Ep 52 - Sabina Hemmi on the GLP-1 Wars: Big Pharma vs. Compounders, Tirz vs. Sema, Pills vs. Shots

Welcome to Hems House, I'm excited to share with you my conversation with Sabina Hemi. Probably the most comprehensive episode on GLP1's we've ever done. But first let me tell you about Mochi. In 2026 a doctor's visit should be a 5 minute call on your phone and your medication should be waiting on your doorstep, not stuck, behind a pharmacy counter. Mochi Health is doing just that. They've built a nationwide platform that operates across all 50 states, matching you, with board-certified physicians who actually specialize in metabolic health. We're talking about a platform that's already helped 400,000 members lose over 5 million pounds. And it's not just weight loss anymore. Mochi is now a full-scale healthcare marketplace that covers over 120 conditions from dermatology and hair loss to sleep apnea and mental health, providing a one-stop shop for your higher health journey. Mochi is making it easier than ever to switch from the old school pharmacy model. For a limited time you can get more than 50 percent off your first month of membership. Go to joinmochi.com that's J-O-I-N-M-O-C-H-I.com, take the two-minute assessment, choose your doctor, and join the growing community now, Mochi Health, stay GLP wonderful. And here's my conversation with Sabina Hemi. M.S. House episode 52, my name is Jonathan Stern. I'm joined today by Sabina Hemi, founder of GLP Winner, which I like to think of as kayak for GLP ones. It's probably the largest and most well-respected price transparency in comparison platform on the web. Sabina goes by Lollipop, that's L-A-W-L-I-E-P-O-P, we'll add a link in the show notes. She goes by Lollipop on Twitter in TikTok and is one of the foremost people really in the entire media circuit covering GLP ones. One thing that I especially admire is that she has actually traveled to the courtrooms to cover the cases that matter most between the compounders and usually Nova Nordisk and Eli Lilly. And so we're very excited to have her here today, Sabina Hemi, welcome to M.S. House. Yeah, thank you so much for having me, huge fan of the Discord and the podcast, so many great episodes. I feel like I'm honored to be a guest on it because you've had so many amazing names on the program and I will just say for background, nothing I say is financial, medical, or legal advice. And for context for Hemi's House listeners, I work in the GLP one space. Everything I say is going to be super GLP one bias or from that perspective, so take that into account when you're listening to what I'm saying. Let's start with an origin story or maybe something personal. I've heard you say that you lost 60 pounds on a GLP one. You just said everything you say will be GLP one bias. That's fine. GLP ones are moving the stock price, 5 or 10% daily, we're all interested in this topic. The thing I wanted to ask is that I know you also previously co-founded something called ELO Entertainment, which built, I think, video game, data platforms and communities reaching like millions of users. So quite a pivot from video games to GLP ones. Can you walk us through that journey and why you switch to doing GLP ones full time? Yeah. The gaming company I started in early 2012, so it's been way more than a decade and I love video games. I started working video games because I needed a job and I played too many video games. And my company is best known for large data analytics platforms for multiplayer games. You think people play games online that generates a bunch of data. We create insights with that. And then we ended up taking a series A, Robustrop took a series A and then used that for some M&A. So that's a super fun company. I honestly could have worked my entire life in video games. There's nothing against it, but I wanted to do something that had a more deep impact. And I was circling around doing something in healthcare and consumer health. And when it came down to it, I was like, what can I do in healthcare having no healthcare background? It notoriously being one of the hardest industries to navigate for outsiders and needing to know how things work. And then I ended up, I actually think GLP one is really similar. We take hard to understand information and try to make it understandable to normal people. That they can take action based on the additional information. So how many companies or providers are you guys tracking at this point? We have around 50 on the site. And I say that because it's hard to pin down because what we try to do is if you're shopping around for GLP one, we try to show you transparent pricing, sourcing reviews. We support both name brand, compounded versions. We don't display them side by side because we consider them different treatments. But if, say, if you were going to shop around and try to figure out where you wanted to get your GLP one, that might mean going to PIMS row, a bunch of other websites, spending 15 minutes giving them your full name, email, phone number, medical history, often before you can see a price. And to me, that was abrasive. So I wanted to create a platform where you didn't have to waste 10 minutes just to see how much something's going to cost. And practically, I think when people are spending cash paying hundreds of dollars a month for a treatment, they need to budget around it, right? It's just reasonable. And obviously, everything is still prescribed by a doctor. You still have to qualify for the prescription. That hasn't changed. We just help you compare the options. Yeah, even hymns, I mean, they, I think, have this long running 20% discount going. There are certain promotional materials that say $199. But that's for, I think that's if you're getting, if you're paying everything up front and it's the six month, I think it's the six month offer. It may be the year long offer, but I don't know how the other telehealths do it. Pricing is very difficult to find. Another thing that is difficult to find is the actual doses that are offered by all of the telehealth. I was in the network tab and scrolling through the HTML on Chrome, the hymns page the other day, searching for 2.2 because I saw in reddit that that dosage was discontinued or that someone had their order canceled by hymns and so it's trying to like figure out what doses hymns actually sells. And I didn't even see 2.2. I saw 2.4, which is the brand, I think it's the branded 2.5 is the branded dose for it's up a tide. 0.25 is the branded dose for some of the tide. And what happens sometimes in the compounding is they'll do a slightly different dose. Sometimes for completion compliance, sometimes to justify the customization for compound. But I mean, that's another thing we look at. There are providers where you start out, it's $200 a month and you think great. And then when you get to the highest dose, it's $750 per month, which is ridiculous. And if you ever started a subscription, it went up that much and you didn't know it was going to go up that much. When you started it, you would be pissed, right? So that's the whole point is trying to make it transparent so you can make your best buying decision. Yeah, absolutely. I think one thing that's important to note about him is that I'm pretty sure the prices are flat across doses. So you're not going to have sticker shock when you go up a dose later in the game. But yeah, some telehealth aren't like that and GLP winner helps, I think consumers figure out what the right solution is for them before they pay hundreds or in some cases thousands of dollars. You've been doing this for how long to be in a couple years now about a year and a half. Okay. What lots changed over 18 months? What stands out about the landscape today versus say this time last year? Yeah, this time last year, we were still in a shortage and everyone was talking about what's going to happen when the shortage goes away and compounding goes away. And there is almost this assumption for some people that compounding was going to completely go away. And to be honest, to some degree, people didn't know what was going to happen with compounding at that point. They didn't know if adding B12 or changing the dosage would count as a customization. And if that would stand through lawsuits through the FDA's interference, like there was a lot more unknown to some degree there. Now the landscape has changed. Yes, there are a lot of lawsuits. This is a broad oversimplification, but I would say compounding is generally being defended. Many of those lawsuits are getting dismissed under the guise of if FDA is the organization that regulates compounding and decides if what can be compounded or why not come to be compounded. And if there is mass compounding and they are acting on the GLP1 space, can a private entity like Elay Lilly or Novo Nordisk sue another private company over them violating a law that is not impacted by them, right? So it's basically like can a private company sue another private company to enforce the law? Is the question? And under those grounds, granted broadly, every lawsuit is a little different. Under those grounds, it hasn't generally been held up. I want to come back to some of these questions and maybe the specifics in a bit. Because again, you really have covered it closer and more thoroughly than probably anyone else. And certainly anyone else in the media that I'm aware of. And so I want your thoughts on everything that's going on. Let's touch on him's first because it is him's house and the investors and others are asking so many questions about GLP1's related to him. First, I want to talk about telehealth hierarchy. I have talked to some founders of smaller GLP1 startups. I'm always struck when they say they don't really see him as their main competition. I don't need names, but like there is massive fragmentation of this market, hundreds of telehealths have popped up or whatever we want to call them, GLP1 vendors over the last year or two. I was surprised. I guess I'm no longer surprised because I hear it a lot. But like the first few times I was surprised when I heard the founders of these smaller companies say they really don't see themselves as competing with him. Now, as someone who tracks the whole market, is that accurate or are you seeing this picture? Yeah. I'm not surprised that they would say that, first of all, because functionally when they're marketing on day to day, they aren't competing for the same eyeballs. Now are they all technically competitors in the same way that Netflix is competing with video games? Yeah, sure. Right? But I think, when I think of him, I think of like this large publicly traded behemoth, one of the stronger brands in the space. And when I think of their marketing, it's really broad. It's based on new recognition. And when I think of the marketing of many of the other telehealths who are smaller in the space, it's kind of like more acute. It's very much like, hey, you're going to get out of GLP1, you're going to lose weight. It's extremely, extremely specific and targeted by contrast. And I think when they think about their marketing efforts, a lot of them think we aren't doing what hymns is doing. We're not actually competing with them. And so the smaller telehealths are competing with each other on price. Would you say? Yeah. Well, a lot of things. They're competing with each other. I think they're having hard times, broadly, anything, hymns falls into this too. Sometimes communicating how they differentiate from other platforms. With hymns, they have a lot of blood tests, they have a lot of other things going on. They support like ED, hair loss, of course, their bread and butter. Some other telehealths, they only do GLP1s. And so when you're comparing GLP1 providers side by side, how are you differentiating from others? There's a few different ways. First of all, people, price is a big one, trust is another one. The specific compounding pharmacies that people are using is important to some consumers who are more engaged. I would say broadly. I do see that on Reddit, actually, which is interesting. Yeah. Yeah. Sometimes I interviewed, you know, 150 patients, so it was getting started. And I was like, hey, would you ever change providers? And a lot of them were like, no, I would not. My doctor picked this compounding pharmacy because of XYZ. And then I said, okay, well, what if I could tell you your medication was coming from the same exact compounding pharmacy? You know, it was cheaper. They're like, in a heartbeat, I would switch. That was the answer many of them gave. So the loyalty sometimes is to the compounding pharmacy. Sometimes patients who are highly engaged have strong opinions on compounding pharmacies they like more than others. And then I also think they're competing based on additional features. Some people, it's a telehealth. They don't want to get on a video call. They just want their medication. They want text only. Text only is legal and over 40 states. And other people, they want, you know, full high touch healthcare where they are having video calls with the clinician, they're getting nutrition, fitness, guidance, etc. So I kind of view, like, those are different types of tiers of the level of treatment. And there are different types of patients that are drawn to different levels of care. Who would you say hymns competes with most directly? I'm thinking row, life MD, maybe noom, although I'm not sure. And then novo and lily, who am I missing? Yeah. I mean, I would argue they aren't as directly competing with a pharma company, but I can see why some people would feel that way if they feel like hymns is offering an alternative. What I think of hymns, they think of hymns row and noom kind of being in their own category of like massive companies that were established before the GLP one trend, that have additional significant offerings to have in a really big ad budget. hymns I think is the only one that doesn't have celebrity endorsements related to GLP ones, right? Yeah. Or maybe none ongoing. Like hymns is part of the countless in the past. Justin Bell, Rob Gonskowski, there was someone else, there were several others that I can never remember on the spot, but some a listers, but none at the moment, which the community is not thrilled with. Which is odd, given when you compare them to, I think the more direct ones, they have their celebrity endorsements, they have commercials running nonstop. And certainly a lot of smaller telehealths also have commercials. I think it's interesting that you put life MD in there. I think there's a lot of other, there's probably a lot of other founders, if you will work at companies being like, we should be in there because there are ambitious telehealths that consider themselves to be competing with hymns for sure. I put them in A because they're public. B because I saw commercial the other day. It was a commercial actually that reminded me more of a pharma companies commercial than anything I've seen from row or hymns. Or noom. Yeah. Noom has Rebel Wilson now. The life MD commercial was a little weird to me. Would love to talk to them and like, yeah, like life MD, I like row. Actually, we'd love to, we've had the Noom CEO on the podcast, would love to have Zach on the podcast, CEO of row. So if you're listening, please come on anyway, okay, I think that helps me think through the layland and GOP ones, let's talk about hymns and Novo because there's a little drama there. Obviously they had a deal. The deal exploded Novo tore it up and then accused hymns of both deceptive marketing and illegal mass compounding. See two months ago, two plus months ago during hymns Q3 earnings, Andrew said that hymns was in hymns is in active talks with Novo Nordisk. Some time has passed, no deal, the Wigovie pill is out, no deal. Will we ever get another deal between hymns and Novo or will they hate hymns forever and ever? What do you think, Sabina? I don't know. They have a new CEO. There's a lot of the lot that's changing at Novo. I wouldn't have passed hymns to work out a deal with Novo. I think it's very much like, are they still going to be doing compounding, which I assume they will? Their entire business model is a lot of compounded medication even outside of the GLP1 space. And will Novo accept that? I think that's the real case. It's funny because in theory, you look at Novo's direct to consumer pricing. In theory, any doctor can prescribe to Novo care their pharmacy, but it's been really selective about who can advertise those prices and that they have a special deal with Novo Nordisk. There's a really interesting lawsuit that I need to follow up on. I haven't looked at it recently. There was a state of Texas suing Eli Lilly, basically citing the direct to consumer Lilly direct marketplaces being like, hey, if this pharma company who shouldn't be paying doctors for prescriptions is functionally listing telehealth or doctor's clinics on their site and then driving millions and millions of marketing dollars towards Lilly Direct, where then they are promoting certain providers, does that count as a kickback, right? Is that actually like a kickback because it's functionally marketing, which is arguably as good as cash to some companies. It's interesting to see how the direct to consumer price point when we have, I don't think him has any insurance support, where we have cash paid telehealth, they can literally just send a prescription to Novo care, but him's isn't advertising a special relationship with Novo Nordisk. I feel like some of this is optics and some of this is how they can market. Without Novo Nordisk, getting upset. Yeah, I think in Canada, him's may support insurance now, but that's the only caveat and definitely not in the United States. Yeah. What about him's in Lilly? Him's in Lilly, I mean, look, I'm sure they're constantly having conversations with each other. I have, first of all, I have no insider information on this, but I'm sure they're constantly having conversations with each other, and I'm sure, you know, Lilly is wanting them to stop supporting compounded broadly, granted, they have never supported compounded, she's up ahead, right? They've alluded that they're going to support it. Yeah, I was thinking about, I mean, this is more of a business question here, but like thinking through the margins that him's made on that branded wagovy for the month and a half or however long it was that they sold it at a discount on the platform. It gets probably the right business decision to continue to sell compounded semi-glutide and for go, the branded wagovy, right, at least, at least for the last six or seven months, right? I think that the revenue, it was no brainer from a revenue and margin perspective. Now, going forward with this wagovy pill, do you think it might make sense for him to give up some or all of the compounded semi-glutide in order to support, in order to be able to offer the wagovy pill at the prices that their competitors are offering? Yeah, certainly not all of their compounded revenue, certainly not. My impression, not having run a business that is a telehealth in the space, this is like totally speculative, is the margins on compounded medication are a lot more flexible and a lot larger than when they work on name brand medication. They functionally have to be charging a clinician fee, forcing the doctor and maybe like a monthly subscription on top of that, on top of the name brand medication. So, look, does it feel on brand for him to support oral wagovy? Yeah, probably. It seems like something that their client base and patients might be interested in. Does it make sense for them to completely stop offering any compounded medication for the GLP1's just to support that, I don't think so? Do we know if Ro or life MD, the companies that do weight watchers, I guess weight watchers never offered the compounded right, just thinking through the companies that have- We worked with offer compounded for a short period of time. We did that. Okay. Just thinking through the companies that have agreements with NOVO. So, don't Ro and life MD still offer some compounded semi-glutide? They're just not advertising it or pushing it. Is that right? So, I didn't, I'm not sure about life MD, I'm pretty sure Ro still offers compounded, but they're very quiet about it. I don't know, for sure if it's compounded semi-glutide, I'm pretty sure they do, but I would have to confirm. Okay. That's right. We've always offered compounded trizapatide. Everything life MD may have totally stopped. I'm not sure about Ro. It's not, I'm not making the claim that Ro is still selling compounded semi-glutide. I did make that claim like six or seven months ago as I went through the flow and was offered the compounded semi-glutide even after they had a deal with NOVO. But that's neither here nor there a lot of time is passed since. And they're definitely not as loud as him's about it. So. They're very quiet about it. Yeah. Maybe that. If you go to Ro and just browse the website, you would feel like, okay, well, I'm probably getting knee and bram, but I could get another treatment. I don't know. Yeah. Right. Yeah. Okay. Let's, let's move to trizapatide because, well, two questions about trizapatide. Number one, it's just like the, it's the GLP one. At least as I have started to understand, um, like, ozempic is the name that I think a lot of people in the, a lot of, it's the household name. A lot of people know better than minjarra, better than zip down. But when I talk to people in the space, there are some founders who say 90% of their customers are asking for trizapatide, clearly it's the superior drug, clearly most people prefer. I don't know if 90% that seems a little high, but like, nevertheless, um, many, many more demanding trizapatide than semi-glutide, is that what you're seeing in the GLP winner data as well? Yeah. It's 70% trizapatide. Either name, Rian or component. 70% trizapatide. And I know, I feel like I have a perception. This is like me speculating, right, perception from conversations that when the trizapatide shortage went away and some telehealth stopped offering trizapatide when they were previously offering both, that their, their, their, their patient panels sit tanked, like their numbers tanked as a result of that, because everybody wanted trizapatide. Um, you know, I've been on both medications, and for me, like, trizapatide is clearly superior. Everybody is different for some people, so my glutide is clearly superior. But by and large, and you look at the data, most people get more weight loss and have fewer side effects on trizapatide. And for you, is it the side effects or the weight loss or both? I could not even tolerate getting to a therapeutic dose on some glutide. I was throwing up three times a week. Side effects. Um, so, and I, I get a lot of side effects. I get a lot of side effects on trizapatide, but it's, it's more effective. Um, like, I, you know, I, I, I could spend an hour talking with my personal experiences and the differences and experiences I've heard patients talk to you, but by and large, you know, when, when people come up to you and they're like, which one should I start on? It's like, well, some glutide is cheaper, right? And it's good enough for a lot of people. You could totally start on some glutide. It could be totally fine. But if you're the kind of person who gets lots of side effects from medications, or you just want the best and you're willing to pay more trizapatide, and there are a lot of people who are like, well, I'll just go to the best. Question about micro dosing, because I know, hymns and nune both offer it. Or both are definitely doing some agglutide, not trizapatide micro dosing. Um, any, is it, is it sort of the same from customers that most are demand, most are asking for trizapatide for micro dosing as well? Yeah. Yeah. I mean, I would have to look specifically in our data, but I think most of the people we have offering micro dosing is trizapatide as well. Okay. Um, yeah. Yeah, and then we don't have to speculate too much about hymns and trizapatide, but question is why have, let's look backwards, and like, do you have any thoughts about why they haven't launched it yet? I mean, there are a number of other competing telehealths, right, that despite the lawsuits, despite the legal threats, um, despite the shortage being over, despite the dosage, I guess, like the, the doses aren't as wide between the right, like they're, they're a little tighter. Um, it's like 2.5, 5, 7.5, 10, they're very similar between them, the two, like when you compare them, they have similar dosing, the, um, between trizapatide and trizapatide. Oh, right. Yeah. I would say why I think hymns didn't do trizapatide. Let's look it back when they made that decision, right, which is likely when the trizapatide shortage was ending. Most people who didn't offer trizapatide back then did so because they were scared of lawsuits. Right. Maybe there was something else, like a conversation with Lily that was also a factor. I don't know what was going on at hymns. I suspect that's what happened. And I think they were expecting for lawsuits to play out maybe in Lily's favor, maybe Fritchard's appetite to go away, compounded, I don't know. But at this point, it's, it's stuck around. What's funny is a year ago, people were saying, oh, semi-glutite will always be around because they felt like the patent was less defensible than trizapatide. And now it's sort of like the, well, they're both around, right? We're in a, we're in a market where both of them are accessible through compounding and a lot of patients prefer trizapatide because of the side effect profile and the higher effect of this. There's been some speculation on Twitter that hymns will launch trizapatide in combination with B12. Feel free to weigh in on that, but also like main question is, would that constitute a significant difference? There's been a lot of chatter about like whether mixing it with B12 or mixing with other stuff allows the compounders to continue to offer it on solid legal ground. Do you have, again, not legal advice, not legal thoughts, but do you have thoughts on that? Yeah. Here's what I will say. Many people are offering trizapatide in B12 or similar additives and so far it seems to be not an issue to the FDA. The FDA hasn't acted on it as far as I know. And the FDA, when you think about mass compounding, the FDA has been acting on mass compounding. They just, as far as I know, haven't done it in the GLP1 space. So I would say not to comment on the legality or not because I'm, you know, it's for the FDA to enforce. The FDA doesn't seem to have an issue with mixing trizapatide with B12 so far. Great. And when you say they're acting on mass compounding, do you mean 503A pharmacies? Yeah. I mean, other medications and going on potentially, you know, acting on mass compounding is what I've been told from pharmacy lawyers basically is that they do, they do act on mass compounding, but they haven't acted in the GLP1 space as far as I know. Okay. Let's move to legislation and regulation. You've had a couple of times, semiglutide and trizapatide are still around. Yeah. But it's very much the case that novo, by semiglutide and trizapatide, compounded semiglutide and compounded trizapatide are still around. They very much are, it's also very much the case that novo and lily would like that not to be true. Sure. They're actively working, I think still behind the scenes and maybe not so behind the scenes in certain cases, to ban or to limit compounded GLP1s. And so I think the foremost legislation that was recently proposed is the Safe Act, I don't have the acronym on hand. But it's S-A-F-E Drugs Act, introduced in December, would impose pretty harsh restrictions on compounders, limit 503-A's to 20 compounded prescriptions per month for drugs with active ingredients in commercially available products, plus new reporting requirements. Thoughts on that act before we get to some of the others and odds that it passes. So first of all, it's somewhat unlikely that it passes, but some of that is me commenting on general political situation and that it's hard to pass anything in the house right now. But I think what's interesting is it sort of does things that already exist. And if you look at the summary from the co-sponsors, which are from Indiana, it basically says this is designed to get rid of mass compounding. If you read the actual legislation, it's kind of confusing what the goals are, because what it's doing is it's putting definitions for things that already have definitions by the FDA. So it's almost like undermining the FDA and trying to take a discretion authority away from the FDA and then put it into actual law, like more concretely. I mean, it's kind of is already a law, but what stood out to me about it is that they want reporting on numbers of prescriptions. I think this is solely to fuel litigation, right? How can U.L.I. Lillier and Novartnortis claim damages against these telehealths? It's that they need to understand how many prescriptions are out there, so they can have a better case for mass compounding, so they can have a better case for damages. So I think that's a big motivation. I also think the Federal Bill, the Safe Drug Act, is honestly being used as something they're pointing to while they're trying to get state legislation in. And the state legislation is a lot nastier. And by state legislation, you mean the bill in Florida and the bill in Indiana. And I think there's one in Virginia as well. Okay. Yeah, you mentioned that last night, I wasn't even aware of the Virginia. Maybe I need to catch up on your TikToks, but I wasn't aware of the Virginia, okay. So I don't know if you're welcome to sort of map out the playing field here, the details of each and the differences, or you could just take us through which you think is potentially worse for the compounders, which you think has the highest likelihood of passing that sort of thing. Yeah. I'm going to take this wherever you'd like, because the regulation is pretty prickly. And honestly, I'm not sure what to ask, but yeah, give us the lay of the one. Okay. Okay. So I'll talk about the Indiana bill and then I'll talk broadly about what's in these bills, kind of generalizing because they're all a little different. So in the Indiana bill, which I think is the most likely to pass because it was introduced probably like three weeks ago, it went to committee last week, it went to committee twice. The first time I was in committee, it was, the version of it was that it stopped basically all compounding in Indiana. And so they had a bunch of compounding pharmacies come and testify. Literally all compounding of any drug of any drug. Many, many drugs. So things like a kid can't swallow a pill. So we're going to like crush up the pill, add cherry syrup. Like that was potentially a play to go away in the original legislation. Also like compounding gets used a lot in veterinary care. That would be restricted. So you think about like human drugs that might work for pets. The dose that it takes for a horse and the dose that takes for a 10 pound chihuahua is totally different. Compounding gets used all the time in veterinary care. And then also hospice and end of life. So think about somebody who's at end of life. They can't swallow a pill anymore, but they could have therapeutic medication. They just can make a tincture that you can put in their mouth. That then they can have comfort at end of life. So those, all of those things were originally threatened by the Indian law and went to committee. It was very mixed. Of course, Eli Lilly is the biggest employer in Indiana. And it went to committee again last week and was unanimously passed. But what was interesting was lots of people wanted to comment on it. The senators wanted to comment on it and the lot of their comments were very much like, I don't think this is perfect. And maybe more changes need to happen. And they also passed an amendment that made it just weight loss or GLP1 compounding. So it's just restricting that. And this happened when the modification of the last, and I'm seeing here the APC, the Alliance for Pharmacy compounding just released an essay or some news bulletin and says, Indiana bill better but still awful. Yeah, it's still awful. So some of the things that are kind of in all these bills is trying to regulate the API. And the API is the active pharmaceutical agreement, the active pharmaceutical and gradient. They give it as like the active ingredient. Like I talk about like if you imagine compounding GLP1 is like lemonade, it's like the lemon juice that makes the lemonade. And like, yeah, maybe they add some other things to make the actual usable medication. But what happened was the FDA did a bunch of work specific to GLP1s. They released a green list of manufacturers that they felt like were safe just for GLP1s. And these state bills kind of ignore that. And they say actually we're going to instill totally different standards. So some of the standards they were looking at is that they've been inspected by the FDA, which they are inspected by the FDA, right, and that they had a certain designation. So there's, I can't remember the exact ones, there's basically like a great score, there's a pretty good score, and there's a bad score, OAI, official action indicated as the bad score. And so if somebody in a manufacturer had that designation after inspection from the FDA, they would not be able to be used for compounded GLP1s. Now granted, not to like distract the podcast, but there is a large drug manufacturing facility in Indiana, Cadillanth that is owned by Nova Nortis, that just got that OAI official action indicated that had reports of like mammalian hair, maybe both. That hair, maybe human hair, some people are like speculating rat hair, right? Like, it has major sanitation issues. And what's interesting is the day that they announced they released the Wogovie pill was the day that you did a massive recall on Wogovie that had hair at it, right? So it's like in Indiana, if you actually care about patient safety, maybe you should restrict this drug manufacturing plant that's in your state borders that is not meeting that standard, right? But no, this is just for compounding, this is just for compounded GLP1s. The other interesting thing that I think is, it's really hard to understand I'm not a lawyer in the pharma space, I'm just a person. But they talk about a lot of the API and it almost sounds like they need to buy the active ingredient from big pharma. And of course, pharma won't want to sell active ingredient for compounding for people, or maybe like eventually, like if compounding went away, they would sell in small quantities, I don't know. But it talked about having an FDA-reviewed new drug application, which is basically like the, the NDA number that people have when they're trying to make a new drug. So it's almost like it needs to go through. It's implying that it needs to be FDA-proved, but it's unclear how it's written. And it will be unclear how it will be enforced when the Indiana bill potentially gets passed into law. Okay. So, Indiana, I'm probably the most likely bill to pass the bill on it this week. I don't know if that's delayed because of whether it could be today, it could be tomorrow. Okay. You're voting on it in the Senate and then I assume it's going to go to the House. We'll stand by on that. The Florida bill, I think you are a little worried about initially, right? Because 30, I think this is the number I'm getting from you, 30 percent of all compounding for GLP1s. I think it's, that's a speculative number, that's me speculated, that's a made up number. But I seriously like most compounding pharmacies are in Texas or Florida. There are a lot, a lot of large compounding pharmacies in Florida, including BPI, which I think might supply him. BPI definitely did. They may still. Yeah, I don't know if they still do it, but. Not sure. There is. Okay. So Texas and Florida, big time for compounding. What about Arizona? I mean, Arizona is up and coming, we've strived there, right? And him. Yeah. Yeah. Just next door, close. Yeah. Yeah. Okay. But I mean, Florida is a major supply chain for compounding in the United States. If Florida stops being called to boost compounding medication, then, you know, we're all going to have supply issues when we try to fill prescriptions. Anything on the radar in Ohio, I know him's operates there, or I guess Arizona. Yeah. I don't, I don't have anything specifically. I know the Board of Pharmacy in Ohio has said some like anti compounding stuff in the past, or there's been something there, but I'm not as familiar with it. I would say the Florida legislation, there's a house companion, which is significant because if you're a representative of the house of Florida, you can only introduce seven pieces of legislation per session. So somebody picked this to be one of their seven pieces of legislation. And it's nasty. The penalties for the Florida one are $1,000 per dose, which is totally untenable. But somebody could get penalized $1,000 per dose. And again, it has, you know, many of the same API requirements, more strict API requirements because it requires the FDA has inspected the API manufacturer in the last two years. And let me tell you, API manufacturers have no authority over when the FDA inspects them. And if they're in good standing, it could be longer periods of time. It could be like five to seven years, so. Adverse events. I want to move to that. Yes. I think Nova and Lilly talk about this. FDA has cited over 1,000 adverse events, reports linked to compounded GLP ones. How should the patients think about that? How should the compounders selling the GLP ones think about that? Is that a high number or not? How does it compare to the branded? That's not a high number at all. I'm completely unfazed by it. And when you look at the FDA statement, I have it open over here. They literally say, let me find. They literally say that, you know, the adverse events are not significantly different. So if you're on compounded medication versus new ran up medication, you are getting different adverse events. And it's possible, anything like name ran medication has over 40,000 adverse events that said 503Bs must report adverse event. 503A compounding pharmacies don't have to report adverse events. It's possible adverse events are under reported for compounding. It's possible that some adverse events for compounded are getting like lumped in with name ran up medication. So there's a little bit of like, I think it's causing the data, right? But I'm totally unfazed by a thousand adverse events. Totally. An example of an adverse event. Oh, anything. Like, you know, somebody, like, I assume you're throwing up three times, or does that not qualify? If you want to report it to the FDA, it's an adverse event. Okay. But I mean, people will get gastroparesis. And when they go to, and they'll like maybe go to the hospital, that's where like your digestive tract stops, basically stops moving. It can get really gross. You can start vomiting, whoop, right? Like, it is not pretty. There's also like gallbladder issues, gallstone issues. But functionally, when there are millions of people taking a medication, there's going to be all kinds of adverse events reported just due to the sheer number of people on that medication. And maybe when you started that medication, you had a heart attack or stroke or like died. And then that gets reported as an adverse event. But maybe there isn't enough data that it seems like it was caused by that medication, right? Yeah. That's helpful, because I hear that terminology and I just didn't know what, I just didn't know what fell under that bucket and what didn't qualify. Okay. Yeah. We've talked a little bit about the, would go be pill, but a little bit more on that. Novo just launched in January, it's the first oral GLP one approved for weight loss. I was intrigued by the statistic thrown out by, I think it was the Novo CEO at the JP Morgan Health Care Conference in San Francisco, and he said, expects the pill to be a third of the GLP one market by 2030. I thought it'd be more than a third, but I think a third is aggressive, but I think he was, I think he was saying that is, oh, wow, it's going to be a third, right? I was surprised that it was just a third. You're like, oh my God, a third is a lot, so like, why is a third a lot? And really, who is taking, because I keep hearing this, who is going to continue to take the injections when the pills are available? Both semi-glutite enters up to, enters up to, enters up to, may be coming in April or June. Yeah. Ron, I think. That's not technically, that's different. Oh. Yeah. Oral medication. But I would say, I mean, most people, I've spoken to you are taking injected, plan on staying on injected. So oral, semi-glutite has already existed. It's rebellious. And so my hot take on the oral wugovie is that Novo Nordisk increased the dose. Granted, you know, the dose is really high because like, if you, if you injected, it's like, you know, 89%, 90% effectiveness, bioavailability. And if you take an oral version, it's like 1%, because your digestive tract is going to destroy the medication. So you're taking high doses, but they aren't necessarily comparable to the injectable doses. I think Novo intentionally designed oral wugovie, so they could hit that 20% weight loss mark. Because if somebody is superficially looking at GLP1 medication, they're going to look at the percentage weight loss, because that's kind of like the KPI that a lot of people look at, and they're going to be like, oh, oral wugovie is so great. But the side effect profile is not great. I would much rather take, chose appetite injected because the side effect profile is better. And the weight loss is better. And then you have to fast for 30 minutes before taking the pill. Is that right? It's, you're supposed to take it first thing in the morning, so you're supposed to already be fasted and you're not supposed to have any, anything other than four ounces of water and you're not supposed to have food or drink for at least 30 minutes, I'd eat a lot more. And even side effects are more severe. And are they more severe than injectable semaglutide? From what I've been seeing potentially, yeah. And there's a slightly different side effect profile. Like diarrhea is more common on injectable semaglutide, some other, like, side effects are worse on the pill version, so. And or forgopron, that's the lily pill. I think the timeline there was just pushed back by a month or two. I didn't know. I thought it was terseptide. I guess I thought that because it's lily, it's not terseptide. What is it? If it's not? Oh my god, I'm forgetting. Okay. I think it might be. It's jeal if you wanted something else. Yeah. This is not the reddit true tide that I keep hearing about. Well, it's not reddish, you should. This is different from that. Uh-huh. Okay. So, uh, so this Goldman Sachs is projecting that or forgopron will dominate because you don't have to fast before taking it. How important is that? And like, is the, is the dominance of the will gov pill, uh, are the days numbered for the dominance there? Is it going to be sort of like the situation where novo launched ozampic first lily sort of, it took lily a little longer to launch their own. But when it got to market, they dominated ultimately is, are we going to see the same sort of thing there with or forgopron or glipron relative to the will gov pill? Or forgopron is just GLP one with the different, um, something different to help it like survive longer, just digestive tract. Um, so I would say I agree with Goldman Sachs that I think or forgopron is going to be, or it's or forgopron. I don't know. It's going to be more effective in the market than Oral will gov and hopefully they have a name like Zepp Boundford. Yeah. Please give it a better name. Yeah. Really. Um, but, you know, I think I agree with that. I think what we're seeing with the Orals is, first of all, there are some people who would never inject themselves or like that was the barrier that was preventing them from getting on to GLP one, right? And, and I also think that we, like, there are narratives that people tell themselves before they're willing to get on basically the weight loss shot or the GLP one in general. And so I think the pill is like a reset where some people are willing to take a pill where they wouldn't otherwise be willing to take a shot. That said, like, I still, I'm still team injectable, like, I, this is a new, yeah, so this is a new market, really, this, it's capturing new consumers new to GLP ones. Yeah. I think so. I don't think, I think it's very unlikely that a lot of people who are on injected get off of injected or maybe they do because they're curious about it, but they're not likely not going to get as good of results. So for people who are GLP one curious and may want to start micro dosing, can you do that with the pill or do you really need to be doing the injectable? I don't think you can do that with a pill. I'm not a pharmacist, so I don't know if you can break up the pill and take a smaller dose, but I assume not. Yeah. Given that it's like a, like, you know, protected molecule within the pill, I assume not because that's how I know to work for other medications, like most people who are micro dosing are injecting. And honestly, I think micro dosing, micro dosing is really interesting to me because to me, if the patient, the patients who are micro dosing fall into a few different categories, there's people who want it for like longevity benefits, there's people who are maybe good candidates for it for weight loss, and they don't want to actually be on a full dose. And that's probably like interesting. Yeah, they don't actually want to be on a full dose, but they're willing to take a micro dose. And then there's people who are potentially micro dosing when they don't need to lose weight because they have other health conditions, maybe inflammation related, and they want to see if the GLP one will help them really. We've seen a couple telehose start to compound oral semi-glutide. I know Mochi launched something, maybe a couple others. Yeah. Any thoughts on compounding the pill? So there have been oral versions of semi-glutide around for a long time. I will say I've never talked to a patient who took an oral compounded version and had a great experience and felt like they got good results. It's almost never. I think Henry Meads may as well, but I've heard it's a little different than what Mochi's doing. I don't know the way they're there. Yeah. I would say having that looked that far into it, Mochi's version seems to be a lot closer to the Wigotbe pill that Noah launched, which I think chemically is like not the most difficult thing to literally make. Now, is that different enough from the neighboring version to justify compounding? I don't know. That's a question for lawyers in the FDA, right? We'll find out more soon. Final question on the pill. Friend of him's house, although I haven't got him on the pod yet, Dave nap, man on the pen. Thanks. Over-the-counter GLP-1 pills are coming. I think he may have said soon, if he didn't say soon, then he definitely said eventually. Thoughts on that. I love Dave. I haven't talked to Dave about this, too. I haven't talked to him about the oral stuff, but I texted him a few times a week, so we're talking about a lot of stuff. I would say, Dave thinks this medication should be over-the-counter. I don't think it should be over-the-counter. You see, saying just pills are injectables, too. I think it's just pills, but they could eventually be over-the-counter. I don't think these medications should be over-the-counter. I know that's controversial. I think they should be very easy to get, because a lot of people qualify for them, right? If 40% of the U.S. are more as a good candidate for GLP-1, I don't think it should be hard for 40% of people to get a GLP-1, broadly. But they have serious set-effects, like, you need a doctor to monitor them. I really worry that people with, say, eating disorders, if it's over-the-counter, are going to take a bunch of it, or people are going to take a bunch of it, because they want to lose weight really fast, not understanding how the medication works, and then any gastroparesis or other serious set-effects. So, just me personally, I don't think it should be over-the-counter, and I know some people will disagree with me. Dave will disagree with me, right? Can you set a probability on that? I have no idea. I think it's very low, but that's just me thinking that's insane, that basically, the cool bunch of diapils would be over-the-counter, and they have serious set-effects, especially if you take a very high dose without having ramped up on that dose, which I could totally see people doing if it was over-the-counter, right? Who hasn't taken too much Advil when they were in pain, right? That's the equivalent of what we're talking about. I want to close with peptides. Where are you in Austin? I am in Austin. Okay. You're in Austin. So, you're not in San Francisco. San Francisco seems like ground zero for these things. I mean, GLP-1s are sort of the first, and they are peptides, but as you know, well, in the last year or two years or three years, they've really exploded, right? There's this BPC-157-TB-500-GHKCU. Some are actually legal to compound, like Smorlin or Cemerellen, and there's one other that I can't remember the name of, crazy names for all of these. Anyway, I'm sure, as you've also seen, searches for peptides continue to hit all time highs on Google Trans. At least I'm posting about this fairly regularly on the hands of Twitter, The New York Times, The Economist. I saw this morning, New York Magazine, I think CNN, The Guardian, all of these publications are talking about peptides, Chinese peptides, if some of them are calling them. Huverman is talking about them. I think he says that his contacts in government suggests that some of them may be removed from Category 2, Bokesless, which for now prohibits some of them like BPC-157 from being compounded. Broadly, what do you think about peptides? Are you excited about this category, or are you going to add peptides to the GLP winner website? What? Probably. I don't. We're probably going to expand outside of GLF1 at some point, but I'm not sure what we're going to do next. I would say, there's a part of me that feels like the whole peptide trend is basically making a supplement market that you inject, but you say you're not going to inject it, because for, I don't know if his house listeners have contacts on this, so a lot of peptides are research peptides, meaning it's not legal for you to buy them with the intention to use them as a medication and inject them, but like, functionally, that's absolutely what's happening, right? To be clear, it's not legal to buy them and inject them, or it's not legal to sell them. I think both. It's not legal to sell them with the intention of people are going to be injecting this and solves, but functionally, it's like, is this just a new supplement market where everyone's like, yeah, I'm just experimenting and taking it for myself, right? It feels like the supplements you're injecting to some degree, right? And when you look at peptides, naturally occurring peptides cannot be patented, right? So when people think of a GLP1, you aren't actually injecting GLP1, you're injecting a GLP1 agonist, and naturally occurring GLP1 in your body has a two minute half life. So if you injected it, it actually wouldn't do that much, potentially, it would be very short-lived. Now, peptides that are also naturally occurring can't be patented by pharma, therefore, they have not been studied as much by pharma. So to me, I think it's a really interesting new market, am I on peptides? No. Could I see, do I understand why people are trying peptides? Yes, I understand why. Do they have as much research as FDA-approved medications, absolutely not? Are there potentially significant long-term side effects, potentially? Like are some people injecting things that have really only been studied and, like, rodents and mice? Yeah, totally, right? I think it's a crazy market right now. And I've heard the same rumor that the FDA is going to approve peptides. I don't know that rumor happened a while ago, and sometimes when I hear a rumor, I hear people repeating the rumor, I'm like, "Hey, somebody in DC said this." When. Actually, the rumor's not going to happen. First here, the rumor, Sabina. Oh, my God. Because I first heard it somewhat definitively, either in late November or early December, as the government was shut down and someone. I heard there was a conversation in October. Oh, okay. There was a conversation in October. Interesting. I read it. who's, like, pretty well respected. I generally don't trust redditors, but, like, fairly well respected, said that the draft of the press release is finalized. We just need the government to reopen, and then it will go out. But here we are. You know, January's coming to an end, peptides remain on the category two list. So we'll see what happens there. I'll say I've heard press releases drafted, but a lot of other stuff at our space. And I think it's one of those, if they wanted to, they would have, after a certain point. Like maybe they need a month or two to organize stuff, but, like, if they wanted to, they would have. And what's interesting is you see Trump has made all these deals with the pharma companies, and we don't understand all the terms of these deals. So I think there's a moment right now with compounding where, like, was part of these deals helping to shut down compounding in some way. Right? Because I know RFK is pro peptides, RFK is pro compounding, pro patient choice and cash pay, which are all trends we're seeing in the space. There's no doubt about that either. Yeah. Yeah. But, like, if deals have been made with pharma companies, you know, like, what's more important, we don't know. And I think actions speak louder than words, and if the press release has been drafted for months, why hasn't the press release come out? Right? Well, it's a negative note to end on. Real quickly on McCary, thoughts on him, relative to RFK? I don't have strong opinions, honestly. All right. We'll end it there. When you get peptides launched on GLP winner, we'd love to have you back and talk more about them. Yeah. Anyway. Yeah, thank you so much for being a part of HIMSAF, so this was really great. Yeah. Thank you so much for having me. This is a lot of fun.