Novo v Hims: We’ve Only Just Begun

Last week was the first time I didn’t send a newsletter since I started Drugstore Cowboy last May.

I’ve been “lucky” over the past year that seemingly every week there is something in healthcare to talk about. Last week was no different, but I couldn’t quite figure out what to make of it. And I’m not someone to talk just for the sake of talking. I needed time to process the news and understand what it actually meant.

If you’ve been reading this newsletter, you know I’ve been closely tracking the ongoing battle between Novo Nordisk and Hims for months now. It’s one of the most important stories in American healthcare.

And for a brief moment last week, it looked like that fight might be coming to an end.

Breaking News: It’s not.

Before we get into what just happened, it’s worth taking a step back for those just joining us. To my longtime readers, you’ve heard this before, but it doesn’t hurt to reset the board.

This entire story exists because of one very specific loophole.

When GLP-1 drugs like Ozempic and Wegovy went into shortage a few years ago, compounding pharmacies were allowed to step in and make their own versions to meet demand. That’s how the law is written. It’s a practical solution to a real problem.

But like most things in American healthcare, what started as a narrow exception turned into something much bigger.

Telehealth companies—Hims being the most prominent—built entire businesses around that loophole. They weren’t just filling occasional gaps in supply. They were marketing, scaling, and distributing compounded versions of these drugs directly to consumers.

Novo Nordisk (and Eli Lilly), understandably, did not like that.

So they did what drug companies do when their core product is threatened.

They pressured. And eventually, they sued—multiple different ways. Last month, I wrote about Novo escalating to patent infringement claims.

That lawsuit mattered. Not just for these two companies, but for what it represented:

A real test of whether FDA approval and drug patents still carry weight in a world where telehealth and compounding can move faster than regulation.

That’s the backdrop.

Now fast forward to last week.

Out of nowhere, Novo and Hims announced a new agreement.

The basic structure was simple:

Hims would begin offering Novo’s FDA-approved GLP-1 drugs directly through its platform. Patients could access the branded product instead of compounded alternatives, using Hims as the front-end experience.

Hims also agreed—in theory—to wind down its sales of compounded GLP-1s and stop actively promoting them to customers.

In return, Novo dropped its patent infringement lawsuit.

On paper, it made sense.

Hims gets legitimacy and the lawsuit off its back.
Novo gets distribution through a platform that clearly understands demand.
Patients get access to an FDA-approved product.

If that were the whole story, it would be a clean resolution.

But it wasn’t.

Because the obvious missing piece was compounding.

The entire conflict between these companies has been about compounded semaglutide. That’s the tension. That’s the money. That’s the reason we’re here in the first place.

And yet, when you looked closely at the agreement, the language around compounding was vague.

No clear statement that Hims would stop.
No firm timeline.
No real enforcement mechanism.

Just… ambiguity.

And we’ve already been down this road.

Almost exactly a year ago, these companies had a similar agreement. It fell apart within a month when Hims didn’t stick to its word on compound sales.

So the obvious question:

Why would this time be any different?

The more I thought about it, the less it added up.

If this deal was supposed to end the conflict, it didn’t actually resolve the core issue.

Hims has spent the last two years building a business around compounded GLP-1s. That’s not a side project. That’s infrastructure, supply chain, marketing, and revenue.

They invested heavily in compounding capacity. They acquired facilities. They leaned into the model.

Companies don’t just walk away from that level of investment.

At the same time, Novo had a lawsuit on the table that many people—including me—thought had a real chance to clarify the rules here and end this debate for good.

So stepping away from that process, without a clear resolution, raised an obvious question:

Why?

If the case was strong, why not see it through?
If the goal was to stop compounding, why not lock that in?

Instead, what we got felt like a temporary alignment.

Not a solution.

A cease-fire—at a moment when both companies had every incentive to stabilize their tanking stock prices.

A few days later, we got the next development.

Novo released new data from an in-depth study highlighting the risks associated with compounded semaglutide—raising concerns about quality, dosing consistency, and overall safety.

You can read one analysis of that report here.

In summary, the findings are hard to ignore.

In some cases, the semaglutide being used by compounding pharmacies wasn’t as pure as advertised. In others, it may not have even been the same drug.

This wasn’t a minor update.

It was a clear escalation.

Novo shifted the conversation away from business and legal arguments and toward something much more fundamental:

Are these products safe to be on the market at all?

That’s a different fight.

Instead of debating contracts and partnerships, they’re now building a case that compounded GLP-1s introduce variability and risk that patients don’t fully understand—and that the FDA has a responsibility to step in.

And importantly, they’re making that case in public.

Not to a judge, but to the people. The Court of Public Opinion is the great equalizer.

When you put these two events together—the agreement and the report—the picture becomes clearer.

The deal didn’t end the conflict.

It changed the way the conflict is being fought.

The lawsuit was one path.

Public pressure, regulatory influence, and safety arguments are another.

Novo has now entered the chat on multiple fronts.

And the timing isn’t an accident.

If the agreement created the impression that things were cooling off, the report immediately corrected that.

So here’s the current state of play:

Hims is now partnered with Novo to sell FDA-approved GLP-1s.

At the same time, there is no clear indication that compounding disappears from their business.

Novo has stepped back from a pure legal strategy and is now pushing a broader safety narrative.

And the underlying issue—the existence of a large, fast-growing market for compounded versions of these drugs—has not been resolved.

Nothing about that says “finished.”

If you’ve been following this story, you can probably see what happens from here.

Novo threw the most recent punch.

Now we wait to see how Hims responds.

Because there is no doubt they will hit back.

There’s too much money involved.
Too much demand.
Too many unanswered questions.

I skipped last week’s letter because I didn’t think the story made sense yet.

Now it’s starting to.

And if anything, it’s becoming clear that this was never going to end with a single deal.

We’re just watching the next phase play out.

We’ve only just begun.

Giddy up.

Alec Wade Ginsberg, PharmD, RPh
4th-Gen Pharmacist | Owner & COO, C.O. Bigelow
Founder, Drugstore Cowboy