Fixing the Broken Obesity Care Supply Chain

Crank and ChainIf nothing else, the last few years have transformed global supply chains from an arcane business concern into something that touched everyone. Setting aside toilet paper and electronics, let’s think for about moment about a supply chain that will be a problem stretching into the coming year – the supply chain for obesity care.

How Deep Does the Issue Go?

The most visible aspect of this problem is the shortage of new drugs that are used in both obesity and diabetes. Of course we’re talking about semaglutide and tirzepatide. The first of those two has been approved for use in obesity in the U.S. for over a year. But even now, the supply cannot keep up with demand. Nonetheless, Novo Nordisk says in their Nov 2 update that they will resolve the supply problems with semaglutide by the end of the year:

“We are on track to make all dose strengths of Wegovy® available in the US towards the end of the year. It will then take a few weeks for product to be broadly available at retail pharmacies across the country.”

But if you dig a little deeper, it seems like the supply problems might not disappear soon. Bloomberg reported yesterday that the company will delay launches in the UK and Europe until it more fully resolves the supply problem. In fact, CFO Karsten Munk Knudsen says that although his financial projections reflect an expectation that the supply will be better in 2023, they also allow for “periodic supply constraints and related drug shortages.”

Although Lilly’s Mounjaro brand of tirzepatide is not yet approved for obesity, the company is seeing a spillover effect on demand and has warned investors of supply challenges.

Radical Advances

Though these challenges have their roots in drug supply problems, there are bigger systemic forces at work. What we are seeing is the intersection of radical advances in obesity treatment with healthcare systems that have worked for years to deny people access to medical care for obesity.

In his Substack post about semaglutide and tirzepatide this week, Eric Topol described these as breakthrough drugs:

“These drugs will likely become some of the most prescribed of all medications in the upcoming years. While there are many drawbacks, we shouldn’t miss such an extraordinary advance in medicine—the first real, potent and safe treatment of obesity.”

From this perspective, it becomes clear that Novo Nordisk and Eli Lilly have a tiger by the tail. The supply issues may be more than a transient problem with manufacturing capacity. It may be the mark of systemic changes in medical care for obesity to address a huge unmet medical need. The bigger issue is the whole supply chain for obesity care. Reliable forecasts will be hard to find.

We’ve said it for some time. The systems that deny people care for this chronic disease must change. We may be seeing the beginning of that change.

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Crank and Chain, painting by Edward Wadsworth / WikiArt

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December 14, 2022