
Speaker 4: You know, when you're a patient and you're trying to
Speaker 4: sort through all of the medical information online and you're
Speaker 4: inundated with a bunch of ads and you just click
Speaker 4: on one that's like, oh, this is cheaper, I might
Speaker 4: as well. This looks legitimate. It has a nice glossy
Speaker 4: website and you know, smiling patients on it and says
Speaker 4: that it's selling ozembic, Like, oh, it probably is. So
Speaker 4: I think that that's sort of the challenge is in
Speaker 4: this you know world of misinformation and online information that
Speaker 4: we're like inundated with just so much of it, and
Speaker 4: it's hard to sift through it and really determine what
Speaker 4: is genuine and what's not.
Speaker 3: Other times, Madison says patients are in fact seeking out
Speaker 3: the cheaper, compounded version of the drug.
Speaker 4: And that's one of the things I mean, especially like
Speaker 4: the on social media, the compounded drugs have really taken
Speaker 4: off off, especially on TikTok.
Speaker 7: Right, So in this bag, I have alcohol slows to
Speaker 7: prep your skin. I also have the needles that you
Speaker 7: use for injection, and then in this little vial right here, it's.
Speaker 1: Actually the compounded medication.
Speaker 7: You can see it.
Speaker 4: A lot of TikTok influencers and people who have large
Speaker 4: followings on Instagram and TikTok are talking about these drugs
Speaker 4: and you know, serving as influencers for the telehealth companies
Speaker 4: and helping to market these weight loss drugs.
Speaker 2: And with the compounded version, as long as there's a shortage,
Speaker 2: I'm going to get my medication.
Speaker 3: Ike says, these compounding pharmacies are growing rapidly, partially to
Speaker 3: meet demand and partially because there's a lot of money
Speaker 3: to be made.
Speaker 5: One of the bankers who I talked to, you know,
Speaker 5: told me that these compounding pharmacy owners are going to
Speaker 5: be living like Versace and cruising around and gold plated
Speaker 5: bent leaves because of the profits from some of these
Speaker 5: compounded medicines.
Speaker 3: Bankers told Ike that annual sales of compounded weight loss
Speaker 3: drugs could ultimately be as high as one billion dollars.
Speaker 3: So there's demand and there's potentially billions of dollars in revenue,
Speaker 3: but there's also one big asterisk. So Madison, now for
Speaker 3: the million dollar question, are compounded weight loss drugs safe
Speaker 3: to use?
Speaker 6: Yeah?
Speaker 4: I mean that's our million dollar question too, is are
Speaker 4: these drugs safe to use? And in the course of
Speaker 4: our reporting, that's something that has been very difficult to determine.
Speaker 3: The safety of knockoff of Zepic that's coming up after
Speaker 3: the break. Drug safety isn't supposed to be a guessing game.
Speaker 3: Regulators have standards that are meant to protect consumers, but
Speaker 3: compounded drugs aren't governed by those same rules. Bloomberg Health
Speaker 3: reporter Ike Sweatltz told me.
Speaker 5: So, I think that the big difference between the compounded
Speaker 5: medicines and FDA approved drugs in terms of regulation is
Speaker 5: that FDA approved drugs, both the brands and generics, have
Speaker 5: to be approved by the FDA before they can be sold.
Speaker 5: So you have to go to the FDA and say,
Speaker 5: here's what I'm planning to sell. Here's how I'm going
Speaker 5: to make it, here is here is how it is
Speaker 5: equivalent to the brand name if it's generic, or you know,
Speaker 5: here's how it works if it's a brand name drug.
Speaker 5: And the FDA reviews all of that and they say, okay,
Speaker 5: we approve your manufacturing process. You know, it looks like
Speaker 5: your drug is working or it looks like it's equivalent,
Speaker 5: you can sell it. That process does not happen for
Speaker 5: the compounders.
Speaker 3: Compounders, I says, are mostly governed by state regulations.
Speaker 5: The states are checking to see if they're following protocols, right,
Speaker 5: you know, if their protocols around cleanliness, protocols, around what
Speaker 5: sort of testing they're supposed to be doing, what sort
Speaker 5: of records they're supposed to be keeping. But the states
Speaker 5: are not going and you know, checking to make sure
Speaker 5: that the drugs work.
Speaker 3: Even still, some state investigators have found some pretty worrying things,
Speaker 3: like unsterile conditions at a compounder pharmacy in Arizona and
Speaker 3: insufficient testing at one in Louisiana. But Bloomberg Health reporter
Speaker 3: Madison Muller says that tracing any ill effects back to
Speaker 3: compounders can be really difficult.
Speaker 4: Even when a patient says I got so and so reaction,
Speaker 4: you know, I had stomach issues or my skin broke
Speaker 4: out in hives or whatever from a compounded drug, it's
Speaker 4: extremely difficult to actually prove that it was from the
Speaker 4: compounded medication and that there was an issue with the
Speaker 4: compounded medication versus any other drug. There isn't really the
Speaker 4: same level of adverse event tracking that happens with branded medications.
Speaker 3: And Ike says that the worrying thing for doctors wasn't
Speaker 3: necessarily wrongdoing at these compounders.
Speaker 5: I spoke with several doctors, and I think they were
Speaker 5: in general more concerned with the lack of evidence than
Speaker 5: evidence of wrongdoing or widespread bad quality or something like that.
Speaker 5: You know, they were talking about the lack of clinical trials.
Speaker 5: They were talking about the lack of peer reviewed studies.
Speaker 5: There are a lot of questions that they have that
Speaker 5: they're looking for answers for about the effectiveness of these
Speaker 5: compounded medicines.
Speaker 3: And it's not just doctors who are worried about compounders.
Speaker 3: The big pharmaceutical companies behind these drugs are also concerned,
Speaker 3: like Novo Nordisk, which makes ozepic and we goo v
Speaker 3: and Eli Lilly which makes zep bound.
Speaker 4: Yeah, so Novo Nordisk and Eli Lilly are both very
Speaker 4: worried about the compounding that's going on. They say that
Speaker 4: it's not necessarily from a competitive perspective. They are making
Speaker 4: as much of these drugs as they can, and you know,
Speaker 4: as we've seen, they're making a lot of money off
Speaker 4: of these drugs as well, So they say that it's
Speaker 4: not necessarily a competitive risk, but they are worried about
Speaker 4: reputational issues. Both drug makers say that they've tested the
Speaker 4: drugs and you know, we haven't seen the results of
Speaker 4: those tests, but they say that there are you know,
Speaker 4: impurity issues. In some cases, the drugs are no more
Speaker 4: than like sugar water basically, and so they're filing a
Speaker 4: lot of lawsuits, dozens of lawsuits against some of these
Speaker 4: medical spas compounding pharmacies to try to limit and crack
Speaker 4: down on some of this.
Speaker 3: But Ike says, many of these pharma company lawsuits aren't
Speaker 3: focused on the safety of the compounders, but on the
Speaker 3: way they're marketing their products.
Speaker 5: So there's a lot of issues that these companies are
Speaker 5: taking with how you know, a website might describe the
Speaker 5: drug as as opposed to concerns about whether the drug
Speaker 5: is harmful to patients or not.
Speaker 3: Even with the lawsuits and the issues reported by patients
Speaker 3: like Lindsay Posey, Ike says, it's important to remember that
Speaker 3: compounders can serve an important role in the market, particularly
Speaker 3: when there are drug shortages.
Speaker 5: These drugs can be safe and you know, can be
Speaker 5: made properly as long as they're made you know, at
Speaker 5: high quality pharmacies.
Speaker 3: But the problem is it's very hard for a regular
Speaker 3: consumer to know just which pharmacies are high quality and
Speaker 3: which ones might have issues, and that's left people like
Speaker 3: Lindsay struggling to get answers on just what it is
Speaker 3: they're taking and how to stay safe.
Speaker 1: It just kind of seems like.
Speaker 2: No matter which avenue you talk to, it's always someone else.
Speaker 2: It could be a bad batch, you know, or it
Speaker 2: could be time temperature abused or got overheated and shipping,
Speaker 2: you know. It could be a lot of things, and
Speaker 2: it's not very comforting.
Speaker 3: Which is why she says that if companies like Novo
Speaker 3: Nordisk and Eli Lilly can eventually manufacture enough drugs to
Speaker 3: meet the demand, there's still this issue of insurance and cost.
Speaker 3: As long as the price of these drugs remain high,
Speaker 3: people are going to look for cheaper, potentially less safe options.
Speaker 8: I feel as though, you know, we wouldn't have to
Speaker 8: go down this route that you could potentially be unsafe
Speaker 8: if these insurance companies started caring it for people like me.
Speaker 3: That's it for this episode of The Big Take from
Speaker 3: Bloomberg News. I'm Sarah Holder. This episode was produced by
Speaker 3: Adrianna Tapia and Jessica Beck. It was edited by Aaron
Speaker 3: Edwards and Cynthia Koons. It was fact checked by Thomas
Speaker 3: lu It was mixed by Robert Williams. Our senior producers
Speaker 3: are Naomi Shaven and Kim Gettelson. Our senior editor is
Speaker 3: Elizabeth Ponso. Nicole beamsterbor is our executive producer. Say Bowman
Speaker 3: is Bloomberg's head of podcasts. If you liked this episode,
Speaker 3: make sure to subscribe and review The Big Take wherever
Speaker 3: you listen to podcasts. It helps people find the show.
Speaker 3: Thank you so much for listening. We'll be back tomorrow