How Gila Monster Venom & American Taxpayers Built the Foundation for the GLP-1 Boom
Why the High-Priced Drug List Is Needed to Ensure Medication Access to the People Who Made GLP-1s Possible
It’s not often that a weight-loss treatment becomes a household name, but more people can name a weight-loss medication today than can name the three branches of the US government. These medications, based on GLP-1 hormone analogs, are transforming the approach to obesity and type 2 diabetes. Yet behind the “overnight” success of GLP-1 therapeutics lies decades of taxpayer-funded research.
Much of the foundational science that made these drugs possible was conducted in government labs and academic institutions long before any pharmaceutical company got involved. This public-to-private pipeline raises important questions about pricing, access, and how we ensure a fair return on public investment, especially in the United States, where taxpayers fund a good portion of global public health research and also are charged, by far, the most for the same medications.
Public Science Behind the GLP-1 Breakthrough
The story of GLP-1 (glucagon-like peptide-1) therapeutics did not start in a pharma boardroom — it began at the lab bench. Back in the early 1980s, scientists supported by the U.S. government were already unraveling clues that would lead to today’s drugs. An NIH-funded researcher, Dr. Jean-Pierre Raufman, discovered unusual molecules in Gila monster venom that affected the pancreas. This odd line of inquiry was driven purely by scientific curiosity (why can a Gila monster go months without eating?) — the kind of high-risk basic research that public funding makes possible.
Fast-forward to 1992: Dr. John Eng, working at a Veterans Affairs (VA) hospital in New York, isolated a novel peptide from that same venom. He named it exendin-4. When Eng tested exendin-4 in diabetic lab mice, the results were remarkable. Blood sugar dropped dramatically, and unlike the body’s natural GLP-1 hormone, the effect lasted for hours. Eng had found a way to mimic GLP-1’s benefits without its biggest limitation (our native GLP-1 gets cleared within minutes). This was the eureka moment researchers had been hoping for — a breakthrough born in a government lab.
It’s worth underscoring just how much public science paved the way here. Academic endocrinologists had first identified GLP-1’s potent effects on insulin release in the late 1980s, and early clinical experiments showed it could normalize blood sugar — but only briefly, and with side effects. Eng’s exendin-4 discovery provided the missing piece. And tellingly, his employer — the U.S. taxpayer-funded VA — declined to patent the discovery. For three years, Eng struggled to get any pharmaceutical company interested in developing it into a drug. The notion of a diabetes treatment derived from lizard venom seemed far-fetched at the time; many industry experts were skeptical that it would ever work.
From Lab to Market: Private Sector Takes the Baton
Eventually, the persistence of public researchers paid off. In 1996, a small biotech company called Amylin Pharmaceuticals agreed to license Dr. Eng’s patent and invest in drug development. The result was exenatide, the first GLP-1 analog therapy, approved by the FDA in 2005. This was a landmark: exenatide proved that targeting the GLP-1 pathway could safely control diabetes. Almost overnight, what had been an academic curiosity became a hotbed of industry innovation. Other pharmaceutical companies quickly followed suit, pouring resources into their own GLP-1 research and development. One European company developed two popular GLP-1 medications, and the Senate recently questioned that same company for charging Americans as much as 10x more for the same GLP-1 medication it offers affordably to much of the rest of the world.
This public-to-private handoff is a textbook example of how healthcare innovation often works. The high-risk discovery phase was underwritten by taxpayers, and the product development phase by private firms. There’s no question that companies took on tremendous expense and risk to turn peptides into safe, mass-produced medicines. They ran large-scale clinical trials, navigated regulatory hurdles, and scaled up manufacturing. The partnership between public science and private development in this case has yielded phenomenal results: GLP-1 drugs are arguably the most significant advance in metabolic health in decades, offering hope to millions struggling with obesity and diabetes.
By 2023, a popular GLP-1 had become the top-selling medication in the United States, with annual spending on it reaching a staggering $38.6 billion, and the European company behind it is now valued at many hundreds of billions of dollars, becoming one of the most valuable corporations in the European Union. That kind of payoff reflects decades of scientific groundwork — much of it done in university and taxpayer-funded government labs — combined with pharma’s investment in bringing a product to market. It’s a triumph of innovation, but it also exposes a tension at the heart of our system: Who reaps the rewards, and who bears the costs?
How is it that the taxpayers who funded the foundational scientific research that motivated the discovery are now charged 5–10x more for the same medication?
When the American Public Pays Twice
Critics have noted that in cases like GLP-1 therapeutics, the public ends up paying twice: first by funding the basic research, and later by paying high prices for the resulting medicine. It has been reported that U.S. taxpayers spent billions to develop GLP-1 drugs only to face steep costs at the pharmacy counter. The sad reality is that a three-month supply of the most well-known GLP-1 medication can cost about as much as the average monthly rent — and this for a medication that may have to be taken for a lifetime.
Let’s talk about those prices. In the United States, the list price of one popular medication is around $1,000 for a one-month supply, whereas the exact same medicine costs a tiny fraction of that in other countries (~ $100 in places like Canada and France). These costs can add up to tens of thousands of dollars per year for a single patient — a huge burden for individuals and health systems alike.
It’s little surprise that, due to the high costs, many insurance plans have been reluctant to cover the new weight-loss drugs. As of 2024, roughly half of large employer-sponsored insurance plans cover GLP-1 weight-loss medications, but Medicare still does not, and only a few state Medicaid programs have opted to cover them. In practice, that means many Americans who could benefit medically from these drugs simply cannot get them. As one medical journal noted, those who might benefit most “may be unable to afford such expensive drugs” at all.
From an equity and public health standpoint, this is problematic. The people most affected by obesity and diabetes are often in communities with less access to care and lower incomes. If effective treatments are available only to the well-off or those with top-tier insurance, the health gap only widens. And remember, these are treatments born from publicly funded science.
If the public paid for the science, should cost be such a barrier to the public’s health?
Toward Fair Access and Public ROI
None of this is to say pharmaceutical companies don’t deserve credit or a return for their role — they absolutely do. My concern is that if US taxpayer-funded research makes possible European commercialization, for example, then Americans shouldn’t be charged 5–10x more than the European company charges Europe’s own citizens.
Put another way — when the balance tips so far that a breakthrough discovered on the public dime becomes unavailable to much of that same public due to price, it’s time to reassess the policy framework.
How can we better align public investment with public benefit? For starters, transparency helps. Acknowledging that NIH and VA research paved the way for GLP-1 therapies can inform policy discussions on drug pricing. If lawmakers recognize that a drug would not exist if not for federal grants or VA lab work, they may push harder for pricing that doesn’t harm the very taxpayers who funded the science.
A Modest Reform with a Big Impact: the High-Priced Drug List
We won’t likely see a new patient-friendly drug pricing law passed anytime soon, given the powerful entrenched interests involved. But there is another way to improve access.
The U.S. Department of Health and Human Services (HHS) could directly address access issues for high-priced drugs, within the confines of their existing authority. HHS could maintain a public database of medications that are priced multiples above the global average. For example, if the global average price of a drug were X, then the drug would be added to the list if Americans were charged 2X or more.
Noom recently launched a full-page print ad in The Wall Street Journal, calling on policymakers to create new guidance around expensive drugs, as compounded essential-copy GLP-1s are set to be taken off the market by the end of May.
Noom’s proposed “High-Priced Drug List” would allow for compounded GLP-1s to be prescribed even in the absence of a drug shortage, but only if the medications were priced exorbitantly.
Such a database would enable patients and providers to see which drugs are excessively priced in the U.S. It would be another way to hold manufacturers accountable.
Congress could use the High-Priced Drug List in a similar way to the current Drug Shortage List: To improve public access to essential medications. If a drug were listed in this database, FDA-regulated 503B pharmacies would be empowered to manufacture compounded versions of these high-cost drugs. In this way, the High-Priced Drug List would not only provide transparency for patients and providers, but also introduce competition to drive down costs.
A Relief Valve for a Broken System
If price, when exorbitant, is not an access issue, then what is it?
Price becomes an access issue when the price of drugs is exorbitant. And that is clearly the case with GLP-1s, where branded medications are priced multiple times higher in the U.S. than in other countries. Until pharma companies lower their prices in the U.S., these medications should be allowed to be compounded by US-based 503A and 503B pharmacies.
A High-Priced Drug List would respect free market capitalism while promoting public health. Under this proposal, when an overseas company chooses to charge Americans more than 2x the price they charge the rest of the world for the same meds, there’d be a relief valve built into the system that allows competition to drive down costs. This would bring down the cash pay price, and maybe even the insurance-pay price, of GLP-1s for millions of Americans.
A Modest Proposal
Creating a High-Priced Drug List would not require legislation. It would merely require HHS to update its guidance. The FDA, today, can take into account “demand” when declaring or ending a shortage. It should consider the demand at a price that is not on its face unreasonably high.
This is Economics 101. How else can the FDA consider “demand” if not in relation to a price, and what better benchmark price is there than that price being charged to the rest of the world?
For drugs produced outside the United States, the FDA should assess the demand for a drug at the lower of the list price and 2x the global average price of the same medication. If the drug manufacturer can meet this demand, then the drug is not in shortage. If the drug manufacturer can’t meet this demand, then there is a shortage.
How can this demand be calculated? The FDA could require 503B pharmacies, which already must report all adverse events to it, to also report the monthly volumes by medication. It could also demand drug manufacturers to show the demand curve of the medication. Rather than simply accept the arbitrarily high list price, sometimes exceeding 10x the global average price, which has the effect of throttling demand and access, FDA could simply choose to evaluate “demand” in a different, and arguably much more “common-sense,” way than it does today.
The High-Priced Drug List is meant to combine Transformative Impact, in the form of lower prices for folks to access their meds, with Pragmatism, in the form of being achievable with HHS guidance updates.
The current U.S. administration and its think tanks have made a point of America-First policy initiatives — including this one.
This Modest Proposal, the High-Priced Drug List, ensures, at the very least, that the American taxpayer, who funded the basic research, is not last in line — forced to fund the research and denied access by 5–10x too-high pricing versus the global average price of the SAME medication.
In our framing, the list would apply only to those medications being developed abroad by overseas companies and sold back to US patients at exorbitant prices — multiples of the price the companies charge people outside the US.
These additional tools could strike a necessary balance between pharmaceutical innovation and patient access while ensuring life-saving medications remain affordable and available to all Americans.
This graphic illustrates how the High-Priced Drug List would work:
Ultimately, the goal is not to punish success but to share it broadly. The discovery of GLP-1’s therapeutic potential is a shining example of what public science and private enterprise can achieve together. Now, as these drugs stand to improve — even save — countless lives, we have a collective responsibility to ensure affordability and access.
Life-changing medications should be available to those who need them, not just those who can afford them.
It’s a perspective rooted in both moral sense and economic sense, because treating chronic conditions like obesity upstream can save enormous costs downstream.
GLP-1 drugs are a triumph of innovation, but also a case study in how innovation happens. American taxpayers helped fertilize the soil from which these medical advances grew.
As we celebrate science, we must also tend to the system that delivers its fruits to patients. That means forging policies that reward innovation and uphold the public interest, so that when the next breakthrough therapy comes along (and it will, with continued public support), we don’t repeat the same disconnect between scientific success and societal benefit.
