GLP-1 Analogs and Pharma's Race to the Bottom
Direct-to-consumer prescribing will force push button, swipe right care
It seems Lilly is edging into the business of care delivery. They announced this week the launch of Lillydirect — a solution created to get Zepbound, their new weight loss drug, into the hands of patients. The platform connects people with an independent telehealth company that prescribes obesity medications, as well as third-party services that can fill prescriptions and send them directly to a patient’s home. And as the arms race for GLP-1 analogs (Ozempic, Trulicity, etc.) heats up, expect the number of manufacturers facilitating this kind of patient care to become the norm. It seems like TV ads were just the beginning.
You don’t have to look close to see that this is a race to the bottom for drug manufacturers and other teleprescribing businesses standing themselves up as clinics. Scroll Instagram and the number of pop-up prescription sites appearing for GLP-1’s is nuts. Even Weight Watchers, which used to embody discipline and self-driven weight management, is now crouching towards the quicker fix.
And it's hard to imagine that anyone doubts the inevitable outcome of these telehealth encounters: a happy ending with a prescription in hand.
The drive-by treatment of chronic disease works well on the front end. Everyone’s happy, it seems. ‘Access’ is improved for people with laptops and credit cards. But in the long run the story may be more problematic. Aside from addressing the co-morbidities associated with obesity, those who are candidates for this medication class require monitoring and ongoing follow-up care. And what do these patients tell their personal physicians? “I took an online quiz and the doctor on the chat thought it was a good idea.” Worse, do they even tell their doctor?
Despite the striking results of these medications, the downstream effects of their unmitigated use aren’t fully understood. But it seems this isn’t part of the equation for those creating spaces for frictionless drug distribution. And for me, this is the biggest concern.
Long-term health effects aside, the GLP-1 experiment marks a pivotal point in how people access care.
As medicine drifts toward precision and efficiency, the role of health professionals in moderating these exchanges will become more unclear. The GLP-1 medicine show is foreshadowing a new kind of transactional care delivery. Direct-to-consumer diagnostics and prescribing will force patient self-care into a push button, swipe right exchange. In this paradigm, metabolic therapies like these will emerge not as medicines but as costly commodities that prioritize convenience over good care.
And then the dream of ‘why can't healthcare be like shopping on Amazon?’ may finally be realized.
I can’t underscore the impact this class of medication will have on those who need them most. But every technology, medication, and convenience comes with a cost. Our great race to the bottom with GLP-1 analogs may ultimately bear this out.
Let me know what you think. And if you like the post, pass it along to a friend who might be interested.
Image created via DALL-E3. It had a hard time understanding the idea of a prefilled dosing pen.
Worse than the script is that a large number of these people are getting compounded medicines. I personally wrote a letter to the FDA, who responded that none of the compounded preparations are approved in the United States. No one knows where the active peptide is being made, and by whom. Large numbers of doctors are becoming wealthy, doing telehealth prescribing a medication made in a factory that the FDA has had no supervision or even awareness of its location. They shut a few down, but they open up even faster. Many of the compounds are not certified for human use, and certainly have not been tested in humans . Patient say they're active so they must be good that's like saying arsenic can help you lose weight, so what's wrong with it?
My concern is that already overworked primary care docs and surgeons will be responsible for managing the complications of these unsupervised drugs. Does anyone remember cardiologists calling us in a panic that the postmenopausal women they put on unopposed estrogen now having dysfunctional uterine bleeding?
That was before the Internet and telemedicine. It’s the Wild West out there.