Ozempic Wars | The Hundred-Year Duel | 1

0:08It's August 2025. An SUV full of FDA agents pulls into a shipping yard in Cincinnati, Ohio. Behind them, U.S. Customs and Border Protection agents roll in, engines rumbling. The agents pile out of their vehicles and walk across the yard, which is crammed with thousands of shipping containers. Soon, the crates will be loaded onto semi-trucks and shipped all over the country. The agents make their way to the manager's office, a dusty white trailer at the center of the lot. The door opens, and a confused-looking man steps out. An agent hands him a warrant, and then the raid begins. Agents fan out, throwing open shipping containers and ripping open boxes.

0:55Finally, an agent steps into a container that recently arrived from Hong Kong. He pulls out a razor blade, slices open one of the cardboard boxes, and freezes. He yells for the other agents to come over. He's found what they're looking for. The agents swarm in and start ripping into the boxes. Inside each one are rows and rows of small glass vials labeled semaglutide. That's the active ingredient in Ozempic, the diabetes medication that millions of people use to lose weight. Except these vials aren't filled with Ozempic. They may not even contain semaglutide. There's no way of knowing what's in them, But that hasn't stopped shady online pharmacies from selling the liquid cheaply to unsuspecting customers.

1:45The agents load up close to 17 ,000 vials of unregulated weight loss medication, worth millions on the black market. The FDA agents know this drug bust is just a drop in the bucket. Across the United States, truckloads of unregulated illegal doses of fake Ozempic are being transported and sold to people desperate to lose weight. But they don't always work. They're dangerous. And they are absolutely everywhere. The FDA wants to remove these knockoffs from the market. And so does Novo Nordisk, the Danish pharmaceutical giant that developed Ozempic. Because these counterfeits don't just threaten public safety.

2:27They're undermining years of careful research and development that went into creating a legitimate medical treatment. Novo Nordisk wants to preserve the integrity of their breakthrough medication and the profits that come with it. As fake versions of Ozempic continue to spread and competitors like Eli Lilly circle, Novo Nordisk is fighting a war on two fronts. And in this$28 billion battle, there's no guarantee that even the original innovator will emerge on top.

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5:12From Wondery, I'm David Brown, and this is Business Wars.

5:38You know, they say that imitation is the sincerest form of flattery. And in business, imitation means opportunity and profit. Scroll through Google's shopping pages and you'll see knockoff after knockoff, each one produced and sold cheaper than the name brands. Sometimes, name brands imitate one another. For example, almost every Coca-Cola product on the market has a Pepsi counterpart. And all of these beverages have supermarket imitators sold at places like Walmart or Costco. So when Novo Nordisk launched its diabetes drug semaglutide, they probably expected some friendly competition. What they didn't expect was a worldwide shortage or a flood of copycat drugs filling the gap.

6:26And all of it hitting right as Eli Lilly, their biggest competitor, launched a rival drug of their own. In this season, we're taking a look at the Ozempic Wars, the latest chapter in a century-long rivalry between two pharmaceutical giants and the opportunistic compounding pharmacies that are upending the industry. This is Episode 1, The Hundred-Year Duel.

6:55To understand how Novo Nordisk became the face of modern weight loss, you really have to go back a century. Novo Nordisk was founded back in 1923 in Copenhagen, Denmark. Back then, it was called Nordisk Insulin Laboratorium. which is exactly what it sounds like in insulin laboratory. Insulin had only been discovered two years prior in 1921. Nordisk was one of the first companies to commercially produce it, and their mission was simple, to mass-produce this life-saving drug to help people with diabetes. But they weren't the only ones competing in the insulin market. Across the Atlantic, an American pharmaceutical company called Eli Lilly launched the world's first commercially available insulin in 1923.

7:42From day one, Eli Lilly and Nordisk were rivals. Over the next several decades, both companies expanded their reach. New drugs, new markets, and new scientific breakthroughs. But diabetes remained their bread and butter. In 1989, Nordisk merged with another Danish lab called Novo Therapeutisk, forming Novo Nordisk. Together, they dominated Europe's insulin business, while Eli Lilly dominated the U.S. During the 1980s, something happens that changes the race entirely. Both companies start working on reproducing the effects of the GLP-1 hormone. Now, let's take a minute to quickly explain what GLP-1 is.

8:30Its formal name is glucagon-like peptide 1, and it's a naturally occurring hormone in the human body. It helps the body regulate blood sugar levels and produces insulin when our blood sugar is running low. In addition to regulating blood sugar, GLP-1 also tells our brain when our stomach is full. But people with type 2 diabetes often don't respond to the hormone the way their body should. So a drug that could help the body produce more GLP-1s or mimic the function of the GLP-1 hormone would be a game changer. Sure, there are other diabetes medications on the market, but many patients don't fully respond to these drugs.

9:09And for them, maintaining insulin levels is a nonstop and life-threatening struggle. And with that, a multi-billion dollar pharmaceutical race begins. One that will pit some of the world's biggest drug makers against each other and change the future of medicine.

9:33It's 1994. Scientist Lata Bjer-Nudsen walks into her lab at the Novo Nordisk headquarters outside of Copenhagen. She's just returned from maternity leave, and her boss has asked her to take another crack at their GLP-1 project. Novo Nordisk has been trying for years to turn the hormone into a diabetes drug without success. GLP-1 has a short half-life and breaks down in just a few minutes once it's inside the body. No one has figured out how to make it last long enough to be useful as a drug. People are starting to wonder if the project is a dead end. But Knudsen's boss isn't ready to give up just yet.

10:13He tells her that her team has one last shot to figure it out. Knudsen is feeling the pressure today. She's young, only 30 years old, doesn't hold a PhD, and this is the first time she's ever been put in charge of a drug development program. And she wonders if she can find the courage to lead this team. It's slow work, but gradually, Knudsen and her team do make progress. Eventually, they add a spacer, which helps GLP-1 bind to albumin, a protein in the blood. This bond helps the hormones stay in the body for a longer period of time. It's a big breakthrough, but Knudsen's already thinking ahead.

10:57If her team can improve upon this work, they just might be able to create a synthetic version of GLP-1. And maybe, in time, GLP-1 drugs can do more than just control blood sugar. They could help people lose weight, too. But Novo Nordisk isn't the only company chasing this holy grail. And the race is on to see who will get there first. Over the next decade, Lata Knudsen's discovery lays the groundwork for a new class of diabetes treatment. GLP-1 drugs are suddenly the next big thing, and every major pharmaceutical company wants in. Eli Lilly gets there first. In 2005, the company partners with a smaller biotech firm called Amalin Pharmaceuticals to launch a drug called Bieta, the first-ever GLP-1 drug approved for the treatment of type 2 diabetes.

11:55And it's pretty effective. It helps keep people's blood sugar levels steady. It also slows down digestion, making people feel full longer. But there is a problem. Bayetta requires two injections a day, which is inconvenient and painful. So while Bayetta helps Eli Lilly find a slim edge over its key competitors, it also leaves the door open for one of them to make an improved version. Novo Nordisk is already at work on the research and development of their own GLP-1 drug. And in 2010, five years after Eli Lilly released Bayetta, they finally succeed. with a diabetes drug called Victoza. It's an improvement over Bayetta in that it only requires one injection a day.

12:46Novo Nordis continues improving on Victoza. And in 2017, they get FDA approval for a new drug. It's called Ozempic. To make Ozempic, researchers created a new synthetic hormone called semaglutide, which has a longer half-life than its previous iterations. and a longer half-life means only once a week injections. Now, let's pause for a moment and think about this from a marketing perspective. More often than not, what customers are really looking for are products that make everyday life a little easier. Turning one shot a day into one shot a week, that's not just a minor perk. It's a different life for some people.

13:28And we've seen this time and again. Remove a customer headache and you unlock demand you couldn't advertise your way into. If you've got a product and you're evaluating your own roadmap, hunt for the leap that's like weekly, not daily. The win is part technology, to be sure, but it's about something more. Something like empathy. And that can make a world of difference. At first, the company markets Ozempic as a treatment for type 2 diabetes. But when their first commercial airs in 2018, It includes a different message. Oh! Oh! Oh! People with type 2 diabetes are excited about the potential of once-weekly Ozempic.

14:14And you may lose weight. In the same one-year study, adults lost on average up to 12 pounds. Oh, up to 12 pounds? Ask your health care provider if Ozempic is right for you. Now, if you watch the commercial as the voiceover says, you might lose 12 pounds. The text on screen reads, Ozempic is not a weight loss drug. Hmm. Here's a dirty little secret about advertising. Think of it as what you hint at is what people hear. Oftentimes, marketing lives in the gaps between words. Say, not a weight loss drug next to a weight number, and the public hears weight loss drug. You can call something a side effect, but sometimes it can be the real main event.

15:01A happy accident of research or a new product line in the making. Well, you probably know where this is going. Weight loss is an off-label effect of the drug, not its intended use. But Novo Nordisk CEO Lars Freurgaard Jurgensen understands that the moment this commercial airs, weight loss is all anyone's going to want to talk about. He knows they're close to unlocking a new market, and a much bigger one than the diabetes patients they're currently serving. But this shift is a gamble, because chasing a miracle can sometimes wind up hoarding disaster.

15:45It's late 2019, just outside of Copenhagen. A handful of Novo Nordisk executives are sitting around a conference room table inside the company's headquarters. They're trying to answer the question that could define the company's future. Should Novo Nordisk start positioning Ozempic as a weight loss drug? Well, the diet drug market is risky. Fen-Fen, Accomplia, they were both disasters. Lawsuits, dangerous side effects like cancer and heart problems. Do we really want to go down this road? Come on, this isn't Fen-Fen. We're already using Ozempic safely for diabetes. Just look at the trial data.

16:25I know, I know, but still, the moment we lean into weight loss, we're inviting scrutiny from regulators, the media, and our customers. If anything goes wrong, we could be the next cautionary tale. Novo Nordisk has good reason to be cautious. The diet drug market has burned companies in the past. But at the same time, diabetes and obesity are becoming harder and harder to separate. Studies report that over 80 % of type 2 diabetics are overweight. The turning point for Novo Nordisk comes during the pandemic. The CDC reports that if you're obese, the odds of ending up in a hospital bed with COVID are triple those of everyone else.

17:12Novo Nordisk execs feel compelled to push the weight loss messaging forward.

17:21In June 2021, Novo Nordisk's gamble pays off when Jurgensen receives some thrilling news. He has approval to take their new drug to market. It's called Wegovi, and he knows it will revolutionize the weight loss industry. Wegovi is similar to Ozempic, both contain semaglutide, but Wegovi is prescribed in higher doses, specifically for weight loss. This higher dose required multiple trials and a rigorous approval process, but it's finally received the green light from the Food and Drug Administration. WeGoVeep isn't a diet pill. It's a once-a-week injection that works by helping users feel fuller faster.

18:04It slows down the rate at which food leaves your stomach, which prolongs that feeling of fullness. And like the GLP-1 hormone, it sends messages to your brain to help regulate your appetite. People who take the injections end up eating around 20 % to 30 % fewer calories each day. In clinical trials, more than a third of people lost up to 20 % of their body weight and were able to maintain this loss through the entire two-year trial. That's a sizable change from the results of Novo Nordisk's previous iterations. Those drugs hovered around an 8 % BMI reduction. Novo Nordisk finally has the edge over Eli Lilly in the GLP-1 arena.

18:48But what started in the lab is about to spill into every corner of American life.

18:58Ozempic first makes national headlines in early 2021 when the Dr. Oz Show airs a segment titled Could a Diabetes Drug Cure Obesity? Dr. Oz invites an obesity researcher from Northwestern to explain the breakthrough. And you're a pretty conservative guy. So after studying weight loss therapies for years, what makes you so excited about this study? Yeah, first of all, thanks for having me on. You know, I don't use the word game changer very often. In fact, it's the first time I've used it in my 40 years of practice. And by early 2022, semaglutide is the hot topic. But getting the drugs isn't easy.

19:39Wegovy is enormously expensive, costing around$1 ,300 a month. And most insurance companies won't cover it unless you meet certain criteria. So it quickly gets a reputation as a status symbol. A luxury drug for the rich and famous. Meanwhile, spirits inside the Novo Nordisk boardroom back in Denmark are sky high. The company is on track to hit$25 billion in sales for the year. That's nearly double their growth since Ozempic first hit the market in 2018. Novo Nordisk has every reason to believe they'll stay on top. They hold a patent on semaglutide until 2032, which means nobody else can produce their synthetic hormone.

20:25So even though Eli Lilly is still selling its own GLP-1 drug, their formula is different. Eli Lilly's doesn't use semaglutide. That's Novo Nordisk's special recipe. And because of that, they have the market cornered, at least for now. But as demand explodes, Novo's miracle shot is about to meet its biggest challenge yet. Keeping up.

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22:26By March 2022, Novo Nordisk is struggling to produce enough semaglutide to meet demand. And that's a huge problem for three reasons. First, Wegovy only works if people take it consistently. If Novo Nordisk's supply dries up, users who suddenly lose access could gain all the weight back. Second, and more importantly, semaglutide wasn't just designed for weight loss. It's a critical medication for people with type 2 diabetes. For them, missing multiple doses could be dangerous, maybe even deadly. And there's the third problem. It opens the door up to competition. NovoNordisk's CEO, Lars Freurigard-Jurgensen, has it on good authority that Eli Lilly is hard at work on a rival version of Wegovy, one that would work the same way, though it would be their own formula.

23:22NovoNordisk does everything within its power to ramp up production, but they just can't keep up. And in March of 2022, the FDA officially puts Wegovi on its list of drug shortages. This is very bad news for NovoNordisk. When a name-brand drug goes into shortage, Sections 503A and 503B of the Federal Food, Drug, and Cosmetic Act allow smaller facilities, called compounding pharmacies, to make their own versions, even if the original drug is patented. They're not creating a generic version of the drug, exactly, but more like a close copy. But this puts Novo Nordisk at risk of losing their control over this market.

24:06Now let's think about what's happened here When you can't meet demand, you don't just lose sales You run the risk of creating your own competition A shadow market New sellers rush in, quality gets uneven And guess who pays the bill for products you didn't make? Your reputation In the long run, prevention beats policing Expanding capacity early, staging launches And publishing clear safety guidance your customers can act on because if you leave a vacuum, it will almost certainly be filled, and seldom to your own benefit. These copycats aren't FDA-approved, and they can only be sold while a shortage exists.

24:48In theory, production should stop once supply catches up. But Jurgensen knows what's coming. As long as these compounding pharmacies keep making semaglutide lookalikes, They'll flood the market, confuse customers, and chip away at Novo Nordisk's profits. So he moves fast, racing to build new production facilities that can produce enormous amounts of semaglutide and meet consumer demand. But no matter how fast Novo Nordisk builds, they just can't outrun demand. And while they beat Eli Lilly to market this time, they know it's just a matter of time before their longtime rival debuts its own blockbuster drug.

25:33Two months later, in May of 2022, Eli Lilly brings their new GLP-1 drug to market. They call it Monjaro. And while it's technically a diabetes drug, it also has weight loss benefits. Monjaro mimics the same GLP-1 hormone as Wegovi, but it also mimics a second hormone, GIP, that helps the body process food and control blood sugar. Think of it like bringing two weapons to a one-weapon fight. While Wegovi uses one tool to combat weight gain, Monjaro attacks on two fronts, making it potentially more effective at both controlling blood sugar and shedding pounds. The market response is explosive. Eli Lilly sells out their entire stock within months, creating their own shortage crisis.

26:22This is actually a mixed blessing for Novo Nordisk. Yes, their rival is gaining ground, but if Eli Lilly is also struggling to meet demand, then they can't dominate the market. Yet. Now, it's a full-blown arms race to see which company can scale up production the fastest. And Jurgensen isn't taking any chances. He pours over$700 million into new production facilities, determined to manufacture more semaglutide. But remember how we said that the moment you get on the shortage list, compounding pharmacies are allowed to offer their own version of a drug? Well, they're hard at work, rushing to develop their versions of Novo's Golden Goose.

27:08Almost overnight, compounding pharmacies flood the internet, each promising their own version of these miracle weight loss drugs. Some are established players, like Remedy Meds. But then come the outsiders, hungry for a piece of the action. And here's where it starts to get murky. New retailers are popping up with slick websites and tempting prices. But ask them where their GLP-1s come from or how they're made? Suddenly, the answers get vague. Still, their ads saturate social media, promising the same results as Ozempic at a fraction of the cost. For Novo Nordisk, it's a nightmare scenario. Each new competitor in each discount option threatens to chip away at their market dominance and their credibility.