Scott's Web Log: Mark Cuban Cost Plus Drug Company Enters the Telehealth Arena for Generic GLP-1s

On June 17, 2025, Mark Cuban Cost Plus Drug Company PBC announced a collaboration with a telehealth company known as 9amHealth (see the press release at https://www.prnewswire.com/news-releases/mark-cuban-cost-plus-drug-company-pbc-and-9amhealth-join-forces-to-expand-access-to-affordable-obesity-care-302482628.html, and one article at https://www.fiercehealthcare.com/payers/mark-cubans-cost-plus-drugs-partners-virtual-obesity-clinic for more details). It is worth acknowledging that 9amHealth is a startup begun Frank Westermann and Anton Kittelberger, and as FierceHealthcare documented, both of those guys happen live with Type 1 diabetes themselves even though their business is primarily focused on T2D and obesity. 9amHealth's services are anything but cheap; membership costs $149 per month, which is why the Mark Cuban Cost Plus Drug Company/9amHealth telehealth collaboration will initially focus on employers.

You may recall that STAT News reported back in October 2024 (the article is behind a paywall, but if you have access, visit https://www.statnews.com/2024/10/17/telehealth-online-compounded-glp1-prescriptions-medical-groups/ for more) that "sketchy" telehealth firms were responsible for a vast majority of the GLP-1 prescriptions. Not surprisingly, all of those prescriptions have been for the newest, most expensive GLP-1 products, never for less costly generic products (as I write this, the U.S. Food and Drug Administration [FDA] has approved three generic GLP-1 medicines, all of which are for the drug known generically as liraglutide [fka Victoza/Saxenda]). You may also recall that I blogged that researchers from Cedars-Sinai Medical Center in Los Angeles showed an overwhelming majority of those GLP-1 prescriptions were for weight-loss instead of for Type 2 diabetes. Regardless, being denied access to less-costly GLP-1s whether for T2D or obesity is an issue, which is why the Mark Cuban Cost Plus Drug Company PBC/9amHealth could be disruptive.

Teva Pharmaceuticals introduced the first generic GLP-1 on June 24, 2024 (I blogged about that at https://blog.sstrumello.com/2024/07/tevas-biosimilar-of-liraglutide-will-be.html). However, I discovered that most of the same companies which are working on bringing biosimilar insulins to market all also have generic versions of liraglutide pending approval decisions. Teva's copy of Victoza was followed by another copy from Hikma Pharmaceuticals USA, which was approved on December 23, 2024 and then another copy from Meitheal Pharmaceuticals on April 3, 2025 (catch my coverage of those at https://blog.sstrumello.com/2024/12/fda-approves-second-generic-glp-1.html for more). More copies of liraglutide from Biocon, Sandoz, Amphastar Pharmaceuticals, and Lannett Company are known to be in development.

There are a few items worth pointing out.

First, these are hardly the only generics, these are merely the first ones to receive FDA approvals. But a bunch more copies now await approval decisions, and with each new generic to hit the market, prices tend to fall even further. The initial discounts were modest at best, so the more that come to market, the more prices are expected to fall.

Second, it is worth acknowledging that the first three copies of liraglutide are currently only approved for the treatment of Type 2 diabetes (fka Victoza). Just as Novo Nordisk did originally, the generics companies will need to successfully apply for an FDA "label extension" for the indication of obesity without Type 2 diabetes (fka Saxenda). Those label extensions have not yet happened, but are widely expected to happen. That's when the real gold-rush on less costly generic products is anticipated to start.

Nevertheless, the Mark Cuban Cost Plus Drug Company/9amHealth collaboration is a new dynamic which should likely send shivers down the spines of executives working in Bagsværd, Denmark where Novo Nordisk is headquartered. The reason is because a generic GLP-1 suddenly has a telehealth entity which can prescribe the generic product as freely as the overpriced branded drugs do, opening access to a much wider audience. That part was never in Novo Nordisk's business plan.

You might also recall that Novo Nordisk's CEO Lars Fruergaard Jørgensen was recently asked to step down (he was essentially fired, although the company Board of Directors instead asked for him to comply with their request that he leaves, or else they would terminate his employment for him, see https://www.fiercepharma.com/pharma/novo-part-ways-longtime-ceo-lars-fruergaard-jorgensen-citing-weight-market-pressures for more). Although the articles on Jørgensen's termination cited competitive pressures in the obesity drug market, that really wasn't the whole story at all.

Novo Nordisk is currently paying big Pharmacy Benefit Managers (PBMs) billions of dollars for "formulary exclusion" of all competing GLP-1 products, which also includes cheaper generics.

Ironically, it was because of magnitude of Novo Nordisk's U.S. rebating practices to PBMs for insulin that Mr. Jørgensen's predecessor named Lars Rebien Sørensen, who "retired" in 2016, leaving behind shareholder litigation over the magnitude of the company's exposure to legally-exempted rebate kickbacks paid for "formulary exclusion" of all competing insulin products. Novo Nordisk quietly settled that lawsuit out-of-court without admission of any wrongdoing (see https://www.bloomberg.com/news/articles/2017-04-28/novo-nordisk-is-sued-over-diabetes-drug-sales-practices for more). Sadly, Mr. Sørensen's successor Mr. Jørgensen not only doubled-down on those kickbacks, but he actually accelerated them, except the bribes were no longer being paid on the insulin therapeutic class of drugs, but on GLP-1s instead (as if that made the practice any different?).

Perhaps it's not at all surprising that Lars Fruergaard Jørgensen got himself fired. He repeated the same ethically-challenged business practices as his predecessor, while he also accelerated those practices. But this post is not about the weakness of Novo Nordisk corporate executives or their lack of ethics. Instead, it is about a marketplace disruptor known as Mark Cuban and his Cost Plus Drug Company deploying the very tactic which sent Wegovy/Ozempic U.S. sales through the roof: telehealth prescribers and suddenly the ability to do this for a cheaper generic product. I've addressed Mark Cuban Cost Plus Drug Company as a disruptive force in the pharmaceutical industry in several previous posts, including the following:

While Mark Cuban Cost Plus Drug Company has partnered with a telehealth company of its own and will target employer organizations as a way for them to slash their costs on GLP-1s as obesity drugs, there is now little which would stop an enterprising company from establishing a mail-order business to sell less costly versions of Saxenda. But telehealth is a key to making it happen.

That ought to make executives in Bagsværd justifiably nervous (and deservedly so).