In their first public appearance since the drug’s debut, the marketing stewards behind GLP-1 obesity medicine Wegovy looked back at a launch for the ages.
“I think there’s this misperception that, ‘Oh, the people at Novo Nordisk must be dancing in the halls and celebrating every single day,’” said Tejal Vishalpura, SVP, commercial strategy and marketing for the Danish drugmaker. “Actually, we hadn’t stopped to even reflect on our journey because we are so heads-down every single day.”
Indeed, the launch of Wegovy — approved for obesity by the Food and Drug Administration in 2021 and containing the same active ingredient as diabetes drug Ozempic — has brought the drugmaker megablockbuster success. Fourth-quarter 2023 sales of the weekly injection reached 9.6 billion Danish crowns ($1.4 billion), just below the prior quarter and four times higher versus the year-ago period. Analysts say an expanding list of indications will fuel market share through 2029.
But it’s far from an overnight success. Novo’s GLP-1 research dates back about 20 years. And Wegovy’s journey has been replete with challenges, namely a supply crunch so severe it led to a promotional stoppage, not to mention a raft of media attention, an online misinformation wave and a flood of counterfeits.
During a fireside chat at last week’s MM+M Transform Conference in New York City, Vishalpura and the team behind the launch took a moment to reflect on the emotional ride it’s been, as well as counterintuitive steps taken and new marketing skills learned.
Lessons from Saxenda
The team knew from having launched Saxenda, an earlier GLP-1 drug which Novo marketed for obesity, that patients struggling with their weight tend to think about treatment in a short-term way.
“What we quickly realized is that this is an acute weight-loss market,” recalled Christine Szymanski, Novo’s obesity consumer lead. “People are very focused on dropping a few pounds and thinking that everything is okay after that.”
They also realized that the stigma associated with obesity touched not only the people living with the disease, whose self-defeating belief systems had been ingrained since childhood, but could be traced to healthcare providers and decision makers.
Market development for Wegovy began by unpacking this bias and stigma. Just a year prior to Saxenda’s approval came the American Medical Association’s famous 2013 recognition of obesity as a disease.
“But even that was not done without a ton of controversy,” recalled Anne McCaughan, senior brand director, obesity, who leads the HCP strategy and market development team for inline and pipeline products at Novo. “A lot of physicians still said, ‘Yeah, this is a behavioral disease, a psychological disease.’”
New marketing muscle
While more than 100 million people struggle with obesity, its recognition as a disease had occurred in very few cases. “It’s ironic because physicians will tell us it’s the first thing they see when they see the patient, but it’s the very last thing they want to talk about,” McCaughan explained.
Thus, her work involved “peeling back the layers of the onion and really figuring out, ‘Where is this bias coming from, where is the stigma coming from?’ And then actually having to have real conversations with doctors and asking them to face those biases and stigmas. Because this wasn’t just about [the AMA declaring], ‘It’s a disease.’ It was about making sure physicians understood it was a disease that was worth treating and wasn’t a disease of willpower,” she said.
That task required use of “very different marketing muscles than any of us had ever tried before,” McCaughan added.
As the June 2021 approval date approached, headlines emerged about how people with obesity were experiencing more severe cases of COVID-19. That was around the same time as Wegovy’s clinical data began to be published, sparking a groundswell of public conversation.
“We had always had heart for, and really believed in, what Wegovy could become,” said Szymanski. “Those headlines told us, ‘It looks like there are a lot of other people who are going to start feeling that way as well.’”
Coverage snafu
Around this time, the Novo team began sensing that the Wegovy launch was going to go quite differently than Saxenda’s. The excitement mixed with trepidation: As much as team members may have thought they could convince the public to reconsider its view of obesity, payers were another matter.
“You can’t overlook the reimbursement landscape in 2021 for obesity medications,” McCaughan pointed out. “A lot of it had to do with how the world viewed obesity, but an equal amount was how it was reimbursed.”
As opposed to diabetes, where 80% of patients have care and 95% have treatment access, fewer than 30% of patients with obesity had access at the time of Wegovy’s launch.. And while 30 million people sounds like a lot, the obesity market is different in terms of reimbursement. Not only does the patient’s PBM have to cover the medication, but their employers must actively opt in.
Even when companies do so, information isn’t necessarily publicly available about who has coverage. Doctors, McCaughan said, described coverage as a needle in a haystack. “It’s like, ‘Yes, I know there’s some coverage out there, but I have no idea how to find it.’”
Low or difficult-to-identify access very quickly morphed into no access. “Very often we were met with physicians saying, ‘It’s just not worth it. I don’t have the time and I don’t have the staff,’” she recalled.
Toss out the playbook
The attention on the new obesity treatment meant Novo needed to strengthen its communications muscle. But nothing could prepare the marketers for how Wegovy’s launch would turn much of their usual medical marketing playbook on its head.
On the HCP side, McCaughan says her number-one tool involves targeting and segmenting HCPs in order to get the right message to the right people. However, there are just a handful of obesity specialists in the country: At the time of launch, most patients were treated by a quiltwork of different physicians, from the realms of pain management and primary care to psychiatry and cardiology.
“It was almost impossible to predict which ones of these specialties were going to be interested in actually writing [a prescription],” McCaughan noted. “So very quickly, we found out that [this] trusted internal marketing tool was not going to be the most important thing for us to do.”
With the help of Wegovy agency of record ConcentricLife, the team set about developing a messaging platform that spanned multiple specialties. Honing the communications was an 18-month process.Big changes were in store on the DTC side, too, given the spotty coverage situation.
“Everyone is familiar with the last line in just about every single TV spot, which is ‘Talk to your healthcare provider,’” said Szymanski. “We thought, ‘If we send everybody in very excited, finally having the courage to have this conversation and ask for a medicine, a large majority of them are going to be very disappointed because they don’t have coverage, but they don’t know that.”
The team ultimately decided to ditch “talk to your doctor” and pivot the last line of its commercials to “check your cost and coverage before talking to a healthcare provider.”
“This was not something we had done before,” Szymanski said. “We talked about it. We said, ‘Listen, we’re trying to help patients and healthcare providers do what’s best for the patient. So how can we enable that in meaningful ways?’ And so this was a big shift in how we operated and how we continue to roll.”
This was anathema for healthcare marketers, whose job is to drive demand into doctor’s offices. Nevertheless, Wegovy ended up joining sister drug Ozempic on the drug-shortage list. So how did demand end up completely outstripping supply?
The first week
From day one of the Wegovy launch, the uptake curve was unlike anything ever seen with any of the company’s previous therapies. It made for some memorable scenes at Novo HQ.
“Not in my wildest dreams did I think that we were going to see what we were seeing,” recalled McCaughan. “We were looking at each other and we were like, ‘Ooh, did we actually break through?’‘Is this going to be the tipping point where people understand it?’ And then the second week, we’re like, ‘Yep, this is going to break.’ The third week is when we started saying, ‘That curve is going to have to break at some point – right?’ And it just didn’t.”
Sales reps used to have to beg doctors to agree to see them to talk about obesity. “All of a sudden, their cell phones were ringing off the hook,” said McCaughan.
She joked that she really knew she had arrived when her 14-year-old daughter came bounding down the stairs one morning with an important update. “‘Mom, mom, you made it!’” she squealed. “And I went, ‘I’ve made it. That’s fantastic. How did I make it?’ She goes, ‘Wegovy is on TikTok.’ I’m like, ‘Wow, okay. That’s how I made it?’”
But the uptake curve and the social media popularity were not only signs of mainstream recognition. They signaled the kind of demand that could trigger a major supply crunch — and that’s exactly what happened.
Szymanski and McCaughan were about to embark on the second phase of the launch, with plans to roll out more resources to patients and healthcare providers, when the first reports of shortages started coming in.
What ensued was an epic supply struggle that forced Novo to do the unthinkable: Cease commercial activities to tamp down on demand. In 2022, the company wound up putting some aspects of the brand’s marketing on ice.
The drugmaker said it gained the upper hand on supply, but it was short-lived. Last May, Novo began reducing supply of the lowest three doses of Wegovy as a way to limit new patient starts. Recent efforts to boost production included buying three of Catalent’s fill-finish sites.
The company also said it has invested $9.5 billion in expanding and building new production facilities in Denmark and France. Existing factories, meanwhile, are running 24 hours a day, 7 days a week.
But there’s still a lag on manufacturing and shortages persist. Earlier this year, the company acknowledged that it won’t be able to completely meet GLP-1 demand for the foreseeable future. Meanwhile, Wegovy faces competition from recently introduced Zepbound, sold by rival Eli Lilly.
‘Please don’t start’
This may well have been the most counterintuitive aspect of the Wegovy launch. “As marketers, you’re kind of wired to drive more demand and awareness,” Vishalpura explained. “We have to step back to say, ‘Actually we might need to dampen demand.’ I can’t think of any other case in our industry where we’ve had to say, ‘Please don’t start new patients. We want to protect the ones who are already on the treatment.’”
There was no internal department set up for product supply challenges within the company, so the communications and marketing teams mobilized people across the company. As they conveyed these messages, the team endeavored to be as transparent as possible.
“We knew that a lot of people were counting on us, those that had started our medicines and those that wanted to start our medicines,’ said Szymanski. “Whether we had good news, bad news, no news, we communicated as often, as quickly and as completely as possible.”
The team also sought to regain trust among doctors and sales reps.
“There’s no doubt about the fact that we lost some trust with our customers,” McCaughan conceded. “They have been waiting for this. They had patients coming in. There were doctors setting up office hours on Saturdays just to deal with demand of patients coming in asking for this, and then we couldn’t deliver.”
The reps, for their part, were navigating uncharted territory and did the best they could to provide solutions to doctors given the supply environment.
Hunger game
Once reps finally dropped in on those offices, the message was one the clinicians didn’t want to hear. “We tried to tell our reps, ‘Please go out and tell healthcare providers not to write,’” said McCaughan.
To physicians, it seemed like a hunger game of who got to write and who didn’t. That led to another new problem: disgruntled doctors. McCaughan recalled some very frank — and tense — conversations with the field force.
As Novo continues to grapple with issues like counterfeit compounded medicines, social media misinformation and scarcity, it is trying to move into a different chapter. The marketers are leveraging the transparency, trust and agility they gained over the last three years as they write the brand’s story anew.
Current ad campaign “Believe On” speaks to HCPs and consumers, with access information front and center. The marketing also reflects the cultural shift that has taken place.
Indeed, there’s been a philosophical sea change since 2021, when weight loss was seen as the single component of obesity. Now there’s a recognition that the disease has genetic and systemic underpinnings. The tone has shifted as well, to one of hope.
Sea change
Asked what stands out most to them when they think about Wegovy’s societal impact, team members pointed to a handful of milestones. Things took a big leap forward in early March when the FDA approved a label expansion for Wegovy to be used as a treatment in heart disease. A week later, the Centers for Medicare and Medicaid Services announced that, in privately administered Part D plans, the agency will allow insurers to cover Wegovy for people who are obese or overweight and have a history of cardiovascular disease.
Given that obesity medications have been barred by law from coverage since the establishment of Part D in 2006, that was a huge turnabout. Several plans have already agreed on initiating coverage.
“That was the moment I think all of us at Novo Nordisk looked at each other for a second and went, ‘We’ve been part of a true societal change,’” McCaughan said.
Between the FDA and CMS regulatory events, Oprah Winfrey aired a primetime special during which she emphasized that weight loss is not about willpower but starts in the brain. Prior to the special, Oprah stepped down from the WeightWatchers board and revealed that she is using an anti-obesity drug.
Oprah’s attention was a sure sign that the new obesity narrative had reached pop culture zenith. After battling weight for 40 years, her choice became clear: Why count calories when it’s possible to quiet the internal voice saying “Eat more”?
It’s a decision scores of other people seem to be making. It’s possible now owing to the more efficacious medicines.
“You can feel the release of the stigma in newer conversations that are allowing people to just be, and to seek the healthcare that they want and deserve,” Szymanski said. “Wegovy served as the tipping point to open up these conversations in ways that, frankly, they should be opened up.”
Vishalpura compared the interest Wegovy sparked in obesity to the attention Lilly’s Prozac and Pfizer’s Viagra focused on depression and erectile dysfunction, respectively.
“Wegovy unleashed and ignited a dynamic among people living with obesity, going from kind of the shadows to seeking and getting attention and visibility,” Vishalpura said. “That was incredibly exciting for all of us.”
This story has been updated.
