Welcome to the latest edition of Peptide Purgatory, a series that evolved out of my desire to share my Mounjaro experience with others of my ilk to what it has now become: a general catharsis of my disdainful relationship with the current healthcare morass in the U.S., replete with greedy corporate caregivers, greedy governmental gallutes, and us, the willingly complicit victims. This is an industry that regularly violates the spirit of the Hippocratic Oath for its own gain. Screw the patient — it’s all about the money!
I’ll eventually get back to my Mounjaro story, but having been stable for a few weeks, I have nothing interesting to report to you. I’m due for an iron follow-up and my hernia repair is scheduled in a few weeks, both of which will provide much fodder for self-absorbed bloviation here.
This Week’s Subjects
Meanwhile, I’m here to expose you to the wolves they try to cloak in sheep’s clothing — cleverly couched, of course, in my Turkeyesque, sarcastic manner, which was honed to a fine art writing about Penn State football. This week’s lead story is another poke at government and its friends, the profiteers in the healthcare industry, a collection of cads who attempt to delude the public regarding motive, while continuously screwing the patient in every way possible. The Affordable Care Act, The Inflation Reduction Act, and now, the grand deal pulled off by the Trump Administration and Big Pharma, all are examples of this “benevolence” by the government-industrial complex.
When someone shows up at your door with a smile saying, “I’m from the Government and I’m here to help you”, run the other way — and don’t bend over!
This week’s Bullshit Corner takes a poke at the medical industry coming down hard on the AI industry for regurgitating information fed to it — by none other than the medical industry!
Politicians, Pharma, PBMs, Compounders, and You
A few weeks ago, I took a flamethrower to the TrumpRx spectacle — that choreographed Oval Office moment where CEOs shuffled in behind the Resolute Desk like morally flexible garden gnomes and declared a “historic” breakthrough in lowering drug prices. I called it performative, transactional, and probably designed to enrich the usual cast of suspects.
Well, turns out I was only partially right.
The performative and transactional parts still hold.
But the enrichment?
That wasn’t petty corruption.
It was industrial-scale market engineering.
What we witnessed wasn’t the White House kneecapping Big Pharma — it was Big Pharma and Washington jointly constructing a federally sanctioned superhighway to the mass-market future of GLP-1 drugs.
This wasn’t reform.
This wasn’t cost cutting.
This was the Great GLP-1 Land Grab.
I. The Price Drop That Didn’t Happen
According to the Wall Street Journal, Lilly and Novo didn’t actually slash prices into oblivion.
They shaved 20–35% off the net, not the list price — the number that matters. In return, they get:
- Medicare coverage for obesity
- Access to tens of millions of new patients
- A federally anchored price floor
- A moat so wide Pfizer, Roche, Amgen, and every biotech startup will need scuba gear to cross it
Big Pharma didn’t lose money.
They traded margin for monopoly scale.
This wasn’t a truce — it was a territorial annexation.
II. Trump Didn’t Profit — He Bragged
In my earlier Bullshit Corner, I speculated that maybe the First Family stood to skim a little cream. Nope.
The truth is more mundane and more insidious:
This wasn’t personal graft — it was political theater.
Trump gets:
- a populist victory,
- a banner headline,
- and a talking point about “historic savings.”
Lilly and Novo get:
- the largest drug market expansion since statins,
- federally guaranteed demand,
- and effective cartel pricing power.
This is not corruption in the classic envelope-under-the-table sense.
This is the state endorsing a duopoly because it’s politically convenient.
III. Meanwhile, My Own PBM Experience Is Pure Absurdity
Now let’s talk about the part where this becomes personal — and revealing.
I am currently on two perfectly legitimate diabetes-tangential medications:
- Mounjaro (GLP-1/GIP) — for Type 2 diabetes
- Farxiga (SGLT-2) — for renal protection in CKD stage 2–3
Both are clinically valid.
Both improve outcomes.
Both are part of modern diabetes care.
Now look at how my Medicare Part D (Wellcare Value Script) treats them:
| Drug | Category | Plan Tier | My Cost |
|---|---|---|---|
| Mounjaro | “Specialty” GLP-1 | Tier 6 | $11/month |
| Farxiga | Preferred brand | Tier 3 | ~$250/month |
This is a pricing strategy only Kafka could love.
The $1,200/month GLP-1?
Practically free.
The kidney-saving SGLT-2?
A monthly shakedown.
This isn’t clinical logic.
This is the outcome of a political pricing scheme, PBM gamesmanship, and the gravitational pull of GLP-1 mania.
Medicare has essentially said:
“Take the GLP-1. Don’t take the kidney drug. Trust us — we know medicine.”
Ladies and gentlemen, this is what practicing medicine by proxy looks like.
SIDEBAR: Compounders — When “Shortage” Becomes a Business Model
The compounders and their telehealth partners made a fortune on semaglutide and tirzepatide knockoffs, thanks to two loopholes:
1. The “Shortage” Loophole
As long as Ozempic or Mounjaro appeared on the FDA shortage list — for any reason, real or imagined — compounders could legally crank out “semaglutide base” like it was bathtub gin during Prohibition.
Novo and Lilly sued.
Courts shrugged.
Compounders flourished.
2. The “It’s Mixed with B12 So It’s Totally Different” Loophole
By adding vitamin B12 (or electrolytes, or unicorn tears), compounders could claim they weren’t copying FDA-approved products — they were creating a “clinically necessary compounded formulation.”
Telehealth hustlers like Hims, Hers, and the army of VoIP “clinics” pushed these blends like they were selling commemorative coins.
Why This Party Ends Now
With brand-name GLP-1s dropping to $245–$350 cash prices, why would any sane person inject gray-market peptide soup brewed behind a vape shop?
The compounder gold rush is ending.
They’ll slink back to testosterone gels and “bioidentical hormones.”
The GLP-1 party was fun, but the sheriffs are in town.
SIDEBAR: PBMs — The Rebate Cartel Finally Takes a Hit
PBMs survive on one thing:
the spread between list price and net price.
The new GLP-1 pricing structure kills that.
When Lilly and Novo publish stable cash prices and Medicare adopts them, PBMs lose:
- the arbitrage,
- the rebate racket,
- and the opaque negotiation charade.
Employers will notice.
Insurers will notice.
Hell, even voters will notice.
PBMs can still reinvent themselves — they always do — but the GLP-1 repricing is the first existential threat they’ve faced in decades.
SIDEBAR: The American Consumer Is Complicit
Let’s stop pretending this was all the politicians’, PBMs’, and drugmakers’ doing.
GLP-1s are the populist drug of the decade:
- TikTok loves them
- Instagram worships them
- The wellness crowd prays to them
- Hollywood injects them
- Suburban Facebook groups evangelize them
- And Americans are lining up like it’s Black Friday at Best Buy
Nobody is clamoring for gray-market Farxiga.
Nobody is buying Jardiance out of the trunk of someone’s Corolla.
But compounded tirzepatide?
People will shoot that into a body part they can’t pronounce.
Public demand — loud, irrational, and relentless — shaped this entire landscape.
Politicians didn’t invent GLP-1 mania.
They surfed it.
Pharma didn’t create the cultural obsession.
They capitalized on it.
PBMs didn’t set the public narrative.
They bent their spreadsheets to it.
And now people like me get to pay $11 for the “sexy” drug and $250 for the kidney-saving one — because the cultural spotlight got its way.
Conclusion: The New American Metabolic Order
The political system, the pharmaceutical system, the insurance system, and the consumer base all conspired — willingly or otherwise — to make GLP-1s the next statins.
This wasn’t a price cut.
This wasn’t a reform.
This wasn’t a negotiation.
This was a market coronation.
- Politicians got a victory.
- Pharma got an empire.
- PBMs got exposed.
- Compounders got crushed.
- Consumers got their miracle shot.
- And the rest of chronic disease management bent around the gravitational pull of GLP-1 culture.
Welcome to the new metabolic America.
Inject responsibly — and keep your kidneys insured.
Healio’s latest pearl of enlightenment informs us that generative AI stigmatizes obesity. According to researchers at ObesityWeek—the annual jamboree where Big Peptide meets Big Buffet—chatbots say mean things about gluttony while image generators have the audacity to show fat people surrounded by cheeseburgers. This, we are told, “worsens stigma.”
Let’s be honest: the machines didn’t invent the stereotype; they merely reflected what they learned from the same medical literature these experts have been publishing for decades. You feed a model thirty years of “obesity is lifestyle-related” papers and you’re surprised it connects pizza to adiposity? That’s not algorithmic bias—that’s faithful reproduction.
The deeper rot here is institutional pandering. We’ve recast metabolic dysfunction as a passive condition cured only by $1,200-a-month injectables and endoscopic blowtorches to the duodenum. Heaven forbid anyone mention that our collective fondness for couches, craft beer, and Costco sheet cake might play a role.
The uncomfortable truth: except for a minority with bona fide genetic defects, we are the architects of our own metabolic entropy. We built this soft nation one drive-thru at a time, lulled by dopamine, DoorDash, and denial. Yet academia’s new gospel declares that acknowledging personal responsibility is “stigmatizing.” The fix, of course, will come from a sponsored molecule with a co-pay card.
AI isn’t the villain here—it’s the mirror. If the reflection offends you, maybe the problem isn’t the mirror.
Well, there you have it. Our nanny-state government abets Big Pharma profits, making hay while the sun shines, under the guise of helping fat people, who are in turn being shamed by AI. Yea, verily, let’s all point fingers at red herring excuses while the fat cats reap big profit from fat humans who are seeking desperation cures for what modern society and its inherent indolence have wrought. The decline of personal responsibility is now an institutionalized reality, and there’s big money in it!
Peptide Purgatory chronicles one man’s ongoing experiment with Mounjaro, metabolism, and medical modernity. Side effects may include sarcasm, elevated skepticism, and mild tachycardia while reading policy papers. So, ask your doctor whether Peptide Purgatory is right for you!
For an annotated catalog of all my Peptide Purgatory and Mounjaro updates, visit my Mounjaro Update Catalog page.
