Big Pharma Is Winning the Price War Over Weight Loss Drugs Like Ozempic: Will RFK Jr. and His MAHA Allies Push Back?

It was early April when Brigham Buhler texted a message to the Health and Human Services secretary, Robert F. Kennedy Jr., asking if they could speak. The two men knew one another well. In 2023, Mr. Buhler appeared on Mr. Kennedy’s “RFK Jr Podcast,” discussing the “broken health insurance system.” Both are also foundational members of the Make America Healthy Again, or MAHA, movement, which has gone from being derisively nicknamed the “Woo-Woo Caucus” by the Atlantic, only last year, to getting control of the levers of American healthcare policy.

Mr. Buhler, in his call last month, wanted to bend Mr. Kennedy’s ear about the affordability and availability of GLP-1s, the class of diet drugs whose most famous brand name version is Ozempic. GLP-1s work by mimicking natural hormones to regulate blood sugar and suppress appetite. By 2022, the blockbuster success and overwhelming demand for GLP-1s forced the Food and Drug Administration to put both semaglutides, like Ozempic and Wegovy, and tirzepatides like Mounjaro and Zepbound on the FDA drug shortage list.

The designation allowed so-called compounding pharmacies – like ReviveRx, Mr. Buhler’s Houston-based 503B business that he owns in addition to biotech company Ways2Well –  to produce their own versions of the weight loss drugs. These compounded medications were much more affordable than the brand-name versions, ranging from $129 to $497 a month, as opposed to brand-name versions like Ozempic, which can cost over $1300 a month without insurance. 

Health insurers rarely cover weight loss drugs unless the patient is gravely obese. By November 2024, compounding pharmacies fulfilled nearly 110 million compounded prescriptions, as consumers turned to them as affordable alternatives to brand-name drugs like Ozempic and Wegovy, or to offset the limited access to brand drugs, according to the Outsourcing Facilities Association, or OFA, a trade association that represents FDA-registered 503B facilities that include ReviveRx.

Then the FDA removed tirzepatide and semaglutide (including Ozempic, Wegovy and Mounjaro)  from its drug shortage list, a decision that Mr. Buhler believes was rash, ill-informed, and dangerous. 

So he reached out to Mr. Kennedy, asking to speak. To Mr. Buhler’s surprise, Mr. Kennedy called him back with an invitation: come to Washington, D.C., for a “closed-door meeting” with high-ranking officials.

Mr. Buhler, a longtime pharmaceutical sales representative turned biotech entrepreneur, accepted the invitation. During that meeting, he talked about alternative therapies like stem cells and peptides, and about the GLP-1 shortage. He and the senior American health officials discussed “all the things that the FDA has declared war on over the last four years,” Mr. Buhler told the Sun. 

“In a room with the big leaguers of the FDA, I asked them what made them decide that GLP-1s were not on the (drug shortage) list? And they said, ‘well, the pharmaceutical companies are telling us that they can meet the demand of the public,’” said Mr. Buhler (the FDA and HHS did not respond to questions regarding this meeting). 

Mr. Buhler countered, citing an OFA study that found that GLP-1s were in stock only 5.8 percent of the time in 30,000 pharmacies nationwide. By taking GLP-1s off the drug shortage list, the FDA was pricing out millions of Americans.

“What’s going to happen is these people are going to turn to black market peptides that they can buy on the internet, because they’re not going to go all of a sudden and start paying $1,300 a month for retail pharmaceuticals,” said Mr. Buhler. 

While the meeting itself was, to Mr. Buhler, a “breath of fresh air,” neither the FDA nor Mr. Kennedy could give Mr. Buhler a clear idea of how they would address the GLP-1 affordability issue. The following day, Mr. Buhler joined Messrs. Kennedy and Makary, along with “Food Babe” blogger and MAHA luminary Vani Hari, for the announcement of the FDA’s plan to phase out “toxic” petroleum-based dyes from the nation’s food supply. Getting rid of artificial food dyes was an issue that had the full support of the entire MAHA community.

The issue of GLP-1s, on the other hand, does not. Now, after two federal lawsuits waged by the OFA challenging the FDA’s decision were decided in favor of the government agency, along with GLP-1 detractors in the MAHA community, it appears that the fight to make GLP-1s affordable and accessible again may very well be a long one. 

The GLP-1 Divide

Originally intended to treat people with Type 2 diabetes, injectable GLP-1s have been found effective as a weight-loss treatment in conjunction with exercise, diet, and lifestyle changes. 

MAHA influencers like “The Biggest Loser” host and fitness expert Jillian Michaels have not shied away from their disdain for GLP-1s, urging people to “try anything else” to lose weight. 

“I cannot issue a strong enough warning,” she told “E! News.” She has been outspoken about the potential side effects of the injectable drug, like stomach paralysis and vision problems (a recent study identified a “potential link” between semaglutide and vision problems, but said more research is needed to help clarify the finding).

Americans taking expensive weight loss drugs indefinitely is the kind of scenario that many MAHA proponents, who inveigh against a culture of chronic disease from which the drug industry profits handsomely, strongly oppose. Calley Means, a MAHA influencer who’s a special government employee and adviser to Mr. Kennedy, has criticized the drugs and the “prevailing wisdom from the medical establishment that we must accept the obesity epidemic and the best thing we can do is mass drug the population,” as he said on a LinkedIn post.

Casey Means, Mr. Means’s sister, a physician and a prominent MAHA influencer who is President Trump’s new nominee for surgeon general, recently wrote on her blog that she agrees there is “utility” for GLP-1s in certain patient-specific situations, but the medication is “not the answer to the metabolic dysfunction crisis” in the country.

Before taking office, Mr. Kennedy had been candid about his dislike of the medication, saying in October 2024 that weight-loss drugs were succeeding in America “because we’re so stupid and so addicted to drugs.” 

“If we just gave good food, three meals a day, to every man, woman and child in our country, we could solve the obesity and diabetes epidemic overnight,” Mr. Kennedy added. (HHS did not respond to questions asking for Mr. Kennedy’s current stance on the access and affordability of GLP-1 medications.)

Mr. Buhler believes the statements are not “anti-GLP-1” but rather a “push to prioritize lifestyle changes over prescriptions.” 

“What the Means siblings and Jillian Michaels are emphasizing—and what Make America Healthy Again stands for—is a more nuanced, root-cause approach to chronic disease,” Mr. Buhler said.

“GLP-1s are a necessary liferaft for some, but they have to be affordable, accessible, and used responsibly — alongside serious investment in nutrition, exercise, and sustainable health habits,” Mr. Buhler added.

A dietitian and host of the “Dietitians Who Lift” podcast, Summer Kessel, disagrees with the MAHA movement’s criticism of GLP-1s, which she said is “not actually grounded in reality or science.”

“I find particularly the MAHA movement as a whole to be deeply steeped in obesity bias and fat phobia,” Ms. Kessel said, calling out what she sees as a tendency to “blame the individual for having a chronic disease of obesity instead of recognizing environmental and biological systems that contribute to (it).”

Criticisms aside, the popularity of GLP-1s is only expected to grow, with sales predicted to eclipse $100 billion by 2030, according to JP Morgan forecasts. 

Part of the reason is the high pricing for the drug itself. Pharmaceutical giants like Eli Lilly, which makes Mounjaro and Zepbound, and Novo Nordisk, which makes Ozempic and Wegovy, have been accused of using their patent system to boost revenue and prolong their monopoly in the market.

In “The Heavy Price of GLP-1 Drugs,” a recent report from The Initiative for Medicines, Access, and Knowledge, or I-MAK, pharmaceutical companies were accused of cornering the GLP-1 market by building “patent thickets” – follow-on patents related to minor modifications of existing products – to extend their patent protection while blocking out more affordable generics and biosimilars.

Meanwhile, GLP-1s, despite their exorbitant price, could be produced for under a dollar per dose, according to a recent study from the Yale School of Medicine. 

“They sell the exact same product made at the exact same facility using the exact same labeling and … requirements, and they sell it in India for $50, so why are we here in the United States paying 10 to 13 times more than what they’re paying in India for the exact same product?” BakerHostetler attorney and OFA Chairman Lee H. Rosebush said. 

“It just doesn’t make sense, and they’ve put patients at serious risk here,” Mr. Rosebush added.

While compounded semaglutide and tirzepatide may be affordable, they are not foolproof. 

The FDA warns compounded drugs “pose a higher risk than FDA-approved drugs because compounded drugs do not undergo FDA review for safety, effectiveness, or quality before they are marketed.”

As of February 2025, there were 455 reports of adverse events with compounded semaglutide.

There were also over 320 reports of adverse events with compounded tirzepatide, per the FDA. ReviveRx itself had two recalls for tirzepatide-related incidents, one when it accidentally mailed 750 vials of testosterone to customers who had ordered tirzepatide, and the other for sending “sub-potent” dosages of compounded tirzepatide. Mr. Buhler said he could not comment on “specific regulatory correspondence.” 

But the number of safety incidents is tiny compared to the millions of Americans using the drugs without incident.

After semaglutide and tirzepatide were removed from the drug shortage list, the OFA filed two lawsuits, one against the FDA and Eli Lilly, claiming the FDA made its decision based on incomplete data provided to it by Eli Lilly. 

Allegations of the FDA’s “across-the-board deference to Eli Lilly” and lack of “any apparent methodology” behind its determination to end the drug shortage are “fairly reasonable characterizations,” Saint Louis University School of Law Assistant Professor Michael S. Sinha, told the Sun.

He pointed to the 2012 FDA Safety and Innovation Act, which requires drug manufacturers to report to the FDA foreseeable drug shortages, which allows the FDA to create contingency plans.

“Shortages of brand-name drugs tend to be less common due to their cost and availability of alternatives, but my sense is that in this case, a surge in demand for the weight loss treatments Wegovy and Zepbound far exceeded manufacturing capacity based on thresholds that had initially been established,” Mr. Sinha said. “The companies were simply not prepared to scale up to meet the surge in demand.” 

On Wednesday, US District Judge Mark Pittman sided with the FDA in a sealed ruling. 

“Drug-shortage determinations affect patient access to medical treatment and should be made based on sound reasoning and verifiable data, not the say-so of self-interested manufacturers seeking to push competitors out of the market,” Mr. Rosebush said in a statement in response to the verdict. The OFA is appealing the decision. 

A second lawsuit against the FDA, which the OFA filed to allow compounding pharmacies to keep making compounded versions of Ozempic and Wegovy, has yet to be decided. Judge Pittman, who is also overseeing the case, rejected the OFA’s bid to continue making compounded versions of Ozempic and Wegovy in the meantime.

“The FDA has determined the shortage of tirzepatide injection products is resolved and will continue to actively monitor drug availability,” an FDA spokesperson said.

“This is why we see so much litigation hedging on the FDA’s decision-making process,” Mr. Sinha said. “In part due to its view that manufacturer data relating to shortages is confidential, but also in part because the decision to remove a drug from a shortage list has never been so consequential.”

In April, Eli Lilly sued four telehealth companies, including Willow Health and Henry Meds, for selling “illegal copies” of tirzepatide that were made in compounding pharmacies. 

“Our medicines are manufactured in FDA-registered facilities and subject to strict regulatory oversight by the FDA and global regulators.  We take our obligations seriously and have rigorous quality systems in place to ensure patients receive safe and effective medicine they can trust.  Compounders aren’t held to these stringent standards,” a Lilly spokesperson said.

Recent deals like Novo Nordisk’s agreement with telehealth firms like LifeMD and Hims & Hers to sell Wegovy, a semaglutide, at $499 a month are designed to give “the appearance of increased access,” said Mr. Buhler. 

“These arrangements still restrict supply, keep prices high, and lock patients into branded, name-only prescriptions with zero flexibility. They also sidestep the fact that compounding pharmacies were filling this access gap safely and affordably for years while the drug was on the FDA shortage list,” said Mr. Buhler.

In April, the Trump administration announced Medicare and Medicaid would no longer cover the anti-obesity drugs. Despite his previous rhetoric on GLP-1s, Mr. Kennedy appears to be softening his stance, saying he is considering a “regulatory framework” for Medicare and Medicaid to cover the “extraordinary drugs.”

Mr. Kennedy told CBS News that President Trump wants to get the cost of GLP-1s down to “something around European pricing.” Whether that plan includes compounding pharmacies remains to be seen.

“Why are we shocked when the FDA comes to decisions that don’t favor humanity and that instead favor industry?” Mr. Buhler asked.

And yet, he remains confident in Mr. Kennedy and his administration’s seriousness on the issue and their determination to resolve it.

“Just reading the tea leaves and being in closed-door meetings with these folks, I think there’s the old regime at the FDA that has pushed agendas for years,” said Mr. Buhler. 

As for Mr. Kennedy and his HHS, “they’re trying to figure out what the good and bad agendas are.”

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