Most of you know me because of On The Pen. You know the guy reading clinical trials, digging through FDA documents, talking about GLP-1s and occasionally yelling into a microphone about something the pharmaceutical or compounding industry did that morning. But you probably don’t know how any of this actually started, and honestly, it’s a pretty cool story.

WATCH THE FULL STORY HERE

Just a few short years ago, I wasn’t working in healthcare, media or anything remotely adjacent to either of them. I was selling traffic signals. I had a job I was good at, a career I genuinely enjoyed, a wife and four kids depending on me, and absolutely no grand plan to become a podcaster. Then I was diagnosed with type 2 diabetes.

That diagnosis eventually led me to Mounjaro. Mounjaro led me down a rabbit hole of trying to understand what these medications were actually doing inside the body beyond these massive weight loss stories that were starting to emerge in the social media world. When I couldn’t find people explaining the science in a way that made sense to me as a patient, I started talking about it myself. That little decision eventually became On The Pen.

But that is only the surface-level version of the story. Recently, Amy Wienands invited me onto You Are More, a podcast I have listened to and loved for years, and she asked me questions that forced me to go much deeper than I normally do when people ask how On The Pen started.

We talked about my dad, including the last conversation I had with him just three days before he unexpectedly died. We talked about spending nearly a decade in a career I somehow knew was a stepping stone, while having absolutely no idea where the next stone was. And we talked about the moment when staying comfortable finally became harder than stepping into the unknown.

We also talked about what has happened since. There have been some incredible moments over the last couple of years, but there have also been moments when this entire thing felt much more fragile than it probably looked from the outside. In fact, I told Amy a story from just the past few months about the new On The Pen studio, losing our largest sponsor at almost exactly the wrong time, needing to suddenly come up with a significant amount of money, and my wife showing up at my office with our four kids because they knew Dad was stressed.

They didn’t come with a check. They came to pray. What happened next is one of those stories I hope my kids remember long after they or the world has forgotten what On The Pen is.

This conversation is probably the most personal explanation I’ve ever given of how I ended up here. It’s about On The Pen, but it’s also about my dad, my wife, my kids, fear, comfort, calling, and learning that sometimes stepping out in faith still feels an awful lot like stepping out in fear.

Most importantly, it’s about looking backward and realizing that some of the seasons of your life that made the least sense while you were living them were preparing you for something you couldn’t see yet.

I don’t know what the next chapter of On The Pen looks like. But after this conversation with Amy, I’m more convinced than ever that I don’t necessarily need to. I hope you’ll watch this one.

For years, American Wegovy patients have been using a remarkably inflexible delivery system for a disease that is anything but predictable. One dose comes in one pen, you inject it once, and then the entire device goes into the trash. If your prescribed dose is 2.4 mg, that pen delivers 2.4 mg. There has been very little flexibility built into the hardware itself.

That may be about to change. On The Pen has now verified with multiple credible sources that Novo Nordisk is preparing to launch the Wegovy FlexTouch pen for the 2.4 mg dose in the United States in the coming weeks.

A few months ago, we noted that the moves were being made with the FDA that could potentially set the stage for this launch. Novo Nordisk has now secured that approval for a U.S. Wegovy FlexTouch presentation containing 9.6 mg of semaglutide in 3 mL, with a single pen intended to deliver four labeled doses of 2.4 mg. The question is when patients will actually begin seeing it at pharmacies, and my sources tell me that answer is soon.

What exactly is changing?

Most Americans currently know injectable Wegovy as a box containing four disposable pens. Each pen is used for one injection and then discarded. The new FlexTouch presentation fundamentally changes that experience because one pen contains four weekly 2.4 mg doses, with disposable needles changed between injections.

If the device sounds familiar, there is a reason. FlexTouch is the same general multi-dose pen platform Americans have already seen used with Novo Nordisk products such as Ozempic. Instead of opening a new complete injection device every week, patients keep the same pen and attach a new needle for each dose.

From a convenience and waste standpoint alone, that is a meaningful change. Instead of four complete pens filling a refrigerator and eventually a trash can, a patient would use one pen over approximately four weeks.

But I also know exactly where the conversation around this is going to go, because patients are going to look at this device and immediately ask whether it means Wegovy dosing is about to become more flexible.

Why only the 2.4 mg dose?

Sources familiar with the upcoming rollout tell On The Pen that this launch will apply specifically to the 2.4 mg Wegovy dose. At least initially, the lower Wegovy strengths are not expected to be part of the FlexTouch launch in the United States.

That actually makes commercial sense. The 2.4 mg dose has historically been the primary maintenance dose for Wegovy, meaning patients who successfully titrate to it may remain there for a prolonged period of time. A four-dose reusable pen format is particularly well suited to that phase of treatment.

The FDA labeling supports exactly that configuration. The FlexTouch presentation contains 9.6 mg of semaglutide in 3 mL and is designed around four weekly 2.4 mg doses, while the familiar single-dose Wegovy presentations remain part of the product lineup.

In other words, this does not appear to be an immediate wholesale replacement of every Wegovy pen currently sold in America. It looks much more like Novo is starting with the maintenance dose, via the cash pay channel, which is the most logical place to begin for a number of reasons.

Then there is the money

This is where the story could become much more interesting. Novo Nordisk has been increasingly aggressive with direct-to-patient and self-pay pricing as the competition for obesity patients has intensified, and the introduction of a four-dose FlexTouch pen adds another variable to that strategy.

The most obvious patient question will be whether the FlexTouch presentation is priced and discounted exactly like the existing box. Theoretically, a physician may elect to prescribe the higher dose flexible pen, and give patients using lower doses a pathway to refill their medication less often. Of course this would go against the label and package insert, but we all know it will happen.

The coolest part? Novo doesn’t have a 45 day refill requirement like Eli Lilly does.

Cheers,

DK

Late to the party, no worries, you can watch the replay on-demand by clicking the video!

-DK

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This may be one of the most important obesity papers published all year. Not because it introduces a new drug, but because it challenges one of the biggest assumptions in obesity medicine. For years, many experts have pushed back on the idea that people with obesity could be “GLP-1 deficient.” This new research suggests they may have been asking the wrong question. One of the biggest themes we’ve explored together recently is that obesity isn’t one disease. It’s a family of diseases, each driven by different biology. If that’s true, different patients shouldn’t just respond differently to treatment. They should need different treatments.

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