What If Ozempic Cost $1.00?
Two scenarios that explore a future world where GLP-1 drugs have become accessible to anyone wanting to lose weight.
Liam is late for work but still manages to pour half a cup of coffee that his wife made into his thermal mug before getting in the car and peeling out of the driveway. He zooms down the freeway to his office, parks the car and hustles into the building. He drops off his bag at his desk and waltzes into the conference room with just a minute to spare. Two years ago he’d be a wreck going into that meeting without a hearty breakfast but he cruised through it flawlessly.
Liam has worked as a software project manager for four years just outside of Seattle. He married his college sweetheart, Colette, two years ago and they live in a cozy starter home with their labradoodle Shadow. On his desk is a frame holding two photos side by side. On the left side was a picture of Colette and him at the beach in the Bahamas during their second year of dating. His belly fat spilled over the waistband of his tropical swim trunks and his moobs were embarrassingly plump. On the right side was another photo of them on that same beach during their honeymoon where he was 80 pounds slimmer. His torso was beginning to look chiseled, with the beginnings of a six pack starting to emerge and his waistband fully visible. The photo on the right was him after a year of using Ozempic.
The pair of photos keep him motivated at work. Both as a reminder of his health journey, but also as a reminder that he can overcome any challenge with the right attitude and tools. He’ll sometimes glance at it before a big meeting to boost his confidence. Liam struggled with his weight all his life. He was bullied as a kid. He got frustrated trying to find clothes. He routinely got winded in parking lots if he didn’t get a good spot. He tried all the fad diets and workout routines but couldn’t consistently keep the weight off. But those two photos looked like a timeline to Liam and he was focused on only moving to the right, or forward in time, away from his previous life as an overweight person.
When Ozempic started to make headlines in the early 2020s, he was intrigued, but it seemed out of reach. He was just out of college at the time and the $1,000 per month cost was unattainable. Now that the patents had expired and compounding pharmacies were everywhere, he got his monthly supply for about $35 a month. They were daily oral pills now, which was great because he hated needles, and he bought them online in three month supply batches after a quick video call with a telehealth professional.
After his last morning meeting, a colleague was corralling everyone into the kitchen area. It was the boss’s birthday and her assistant got a cake. They gamely sung Happy Birthday as best they could and passed around slices of a three layer red velvet cake with buttercream frosting. Not wanting to be rude, Liam took a slice and absentmindedly picked at his with a fork while everyone ate and socialized. The sight of it was making him nauseous but he took one small bite and choked it down. After about 20 minutes, he checked his watch with a look of feigned urgency and walked back to his desk, depositing the nearly whole slice of cake in the garbage when no one was looking.
The old Liam would have devoured his slice then hung around as long as he could to try and sneak a second one in. Now, the sight of sweets repulsed him. He, like millions of other Americans, were on Ozempic and belonged to a mass cultural movement away from decadence. Liam mostly ate modest portions of lean protein with a small amount of starch and vegetable. Meals were usually prepared by himself or his wife at home, but most restaurants now had the option of choosing a smaller GLP-1 portion of a dish, which he would do on his weekly date night with Colette. He used to go out with work friends and drink 3-4 beers with a dozen wings almost every week. Liam still joins his coworkers, but now has a couple non-alcoholic seltzers with lime and calls it a night. A handful of his coworkers also on Ozempic do the same.
Liam’s pantry used to be filled with ultra-processed snacks. He loved the classics, like Doritos, Cheetos, and Cheez Its, but also trafficked in some of the newer snack brands that had a halo of “better for you-ness” to them. Post-Ozempic, they’re mostly banished from his house, save for a few micro-dose sized bags of Nacho Cheese Doritos. Liam now snacked so rarely that if he was going to have something, it was going to be one of the foods he loved all his life, not some new-age snack fortified with functional ingredients.
Big Food had transitioned from a pre-GLP-1 world where snacking occasions were plentiful, to one where snacking was a rarified treat for consumers. They shrewdly evolved their product lines to have smaller portions that left a bigger flavor impression on the palate. Food scientists upped the flavor intensity of snacks so they could deliver a bigger burst of flavor per bite, which was important when selling less product.
Before GLP-1s, Big Food wanted to hit an eater’s bliss point that would keep their tastebuds engaged but not so much that they would only eat a few bites and stop. But now, snack recipes were adjusted to act more like an intensely flavored, but small, amuse bouche. Seven or eight intense flavor explosions was all one needed while taking GLP-1 meds. After all, if you only had a snack once a week while on Ozempic, you wanted to make the experience count.
With a new body, a new wife, and a great career in full stride, Liam was hopeful about the future. His bank account was even growing faster than before on account of not buying so many groceries and spending less on dining out and drinking. Most importantly, his mind and body felt better, which gave him renewed confidence and optimism. Small things like running late for work used to launch him into a spiral of shame and negative self talk, which would inevitably lead to snack binges, but he was now unflappable as ever.
Liam used to think taking pills or injections to stay healthy was cheating. It didn’t feel like you earned it if you didn’t suffer through years of dieting and exercise to have a healthy looking body. No one judged you if you got surgery to reconstruct a torn ACL, so why should they judge you if you used a pill or injection to lose weight? Part of being human was creating and using tools to make our lives better, and Ozempic was merely a tool like any other.
As GLP-1s became more accessible and the masses could afford to be on them indefinitely, social attitudes shifted. The concept of “better living through chemistry” was back and Liam felt lucky to have been born just at the right time to benefit from it. Like measles, balding, or erectile dysfunction, human ingenuity had made obesity a thing of the past. Liam embraced all these advances and with the two photos of him and Colette on the beach in mind, he was happy to be on the right side of history, with Ozempic flowing thorough his veins.
GLP-1’s for Everyone
“The future is already here – it's just not evenly distributed.”
― William Gibson
The story of Liam is a fictional scenario, but rooted in highly plausible realities that are already beginning to play out today. It’s still early days for drugs like Ozempic, but for industries that feed people, it’s never too soon to imagine a world where these medicines have gone completely mainstream. I don’t think any food or agriculture company wants to be caught flat footed when they wake up one day in 2031 to realize that much of the world consumes far less food than they did before.
A lot of pixels and ink have been dedicated to covering the meteoric rise of GLP-1 drugs like Ozempic, Wegovy, and Mounjaro. I won’t recount the whole story of their success, but you can easily Google your way to articles that will bring you up to speed (like this one).
It’s even more remarkable to think about their success when you realize that the name brand versions of those drugs can cost around $1,000 for a month’s worth of injections. It’s a luxury drug that few can afford. Those with an officially diagnosed case of type 2 diabetes can get health insurance to cover that cost, but not for people who are using it in an “off-label” capacity as a weight loss drug. Many compounding pharmacies and health startups have popped up offering cheaper versions of the drug, but they can still cost a few hundred dollars a month out of pocket.
The question of whether GLP-1s are safe and effective over a long term is above my pay grade. Time will tell what the knock on effects to public health might be. But barring some kind of bombshell study that proves them to be harmful to humans, we can almost be certain that the drugs will become cheaper and more prevalent over the next decade. Especially after 2031 when the patent for Ozempic expires, followed by Mounjaro and Wegovy later in the same decade.
It’s highly plausible that one day, after the drug companies have made billions, GLP-1 medications will be as easy and affordable to obtain as a month’s supply of insulin, which can cost as low as $35 today, or just over $1 per day. And even if it never becomes exactly that cheap, the addressable market for obesity is so large that it’s totally reasonable to think that one day it’ll be cheap enough to be ubiquitous.
There will be many more Liams in a world where Ozempic is as accessible as insulin, cholesterol meds, or erectile dysfunction pills. His story is typical of people who are on it all the time now. But what other behaviors might emerge when losing weight is reliably affordable, easy, and effective? Could moral hazard come into play in a world where the virtues of sobriety, restraint, and discipline are replaced by a cheap pill or injection? Let’s explore a slightly different scenario than Liam’s with a character named Julie…
The Mounjaro Cycle
Julie Blankenship and her husband Devin are in their seaside hotel room in Puerto Vallarta getting ready to go out. It’s Devin’s 54th birthday and they came down here for Labor Day weekend to celebrate. They recently became empty nesters when their their youngest son, Jimmy, left for college to Florida State two falls ago. The past two years have been a blast for them and Julie hasn’t had this much unbridled fun since before the kids were born.
It’s 4:30 pm and each of them are already five drinks in since breakfast at 8:45 am. A whole day laying by the pool at their all-inclusive resort with great service makes it easy to drink one margarita after the next. They shared a huge plate of nachos around lunchtime but that was a few hours ago and they’re feeling the hunger return. Good thing their dinner reservation starts soon at an upscale seafood restaurant outside of the resort that their neighbors back in Wisconsin recommended.
Now fully dressed, they both do a shot of tequila on their way out of the hotel room before entering a Lyft. Julie needs a hand from the valet to get out of the car when they arrive at the restaurant, as she’s noticeably wobbly on her feet. Their balcony table has a sweeping seaside view where they can hear the crash of ocean waves over the mariachi music gently playing over the loudspeakers. The server comes by with complimentary bottled sparkling water and presents them with menus. Before he can walk away, Julie orders a round of margaritas for Devin and herself to sip on while they peruse the offerings. That’ll be the 7th drink for each of them that day, but she’s honestly lost count at this point.
They get through three quarters of their margaritas and order a barrage of food along with an 8th round of drinks (spicing things up with a Mezcal margarita this time) to enjoy as they wait for the appetizers to arrive. The server attempted to memorize the Blankenship’s food order but had to whip out his notepad halfway through when he realized how much they were ordering.
For starters they ordered guacamole con chicharron made table side, popcorn shrimp, a chorizo stuffed avocado, and grilled shrimp caesar salad, followed by a small raw shellfish tower, ceviche, a grilled lobster tail with drawn butter, a 24oz medium rare ribeye, a side of french fries and creamed spinach, with churros con chocolate and a slice of tres leches cake with a birthday candle for dessert. They split a bottle of Napa Cabernet and two extra anejo tequilas to sip on after dessert. It was the perfect meal to cap off a long weekend of partying.
After the Labor Day weekend bacchanal in Mexico, the Blankenships go back to their normal rhythms of life back home. They host friends at their home almost every weekend for football Sundays and the occasional college football Saturday for big Florida State or LSU games. This quickly collides with the holidays, which they typically host, and they feast and drink just as they did in Mexico. Their oldest son Sebastian was home from college at LSU for Thanksgiving and brought his girlfriend home to meet the family for the first time. She got a warm welcome from the family but admitted to Sebastian later on that she was overwhelmed by the amount of food at the table. The Blankenships knew how to party and assumed all their guests did too.
Before they knew it, it’s New Year’s Eve. The Blankenships plan one final dinner feast at home with friends before the reality of January 1st hits. Devin has made a huge spread of prime rib, king crab, and caviar for them and 8 of their closest neighbors. No one has to drive home tonight so the drinks have been flowing heavily since 4 pm. They’re having the time of their lives and the prime rib came out perfect. After a dessert of homemade cheesecake and profiteroles, Julie and Devin share a passionate kiss at midnight then continue drinking and eating well into the night, finally passing out on separate couches in their finished basement around 2:30 in the morning.
7 hours later, Julie stumbles awake, showers, and gets dressed. She makes a cup of coffee with a splash of oat milk and two Splendas and sits down at her computer. She logs onto Zoom for an appointment with a compounding pharmacy that she’s had on the calendar for over a month. The physician’s assistant asked a few perfunctory questions and sent Julie off on her way. Minutes later she sees an order confirmation in her inbox for a 6 month supply of Mounjaro pills and a receipt for $242, which includes shipping.
For the next six months, she’ll be in control mode getting ready for summer swimsuit season where she’ll be enjoying margaritas and nachos poolside once again on the weekends. This is Julie’s 3rd year of Mounjaro Cycling, as the influencers call it, where she’ll go on the drug to lose the weight she gained during a busy schedule of summer cookouts and beach vacations, football tailgates, and the holidays.
The drug works like a charm. Julie loses on average 1.5 lbs per week while on it, which more than compensates for what she’s gained the previous six months. By June she’ll fit perfectly into her bikini and can begin the cycle once again. The results are so remarkable that she doesn’t fixate too hard on the tiny voice in the back of head that worries about the state of her heart and liver. She worked hard raising her two boys into wonderful young men while working a full time job as a paralegal since their teenage years. It’s only been a few Mounjaro Cycles and she feels like she deserves to let loose a bit.
The Blankenships are in an upper middle class income bracket and see their exuberant spending on food and alcohol from June to January being balanced out by their relative austerity in the first half of the year. Unlike Devin, who’s one of those guys who can keep his average build no matter what he eats, Julie needs the medication to keep herself from becoming medically obese. She was raised in a big family where long drawn out meals was part of growing up. She thrives on the conviviality that food facilitates. After this many years of these drugs being on the market, it seems like a pretty safe bet to use them intermittently. And at $35 a month, that’s far cheaper than a gym membership, which she hates going to anyway.
On some days by the pool after she’s had one too many drinks, Julie would rant to her friends about how it was irresponsible to not take Mounjaro. With all the health risks tied to being overweight and knowing that the weight can be eliminated for less than the price of your morning Starbucks, they should cancel your health insurance if you didn’t take the drugs.
In her 30s when she was overweight, she embraced the body positivity movement and ate intuitively. Many others did too and it felt like she was a part of a movement to love yourself for who you are. But she started to question those beliefs after she saw how well GLP-1 drugs worked for her and those in her social circle. She reasoned with herself that having virtually free access to Mounjaro and not taking it if you were overweight was no different than not using a fire extinguisher to put out a fire. In Julie’s mind, being overweight was now a choice you made, not a thing that society or your genetics forced upon you.
Julie loved her sons with all her heart and she thought that by maintaining a healthy BMI for most of the year, she would surely live long enough to see them get married and play with her grandkids. She and Devin raised them the way she was raised, surrounded by family, friends and food. After her youngest son came home for the first holiday break of his college career, he had clearly put on the Freshman 15. He, like her, almost certainly partied a lot in college and while she took a “don’t ask, don’t tell” approach to her son’s drinking, his weight gain was noticeable.
She didn’t say anything to him about it but she promised herself to get him on a Mounjaro Cycle if the weight gain continued into the following semester. Like any good parent, she wanted the best for her kids and felt she had cracked the code on staying healthy while enjoying life to its fullest. The best of both worlds. What a gift modern science had given humanity to make obesity a thing of the past. You’d be crazy to not accept that gift, right?
Mise Futures
Good foresight doesn’t ever claim to predict the future, instead it invites you to think and act differently about it in today’s world.
Julie and Liam are fictional characters, but their behaviors and attitudes could easily exist in the very near future, if not already. A good scenario will open your mind about new possibilities and illuminate blind spots in your thinking about our world. And whether these two stories made you delighted or angry, the good news is you can do something about it in real life because these stories haven’t happened yet.
It feels reasonably certain that GLP-1’s will become more accessible in the coming decade. Popular drugs don’t really get more expensive over time, especially after their patents expire. But while their increased accessibility feels like a foregone conclusion, there is still a lot of uncertainty about how their ubiquity will affect society.
Will living your entire life on GLP-1’s like Liam be considered socially acceptable and healthy? Or will people use them as needed instead of dieting and working out like Julie’s feast or famine lifestyle? Both could be true at the same time, along with other behaviors that we haven’t thought of yet.
Futures work is less about having a crystal ball, and more like playing a role playing game where a person can immerse themselves in an alternate world to understand the implications of our actions in a low-stakes way. Except, instead of role playing as a wizard or gladiator battling monsters, the worlds that good futurism builds is rooted in the realities of today.
The stories of Julie and Liam are miniaturized versions of the kinds of scenarios contained in my book Mise: On the Future of Food. Mise is an example of the kind of work I do with food and agriculture clients. My goal is to help organizations in those industries to see the future in a more vivid, thoughtful way so they can plan their strategies and actions more effectively today.
If you might be interested to learn how scenarios like this can help your organization be smarter about the future, check out this document for more on Mise Futures, a service to create custom versions of Mise for food and agriculture organizations, or drop me a line at mike@thefuturemarket.com.
Thanks for reading.