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Weight loss drugs have become the hottest selling drugs in the U.S. market this year, thanks in large part to Novo Nordisk’s products: Ozempic and Rybelsus, approved in 2018 and 2019 to treat type 2 diabetes, and Wegovy, which was approved in 2021 to treat obesity. The medications, which can lead to the largest weight loss yet seen with any prescription drug, are now in high demand, not just by patients who legitimately can benefit from them but also from those eager for a quick fix to drop a few extra pounds, despite the risks of nausea, vomiting and sometimes inflammation of the pancreas that the medications can cause. TIME spoke to Novo Nordisk CEO Lars Fruergaard Jorgensen about the skyrocketing demand for the drugs, and how the company is hoping to balance the clamor with more calm.
How did Novo Nordisk develop the GLP1-based treatments, which are behind Ozempic and Wegovy?
Typically the starting point after you are diagnosed with type 2 diabetes is a tablet-based treatment [like metformin] because most physicians and patients find them easier. We were never strong in the tablet-based space; we did research but nothing really materialized in the clinic.
Then a professor at Copenhagen University discovered that a hormone called GLP1 had this glucose-lowering effect. We took that into research and worked on refining the mechanism, which led to the first launch of a daily injectable product from Novo Nordisk, in 2010.
Was the weight loss effect of that drug obvious from the start?
During clinical development and testing it out in animals, we saw that it had this side effect that both animals and people lost weight. And we knew that 80% of people who live with type 2 diabetes are also struggling with weight. So it was a very attractive added benefit. We kept researching the next generation product, a once weekly injection [Ozempic], which is what we launched in 2017.
You became CEO in the same year that Ozempic was approved in the U.S. Did you expect to see the huge spike in demand that has occurred over the past few years?
At the time I took over it was actually a very difficult time for Novo Nordisk because we had seen price pressure on insulins. In 2016, we had to issue a significant downgrade in our expected growth and we saw our share price go down by some 40% because of price competition in insulins.
Then when we had the opportunity to launch Ozempic, which was a daily injection at first, our main competitor Eli Lilly launched their first weekly injection product for diabetes, which took significant market share. So we were losing market share in the GLP1 category. Then we developed our weekly injection, which luckily had better clinical efficacy than the competition. And when we got that product to the U.S., we started regaining market share.
When did you decide to develop a separate drug for weight loss, based on weight loss you saw with your GLP1 drug for diabetes?
It actually goes back to our first generation product of the daily injection. Back then, we also saw there was a weight benefit for people living with type 2 diabetes. So we had a discussion about the huge opportunity in diabetes with these drugs, did we really dare to go into obesity? Back then there had been a lot of failed launches and a lot of failed product development because some of the anti-obesity medicines had some quite serious side effects. But we felt that is this mechanism [through GLP1] does indeed help people living with obesity, and that fact that we are the world’s leading diabetes care company, and obesity is a leading cause of type 2 diabetes, then if we are able to cure type 2 diabetes through weight loss, why would we treat patients for a disease that could be prevented? We decided the ethical thing to do would be to conduct a clinical trial to create the data to inform physicians about how the product works in obesity.
What were those results and how did doctors and patients react to finally having a weight loss drug?
The experience with the first generation product was that it didn’t really get much uptake. We went into the pandemic kind of flat, with no growth. So we had a lot of concerns about whether this obesity market would open up. Then when we came with the next generation product, and we launched [in 2022], we were very surprised when we saw the uptake because our collective experience had been more of a flat growth since it was a drug that payors would not really cover and for which we saw limited out of pocket or individual payment for. But when we launched in the U.S. [in Dec. 2022], it was a complete game changer. In a matter of weeks, we saw a very dramatic uptake. And that has been the story ever since. It’s the steepest uptake of any medicine we have launched, and perhaps also for any medicine that has been launched.
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Why do you think the demand was so high for the weight loss drug?
I think there are a number of factors. First of all, there are more than 100 million Americans living with obesity—more than 40% of the population. Second, this was the first time that something worked to produce more than 10% body mass weight loss. That is approaching what bariatric surgery is delivering. And third, we saw for the first time that payors [insurers] realized that the clinical benefit was so attractive that it became worthwhile to pay for it. It was a game changer in mobilizing patients, prescribers and payors.
How concerned are you that the weight loss version, Wegovy, seems to be talked about on social media as a magic bullet for losing weight, and may be used by people who may not be overweight or obese, but just eager to lose a few pounds quickly?
That’s something we take very seriously. We try to get involved when possible to clarify misunderstandings, but obviously we are faced with the reality that there are limitations for what we can do and what happens on social media. But we do try to track it and we try to intervene to the degree possible if there are wrongdoings or wrong statements around our products. When the media makes wrong representations of our different products, we try to contact and educate to make sure that the products are described in the right way. We are not in any way supporting the wrong understanding of what our products are intended for. But the biggest impact we have is on physicians because it takes a prescription from a physician. So it’s really important that we educate physicians about what is the right use of our medications.
What future do you see for GLP1-based drugs?
We are testing it in … conditions where fat forms in the liver, and we are also testing it in Alzheimer’s disease. GLP1 works in an anti-inflammatory way, so there is the belief that if you expose small blood vessels in the brain to GLP1, you may improve how the brain works. I have to say this is the most risky of the studies we are undertaking, because Alzheimer’s disease turns out to be a very difficult disease to treat. But if it works, I think this has the opportunity to be kind of a complement to other Alzheimer’s medicines that are potentially a bit more aggressive.
You have recently cut back on the supply of Wegovy in the US despite increasing demand. Can you explain why?
When we saw the uptake, we obviously decided to ramp up manufacturing. But when you see an object with demand that’s close to a straight line going to the sky and there’s a potential of 100 million patients, you cannot just keep going. So now we are reducing startup doses to make sure that patients who start treatment in the U.S. can have the good experience of actually staying on the treatment. I think we have an opportunity to serve millions of patients and have a huge impact on individuals’ health, but also on health care systems by taking the burden off of them for long term care of patients with chronic conditions like diabetes and obesity.