The Unethical Business of Ozempic

When a Life-Changing Drug Meets a Broken Healthcare System

Modern MBA is known for thorough business breakdowns, and their analysis of Novo Nordisk and the Ozempic phenomenon is no exception. With nearly 173,000 views, this video hit a nerve because it asks the question that many patients, physicians, and policy experts are asking: how did a genuinely revolutionary medication become a case study in pharmaceutical industry dysfunction?

This is not an anti-Ozempic video. It is an anti-exploitation video. The creators acknowledge that semaglutide is one of the most significant pharmaceutical breakthroughs in decades. They then spend the rest of the video documenting how the business model surrounding it fails the patients who need it most. If you are someone who cares about access, affordability, and the ethics of healthcare pricing, this video will both inform you and frustrate you.

The Pricing Problem Is Worse Than You Think

The retail price of Ozempic in the United States is roughly $950-$1,000 per month. Wegovy costs approximately $1,350 per month. These are list prices before insurance negotiation, but they represent the starting point from which all pricing conversations flow. In most other developed countries, the same medications cost a fraction of that. In Germany, Ozempic costs roughly $300 per month. In the UK, the National Health Service negotiated a price around $250. In some countries, the price is under $100.

The video explores why this price disparity exists and concludes that it is not driven by manufacturing costs or research and development recoupment. Novo Nordisk's profit margins on semaglutide products are enormous by any standard. The company's total revenue roughly doubled between 2021 and 2024, driven almost entirely by Ozempic and Wegovy sales. Their market capitalization briefly made them the most valuable company in Europe, surpassing luxury goods conglomerates and energy companies.

The pricing power comes from a specific feature of the U.S. pharmaceutical market: the lack of meaningful price negotiation by the largest payer (the federal government) combined with patent protections that prevent generic competition. Unlike most developed countries where governments negotiate drug prices directly, the U.S. system relies on a convoluted chain of pharmacy benefit managers (PBMs), rebates, and formulary placement decisions that ultimately keeps prices high while creating the illusion of discounting.

The Patent Thicket Strategy

Modern MBA digs into Novo Nordisk's patent strategy, which is aggressive even by pharmaceutical industry standards. The company has built what industry observers call a "patent thicket" around semaglutide, filing dozens of patents covering more than the molecule itself but its specific formulations, delivery devices, dosing schedules, manufacturing processes, and clinical uses. Each patent extends the window during which generic competitors cannot enter the market.

The original patents on semaglutide's chemical structure will eventually expire, but the layered additional patents could prevent affordable generic semaglutide from reaching the market for years beyond the base patent expiration. This strategy is legal but raises legitimate ethical questions when applied to a medication that addresses a condition affecting over 40% of the adult population. Patent protection serves an important purpose in incentivizing pharmaceutical innovation. But when it is used to maintain pricing that excludes most patients from accessing a treatment, the system is not functioning as intended.

The Access Gap: Who Gets Treatment and Who Does Not

The most pointed section of the video examines who actually benefits from GLP-1 medications given current pricing and insurance coverage. The answer is stark: primarily people with commercial insurance from large employers, people with sufficient disposable income to pay out of pocket, and people with specific diagnoses (primarily type 2 diabetes) that trigger insurance coverage.

The people most likely to benefit from effective obesity treatment, lower-income individuals and communities with the highest rates of obesity and its complications, are the least likely to have access. Medicare, which covers the elderly and disabled, does not cover anti-obesity medications due to a statutory exclusion dating to 2003. Medicaid coverage varies by state, with many states excluding weight management medications. Even commercially insured patients often face prior authorization barriers, step therapy requirements, and high copays.

The video frames this as a public health failure with real consequences. Untreated obesity leads to type 2 diabetes, cardiovascular disease, joint replacement surgery, sleep apnea treatment, cancer treatment, and a host of other expensive medical interventions. The cost of treating obesity-related diseases in the U.S. exceeds $170 billion annually. A medication that could prevent a meaningful fraction of those costs is being priced beyond the reach of the people who would save the system the most money in the long run.

The Shortage That Revealed Priorities

The video also covers the supply shortages that plagued both Ozempic and Wegovy through 2023 and into 2024. When demand vastly exceeded supply, a revealing pattern emerged: the medication was available at compounding pharmacies for a fraction of the brand-name price. The FDA allowed compounding of semaglutide specifically because the brand-name products were in shortage, and compounding pharmacies filled the gap at prices ranging from $150 to $400 per month.

Novo Nordisk's response was to aggressively lobby the FDA to shut down compounding pharmacies once the shortage was declared resolved. The company argued that compounded semaglutide posed safety risks (a legitimate concern in some cases, though many compounding pharmacies follow rigorous quality standards). Critics argued that the real motivation was protecting profit margins, not patient safety. The legal and regulatory battle over compounded semaglutide continues and represents one of the most consequential pharmaceutical access fights in recent years.

What Needs to Change

Modern MBA does more than diagnose the problem. They outline several potential solutions that are being discussed by policy experts. Medicare coverage of anti-obesity medications would be the single most impactful change, extending access to 67 million Americans and creating negotiating leverage that could drive prices down across the market. The Inflation Reduction Act gave Medicare limited drug price negotiation power for the first time, and obesity medications could eventually fall under this framework.

Biosimilar competition is another pathway to lower prices. As the base semaglutide patents expire, manufacturers of biosimilar products (the biological drug equivalent of generics) will enter the market. However, the patent thicket strategy means this competition may be delayed well beyond the base patent expiration. Legislation that addresses patent gaming could accelerate biosimilar entry.

International reference pricing, where U.S. prices are benchmarked against what other developed countries pay, is a more radical proposal that would dramatically reduce prices but faces fierce industry opposition. The pharmaceutical industry argues that U.S. prices subsidize global research and development, and that reducing U.S. prices would reduce innovation incentives. Critics counter that Novo Nordisk's profit margins are so large that significant price reductions would still leave ample incentive for continued investment.

What This Means for You as a Patient

If you are a patient navigating the GLP-1 space, this video provides valuable context for understanding why access is so difficult and expensive. It is not a personal failing or a bureaucratic accident. It is the predictable result of a system designed to maximize pharmaceutical revenue rather than maximize patient access to effective treatments.

Practically, this means being proactive about exploring every available pathway to affordability. Manufacturer savings programs, patient assistance programs, insurance appeals, pharmacy shopping, and (where legally available) compounding pharmacy options are all worth investigating. Many patients find that the effort required to navigate these options is significant, but the financial impact of finding the right pathway can be thousands of dollars per year.

The Bigger Picture

This video is ultimately about whether healthcare innovation should be accessible to the people who need it most. Semaglutide is not a luxury product. Obesity is not a lifestyle choice. The intersection of a genuine medical breakthrough with a pricing model that restricts access creates a moral tension that will define pharmaceutical policy debates for years to come.

Modern MBA presents the facts and lets viewers draw their own conclusions. But the facts themselves paint a clear picture: the science behind GLP-1 medications is extraordinary, and the business model delivering those medications to patients is failing by any reasonable measure of public health success. Whether you are a patient, a healthcare provider, or simply someone who cares about how the healthcare system works, this video is worth your time.

The International Access Disparity

While the video focuses primarily on U.S. pricing, the international dimension deserves attention. In developing countries where obesity rates are rising rapidly, GLP-1 medications are either unavailable or priced beyond reach. The global burden of obesity-related disease falls disproportionately on low- and middle-income countries with the least capacity to absorb high pharmaceutical costs.

Even within countries with national healthcare systems, access is not guaranteed. The UK National Health Service, while negotiating lower prices, has implemented strict eligibility criteria that limit access to patients meeting specific clinical thresholds. Many obese patients in countries with universal healthcare still cannot obtain GLP-1 medications through public systems and must pay privately or go without treatment.

This global access disparity is not unique to GLP-1 medications, but the scale is particularly stark. Approximately 650 million adults worldwide have obesity, projected to exceed one billion by 2030. A pharmaceutical intervention that works but reaches only a small fraction of those who need it raises fundamental questions about how pharmaceutical innovation distributes its benefits. Modern MBA does not resolve these questions, but they make them impossible to ignore.