The GLP-1 economy is here

ZACH REITANO: People talk a lot about Ozempic face or Ozempic butt or things like that, and I think the media was using it as an element of fear. It reminded me, actually, that in the late 1800s, probably around 1895, they literally wrote about bicycle face. It was a way to criticize the idea of women using bicycles because they would get flushed in the face and their hair would get sweaty. So I think the same thing is happening in many regards as it relates to using these weight-loss medications. Should everyone get a GLP-1? No. But I would say far more people are both clinically eligible and would statistically benefit from one than I think people are giving it credit for.

BOB SAFIAN: That’s Zach Reitano, CEO of telehealth company Ro, the leading provider of branded GLP-1s in the U.S. Zach was the first guest on this show two years ago, in the early Ozempic, Wegovy, and Zepbound craze. Since then, he’s helped drive an exploding market in weight-loss drugs. Already in 2026, Ro grabbed attention with a Super Bowl ad featuring Serena Williams and was chosen by Novo Nordisk as the official telehealth partner for the new pill form of Wegovy. Today’s episode digs in with Zach on all that and more, including controversial questions about the long-term health impacts of GLP-1s, cultural backlash, and economic implications. It’s a candid, high-energy session with one of health care’s most disruptive builders. So let’s get to it. I’m Bob Safian, and this is Rapid Response.

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I’m Bob Safian, and I’m here with Zach Reitano, CEO of telehealth company Ro. Zach, welcome back to the show.

REITANO: Thank you so much. I’m glad to be back.

Copy LinkHow Ro used high-profile advertising to reframe GLP-1s

SAFIAN: You and I talked in what was the early phase of GLP-1 mania, as weight-loss drugs Ozempic, Wegovy and Zepbound were becoming household names. Since then, you have been in the heart of the action. I saw you had a Super Bowl ad this year featuring Serena Williams. I see your subway ads here in New York City with Serena and Charles Barkley all the time.

REITANO: Yeah, love that. I love them.

SAFIAN: Good. I assume that having Reddit founder Alexis Ohanian, Serena’s husband, as an investor and on your board sort of helped make that possible, helped connect you to Serena?

REITANO: Definitely helped with the initial introduction, but I think we would give her all the credit in the world for telling the story and making it happen.

SAFIAN: Yeah. A Super Bowl ad is expensive. What made you decide to do that? Because early on, it almost seemed like advertising wasn’t even a good idea with GLP-1s because there wasn’t enough supply.

REITANO: It’s a lot of money, but I actually don’t think it’s expensive when you think about it. The key distinction there is that it is the only time in the entire year where 100 million-plus people gather and ads are part of the product. All other times, they’re an interruption in your life. You’re trying to get past them. I genuinely enjoy ads and the storytelling behind them. My wife makes fun of me for it. But most of the time, when you’re watching a TV show or a football game, it’s the time where you pick up your phone or you go to the restroom. During the Super Bowl, it’s actually the time where many people, not everyone, but many people, pay the most attention. So it provides a very, very unique opportunity. For us, we announced our partnership with Serena in August, really trying to emphasize the concept that GLP-1s are not a shortcut.

Weight management and weight loss, and that journey for people who struggle with it, is often perceived as a lack of self-discipline or willpower, and using a medication for it could be perceived as a shortcut. I think it’s fairly obvious that there’s probably no one on the planet with more self-discipline and willpower than Serena Williams. That was the first myth we wanted to bust. We felt like she was the perfect person who uses every tool to optimize performance and optimize her health, but would never take a shortcut. She also talked about her improvement in blood sugar levels. She also talked about her reduction of heart disease risk, reduction of cholesterol by 30 percent, and her improvement in knee pain. But that was not the story that got picked up. So with the Super Bowl campaign, the intent was to try and break this second myth, that GLP-1s are only for weight loss. The last time we spoke, I believe that GLP-1s were only approved for diabetes and, newly, obesity.

SAFIAN: That’s right.

REITANO: And the cash-pay prices were about $1,300. Fast forward to today: They’re approved for diabetes, obesity, heart disease, kidney disease, liver disease, and sleep apnea, and they’re being studied for neurodegenerative diseases, substance use disorders, and pain management. So we felt it was, again, a very, very powerful story to tell. And it was not about needing more demand. I think it was about continuing to reach and give other people permission to seek out the best tools for their health.

SAFIAN: The last time we talked, we talked some about the backlash that was going on then about GLP-1 ads, with some folks saying, “Oh, you’re kind of labeling folks who are carrying more weight as needing to change their bodies.” Did that risk give you any pause about the Super Bowl ad or any of the rest of this? Or has the cultural conversation moved away from that?

REITANO: I think there has been, fortunately, a reduction in the stigma, but it still very much exists, and it exists in all aspects of life. It exists when someone walks into the doctor’s office, it exists on social media, it exists with friends and family. It’s wrapped up in so many different components of people’s lives. What is interesting is that what was seen as shocking maybe three and a half or four years ago, our ad that we originally talked about was literally a subway campaign where it showed the medication, it showed the pen, and then it showed someone injecting the pen, and then it said, “A weekly shot to lose weight,” and had the safety information.

SAFIAN: Yeah, it was a very calm, measured ad compared to the reaction, which was super emotional.

REITANO: It just said what the thing did, and it showed people using it as their doctor would direct them to. So I think that “a weekly shot to lose weight” probably is not surprising to people today. So we would say, “Hey, if we ran that same campaign, would people have that same reaction?” I think no. The fact that they wouldn’t have that same reaction is, to me, a sign that there has been some level of improvement. I think we’ll look back five years from now and see Serena sharing her story as sort of this watershed moment.

Copy LinkWhy pill-based Wegovy is opening the market to new patients

SAFIAN: Along with your Super Bowl ad, big news this year has been Danish company Novo Nordisk launching Wegovy in pill form at $149 a month. Ro is Novo’s telehealth partner for the launch.

REITANO: Yeah.

SAFIAN: What’s been the uptake on the pill so far? Is it destined to take over the market? Or are the injections still more effective?

REITANO: First, can we just acknowledge how awesome it is that the starting price is $149? The fact that it’s come down 90 percent, I think, is a really powerful indication of the power of direct-to-consumer health and cash pay. It’s the combination of, I think, in this industry, things that regulators and policymakers have been trying to do for decades, which is create competition that leads to transparency, higher-quality products, more convenience and lower cost, basically happened when the market was forced to operate in a consumer industry.

But in terms of who it’s resonating with and what the expectations were for the pill, we had really high expectations and high hopes for the pill. What has been really exciting to see is that the results have far exceeded our quite high expectations. By an order of magnitude, the demand for the pill has been tremendous. I think part of it is price, absolutely. But part of it is also because we believe, and we’ve started to see this, that there were tens, and still are tens, of millions of people who were sitting on the sidelines simply because of the form factor.

SAFIAN: Yeah. Injections scare people, right? The idea of injections scares people.

REITANO: That’s right. Whether it’s stigma or whether it just seems “too serious” to take that step with an injection, a pill completely disarms that. The question was, “Hey, would the pill cannibalize the existing injectable market?”

SAFIAN: Yeah, I was going to ask that. Are people switching?

REITANO: So I would say the vast majority, vast, vast majority, is net new, and it’s market-expanding. There are probably two groups: some who just have injection fatigue every single week and prefer that daily pill option, and travelers. Because of the cold-chain requirement with the injection, it’s a little bit cumbersome to travel with. So a daily pill that they just take every morning when they wake up is a little bit easier. But the vast majority of people are net new to the product.

SAFIAN: The effectiveness of, if I’m starting today, whether I’m taking the injection or whether I’m taking the pill, if I’m cost-agnostic, is one more effective than the other?

REITANO: They are quite comparable in terms of weight loss. So the pill, if you use it as directed every day in the morning, fasted, with a little bit of water, you’ll see patients lose 16 to 17 percent of their body weight, quite similar to around 16 or 17 percent for the injection. There is an injection by Eli Lilly called Zepbound. Maybe people have heard Mounjaro or the active ingredient, tirzepatide. That is more effective. Patients lose about 22 percent of their body weight. But you’re now starting to see a larger segmentation process.

So what you’re going to see over the next year, two, three, four, five, is that patients are going to see multiple options in terms of price and starting price. You’re going to see continuous competition. For weight loss, you’re going to see options that are 12, 15, 17, 20, 25 and 30 percent. And then you have this range on frequency and form factor. You’re going to have daily, weekly, monthly, potentially quarterly, six-month and annual options in the coming years, as well as injectables and pills.

Copy LinkHow more treatment options are reshaping weight-loss care

SAFIAN: I know. It sounds like it used to be you would go to the shelf and there’d be one thing, and now there’s a whole row of shelves of different things that are available for you, and that shelf space is just going to grow.

REITANO: That’s right. It’s going to be able to better fit each individual patient’s needs based on what they value.

SAFIAN: When Hims & Hers announced a $49-a-month version of the Wegovy pill earlier this year, the FDA stepped in to shut it down. What’s the competitive landscape there? Do you look at Hims & Hers as sort of a brother in arms in building this space? Or is it like a nemesis that makes things more difficult for you?

REITANO: It’s very similar to driving a car, which is, you have a destination in mind. That destination is not identical to everyone else’s. But 5 percent of the time when you’re driving the car, you’re looking left, you’re looking right, you’re looking behind you, you’re aware of your surroundings. I’d say we look at competition very similarly. Ro is the leading provider of branded GLP-1s in the country, absolute No. 1, far and away. The reason that is the case is because we, relative to all competitors, not naming one specifically, but all competitors, really work backward from prioritizing what is absolutely best for patients. We offer cash-pay and insurance options. We have the strongest formulary. And then we have the highest-quality care, which we’ve published data on showing that patients on Ro lose the same amount of weight as they do in clinical trials, which is very rare when you see real-world evidence match clinical trials. So we’re less obsessed with what competitors are doing and far more obsessed with what our patients need and want.

SAFIAN: To go with your car-driving analogy, if there’s a car near you that sort of gets pulled over by the cops or is blocking traffic in some way, that’s not necessarily something that you’re focusing on or worrying about happening. You’re just going to find your own route.

REITANO: I don’t think it’s great if a car drives off the road, crashes into a tree, and then that tree falls on the road, because I think that has the potential to be a net negative for patients, for all builders who are trying to better serve patients. So I think the industry was very appreciative of how fast the market responded in that way.

Copy LinkZach Reitano on GLP-1s as a lifetime prescription

SAFIAN: So GLP-1s are like a lifetime prescription, right? The benefits tend to dissipate after you stop the medication, and that’s a pretty compelling customer relationship. Has that impacted how you think about the business? You could focus on just being a shop for GLP-1s as opposed to broader telehealth. The last time we talked, you were sort of in the middle of navigating that a little bit.

REITANO: What’s very interesting to me is when people say, “Hey, you have to take the medication to continue to see the benefit,” that’s the same for any, not even just medication, but any good act related to your health. You can’t just do one pushup and have it stick with you for life. You can’t just eat one healthy meal. And same thing with medication, right? You can’t just take your hypertensive medication, birth control, statin or GLP-1 once and assume that it sticks with you for life.

SAFIAN: Right.

REITANO: Any good behavior, if you have one good night’s sleep, you can’t stay up the rest of your life. But it’s fascinating because when it comes to weight in particular, you see a heightened focus on that question. I think it’s largely because of the stigma attached to weight loss and obesity. What the data shows right now is that if a patient stops using the medication, the majority of patients, not everyone, but the vast majority of patients, will typically regain the weight that they lost. Unfortunately, they also will lose the metabolic health benefits that they got, and those are actually lost even faster than the weight regain.

Now, that’s if you look at a binary: You’re either on the medication on a weekly basis or you stop entirely. Are the benefits linked to absolute perfection in terms of adherence? What the early research is starting to show is that that’s not the case. And that is really exciting, I think, for people. The studies are small, in groups of 10 people, 20, 30, 40, 50, so really, really small, but quite consistent and strong in the data, showing that if patients take it every 10 days or every two weeks, they’re actually able to maintain their weight and the metabolic health benefits while taking basically half the medication. So that would cut the price in half. It’s early, but we’re starting to see things where you can personalize that patient’s journey. So I think there’s a lot left to learn, but I think patients likely won’t be stuck between all or nothing.

SAFIAN: The dramatic evolution of the GLP-1 market fascinates me, and clearly there’s much more to come. So what kind of responsibility is required with such fast-paced change in health care? And can GLP-1s really cure addiction? We’ll dig into that and more after the break. Stay with us.

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Before the break, Zach Reitano of Ro talked about the fast-growing market for GLP-1s. Now we talk about the impact on spending habits, thinness obsession and, yes, the role of AI, plus what TrumpRX is really doing to the drug market and how pharma companies can fix their reputation. Let’s jump back in.

Copy LinkThe intersection of AI and GLP-1s

When we spoke last time, you compared GLP-1s to AI, how they both have this potential exponential impact on society. There’s a lot of discussion right now about responsible AI. Do you talk about what is responsible GLP-1?

REITANO: I’m pretty proud of us. We’ve gone like 35 minutes without mentioning it, and we’re a technology company.

SAFIAN: I know.

REITANO: It’s pretty good. It’s inevitable. Yes, we think about responsible AI and responsible GLP-1s. If you think about our feedback loop, ultimately we create the technology to collect data for a provider. The provider then makes that treatment decision. And then we build more technology and more tools for that patient to share more data with their provider, whether that’s a lab test, whether that’s a device, whether that’s through a conversation, whatever it may be. The tighter that feedback loop is, the better their care journey is personalized and the better outcomes they can have.

Every single message that’s actually sent through Ro from a patient to a provider is routed through an LLM, and it’s assessed from a topic perspective and an action perspective. But one of the coolest things that the team was able to build, and we’ve published data on this actually, is the ability to detect whether a side effect is mentioned in that raw text. If it is, it creates a structured side-effect report, routes it to a provider, and we’ve reduced side-effect response time by 70 percent. The median response time to a side effect on Ro is 15 minutes, 24/7, seven days a week.

SAFIAN: Wow.

REITANO: So that is very, very cool. Again, it has to be done responsibly, and I think the team is doing that.

Copy LinkInside the cultural backlash to GLP-1s

SAFIAN: Critics talk about the cult of thinness, right? HuffPost recently noted that extreme thinness is back and there’s a skinny-talk hashtag. Do you think about that end of it, sort of abuse of it at that end, the way online gambling companies worry about gambling addicts?

REITANO: We do have a significant number of safeguards in place to make sure that the right patient comes in and gets the right product for them, and that they’re under the supervision of their health care provider. I think as far as the zeitgeist or cultural criticisms, people talk a lot about Ozempic face or Ozempic butt or things like that, and I think the media was using it as an element of fear to criticize people who were seeking these things out. It reminded me, actually, and I don’t know where I originally saw this, but in the late 1800s, probably around 1895, there was a media company and they literally wrote about bicycle face. It was a precursor to the suffragette movement, and it was a way to criticize the idea of women using bicycles because they would get flushed in the face and their hair would get sweaty. They called it bicycle face as if it were a negative that women were using bikes to move throughout the city and exercise.

So I think the same thing is happening in many regards as it relates to using Ozempic and these weight-loss medications. Again, that’s not to say that anything can’t be abused. People abuse exercise, right? Everything can be abused. If you obsess over body composition to the point where it has extremely negative effects on your day-to-day life, then that needs to be curbed, and ideally someone seeks support for that. Should everyone get a GLP-1? No. But I would say far more people are both clinically eligible and would statistically benefit from one than I think people are giving it credit for when they have the conversation.

SAFIAN: We talked last time, too, about some broader cultural issues, about how GLP-1s might hit consumption, groceries, restaurants, travel. We’ve seen some signs of reduced spending in those areas, though I also saw that chocolate maker Lindt announced that weight-loss drug users are growing as customers. Did that chocolate news surprise you? What’s actually playing out?

REITANO: What’s interesting is there are certain studies showing a reduction in overall grocery bills. So people are ordering and, I think, saving about $100 a week on groceries. They are also eating out less. They’re actually making more food at home. They are traveling more.

SAFIAN: They’re waiting to see restaurants offering GLP-1 portions or GLP-1 menus.

REITANO: They could. The Lindt chocolate thing was interesting because I do think what you’re seeing some people do is they might actually increase the quality when they do spend on those sweets. So you can imagine them eating fewer Hershey bars, but saying, “Hey, when I do want something sweet, because I’m only going to have one bite or I’m going to have two bites, well, I’m going to have Lindt or Godiva or whatever, Ferrero Rocher.” So you could see the luxury sweets benefiting, but maybe the quantity-based sweets less so. I could see that happening. Clothing is another big one, too. Patients are kind of uncertain about how to spend and how much to spend and what to buy during their weight-loss phase because it’s quite rapid, right?

SAFIAN: Yeah.

REITANO: If you think about it, if you have a growing kid, do you buy them nice clothes on the way? Probably not. So they’re navigating that.

SAFIAN: That’s what hand-me-downs are for. Yes, that’s right, with your kids.

REITANO: But once they hit their maintenance phase, then I do think, in a good way, you see a lot of patients feeling far more confident and really rewarding themselves.

Copy LinkCan GLP-1s reduce addiction?

SAFIAN: Yeah. You alluded to this earlier, new research suggesting that GLP-1s could reduce addiction, not just food, but alcohol, opioids and cocaine. It’s the same mechanism, I guess, that quiets food noise, quiets drug noise. How much is the industry leaning into this? How clear are these results?

REITANO: If you think about it, and this is where we’re learning as a society, there is clearly something connected among certain reward-based behaviors. Some people really talk about seeing a dulling in those areas. Can these medications also be perceived as anhedonic? Is the light being dimmed for some people? So we don’t know enough yet. You are seeing what I would call anecdotal data, with people reporting that and saying, “I do feel a dulling sensation.”

Now, for some people, if that noise is so loud, that dulling can be quite tremendous. Any amount of dulling might let them focus more. And if they can focus more or sleep more, and then they can exercise more, then this incredible positive feedback loop occurs. But again, this is where the right product for the right person, the right strength, all of these different things matter. Different people will have different responses because, yes, there are common experiences, but all of us are also quite unique in our physiology as well.

SAFIAN: It’s early days in the development of all these things.

REITANO: It’s so early.

SAFIAN: I was thinking about how a lot of folks with substance abuse problems are very low weight. So to take something that might dampen their appetite for food is not necessarily a good thing, but you want to dampen their appetite for these other substances. And we don’t necessarily have the tools yet to know how to modulate that.

REITANO: Right now, we’re basically pushing buttons on these hormones, and we’re pushing one at a time, then we’re pushing two, then we’re pushing three. We’re trying to balance them out. We’re pushing ones that increase energy expenditure at the same time that we’re pushing on ones that decrease energy intake. And we’re trying to do it all at the same time. But it’s teaching us far more about the connection between our gut and our brain, far more about our reward-driven behavior. So to your point, we might actually find that there are certain medications that can dampen that reward-based behavior but not increase satiety in the same way. So we’re very, very early, which is why we talked about this as sort of 2.0. You see 3.0 coming out over the next three to five-plus years, but I think you’ll see even more.

Copy LinkZach Reitano: Why TrumpRX has been a net positive for GLP-1s

SAFIAN: A lot of health businesses are struggling over how to deal with the Trump administration and what the MAHA movement is about, companies like Moderna and the mRNA space and vaccines. The White House has brought GLP-1s into Medicare and Medicaid at a $50-a-month copay or something. Do you think about MAHA and dealing with this administration? Does that come into your calculations?

REITANO: I think TrumpRX is a great example of what you’re talking about. What’s fascinating about TrumpRX is there’s been a lot of talk and criticism about what it doesn’t do instead of, in my mind, a lot of what it has done. I don’t just say this to compliment the administration. I say this genuinely because the reason these drugs are $149, or even lower, and the reason they’ve actually increased in price in other countries to rebalance that, where Americans are not paying disproportionately more than other people, is because of TrumpRX. Not just the website, but the overall negotiations between the administration and pharmaceutical companies that have led to a significant reduction in the price of GLP-1s.

In other drugs like Repatha, Repatha is a PCSK9 inhibitor for heart disease, the drug used to be $600, now it’s $200. Imagine if I launched a start-up and within six weeks, people were like, “Did you cure the health care system? Did you fix it all?” I’d be like, “It’s been out for six weeks. What are we talking about?” But what has happened in the six weeks since it’s launched is that you’re going to have a lot of people save thousands of dollars a year, and that’s progress. Is every single drug in the United States much cheaper? No. Are many cheaper? Yes. Is that a good thing? Great. Can we move on? Let’s keep having this progress because it’s good. So I think that we’re a little overly obsessed with needing every new thing to be the complete solution instead of really seeing how progress is done, which is inch by inch across a lot of different factors.

SAFIAN: There’s this subtext culturally that drug companies are bad, like they charge too much and they’re ripping people off and whatever. You work with drug companies. There’s good, and there’s bad in there. Where does that sit for you?

REITANO: I am biased because I have a congenital heart condition, and modern medicine largely saved my life. But what is fascinating to me is when you look at the things that have extended life expectancy over the last 100 years and have improved population health, unequivocally the leading driver is drugs. So I think that the pharma industry, and again, no stakeholder is completely blameless in this situation, but the incentive structure in the industry is far more to blame than any individual stakeholder. The reason you can see that is, look what happened when GLP-1s went direct to consumer. They just miraculously went from $1,300 to $149, right? Same pharma company. What changed? The incentive structure changed, and then suddenly they were actually able to reach far more people far more conveniently. Both Lilly and Novo did this. You’re seeing them looking at cash pay. GLP-1s are actually the fastest-growing part of the market and soon may exceed the insurance-based segment.

When you removed PBMs and insurance companies and other stakeholders, pharma companies were miraculously able to lower the price and make the products more affordable. So again, I’m biased, but I think they need a massive rebrand. They have a massive branding problem. If you think about where that branding problem stems from, it’s very natural. When people get to have agency in their purchases and decision-making process, that’s an empowering thing for individuals. A lot of times with medication, there’s this overlap where they don’t have as much choice in which one they get, and they’re then being told they’re forced to pay for it. That’s not a recipe for a high NPS score. So I think what you’re seeing is, if you were to look at their NPS and the love that people have for them over the last five years compared to the previous 20, and then think about what’ll happen over the next 10 or 15 as they go direct to consumer, I think it’ll radically change.

SAFIAN: Well, Zach, I always love talking to you.

REITANO: Right back at you.

SAFIAN: Thanks so much for doing it.

REITANO: Of course. Thank you. It’s great to see you.

SAFIAN: Zach’s belief in the clinical impact of GLP-1s may be matched only by his ardor for Ro’s direct-to-consumer model. But at this point, truly, it’s tough to argue with either one. As Zach acknowledges, there are risks with any new medicine, new tool or new practice. Anything can be misused, so we need to be measured. Still, I’ve yet to see a measurable downside, except for the advantage that wealthier people have in benefiting from these drugs, which is narrowing as prices fall. Will this be good or bad for drug companies in the long run? For insurers? The health care industry is so complicated, it’s hard to know. What’s undeniable for now is the progress that many patients are seeing, and in that respect, it’s hard not to be hopeful. I’m Bob Safian. Thanks for listening.