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[159.112.244.9]) by mx.google.com with UTF8SMTPS id 6a1803df08f44-89c6ba07c25si45213186d6.373.2026.03.18.15.27.38 for (version=TLS1_2 cipher=ECDHE-ECDSA-AES128-GCM-SHA256 bits=128/128); Wed, 18 Mar 2026 15:27:38 -0700 (PDT) Received-SPF: pass (google.com: domain of bounce+91e48a.63af5d-tjphuhs=gmail.com@mg-d0.substack.com designates 159.112.244.9 as permitted sender) client-ip=159.112.244.9; Authentication-Results: mx.google.com; dkim=pass header.i=@mg-d0.substack.com header.s=mailo header.b=ukoHKl2M; dkim=pass header.i=@mailgun.org header.s=mg header.b="X/MpKOJT"; spf=pass (google.com: domain of bounce+91e48a.63af5d-tjphuhs=gmail.com@mg-d0.substack.com designates 159.112.244.9 as permitted sender) smtp.mailfrom="bounce+91e48a.63af5d-tjphuhs=gmail.com@mg-d0.substack.com"; dmarc=pass (p=REJECT sp=REJECT dis=NONE) header.from=substack.com DKIM-Signature: a=rsa-sha256; v=1; c=relaxed/relaxed; d=mg-d0.substack.com; q=dns/txt; s=mailo; t=1773872858; x=1773880058; h=List-Unsubscribe-Post: List-Unsubscribe: List-Post: List-Id: List-Archive: List-Owner: Reply-To: In-Reply-To: References: Sender: Sender: Date: Message-Id: To: To: From: From: Subject: Subject: Content-Type: Mime-Version: X-Feedback-Id; bh=5+EZFF0NHyJkB28ClRCt9QdLgbhoMxdwswsHt5LLFyM=; b=ukoHKl2MjPMUynxl+3tmZGt5eFhIPz5zgv4pjebU6iQLbg8f5t8sBv7Tpo42Abk6oW6evJeco4sezcfgkc/rMQ7+7X7ZE5QlDLolS2e5swtcv/befzKBT1cqWmYO8G59QROt1+zj7YYEjZKAVbsdZEvpTbrCWOaSc6FNi28qAeI= DKIM-Signature: a=rsa-sha256; v=1; c=relaxed/relaxed; d=mailgun.org; q=dns/txt; s=mg; t=1773872858; x=1773880058; h=List-Unsubscribe-Post: List-Unsubscribe: List-Post: List-Id: List-Archive: List-Owner: Reply-To: In-Reply-To: References: Sender: Sender: Date: Message-Id: To: To: From: From: Subject: Subject: Content-Type: Mime-Version: X-Feedback-Id; bh=5+EZFF0NHyJkB28ClRCt9QdLgbhoMxdwswsHt5LLFyM=; b=X/MpKOJTlSqVDHa8NoQjvt0eHflSIueWD89loXSaFk3IYXotWdCIcCHlagxgA6wDe1zy9+8X884/2HgOBwNaJa0EHZxYRSCHUO16lGwNGjN7CjU/Tg72RFnn8adSG4quqQTnKJ145aJbwiem8d8e0bDpTNZAVBur6FNb0Q2Y2Oc= X-Mailgun-Sid: WyJkZWU4NyIsInRqcGh1aHNAZ21haWwuY29tIiwiNjNhZjVkIl0= X-Feedback-Id: postmaster@mg-d0.substack.com:post:6148c7d8a45790427cda307f:mailgun Received: by 2578e3f30a091904c65a0838141ab1f761baab9390f916256066563fe8ec8bc7 with HTTP id 69bb26da257cb0394ebee380; Wed, 18 Mar 2026 22:27:38 GMT X-Mailgun-Sending-Ip: 159.112.244.9 Mime-Version: 1.0 Content-Type: multipart/alternative; boundary="a8bbe427cdaa24e58183169b08896b99123ca519065db09b6507635444b6" Subject: The GLP-1 Moment Is Breaking the Healthcare System Wide Open From: Dave Knapp from On The Pen To: tjphuhs@gmail.com X-Mailgun-Tag: post X-Mailgun-Track-Clicks: false Message-Id: <20260318222727.3.fc144593e29ba4d0@mg-d0.substack.com> Date: Wed, 18 Mar 2026 22:27:27 +0000 Feedback-Id: post-191421394:cat-post:pub-4808993:substack Sender: Dave Knapp from On The Pen References: In-Reply-To: Reply-To: Dave Knapp from On The Pen List-Owner: List-Url: List-Archive: List-Id: List-Post: List-Unsubscribe: List-Unsubscribe-Post: List-Unsubscribe=One-Click X-Mailgun-Variables: {"category": "post", "email_generated_at": "1773872858001", "is_freemail": "true", "post_audience": "everyone", "post_id": "191421394", "post_type": "newsletter", "pub_community_enabled": "true", "publication_id": "4808993", "subdomain": "onthepen", "user_id": "273622398"} --a8bbe427cdaa24e58183169b08896b99123ca519065db09b6507635444b6 Content-Type: text/plain; charset="utf-8" Content-Transfer-Encoding: quoted-printable View this post on the web at https://onthepen.substack.com/p/the-glp-1-mome= nt-is-breaking-the I=E2=80=99ve said this a number of times, but it keeps proving itself out. = GLP-1 medications are not just transforming lives, they=E2=80=99re transfor= ming our healthcare system in a way we haven=E2=80=99t seen in decades, and= it=E2=80=99s happening faster than most people realize. What started as a shortage story, and one that On The Pen covered closely, = turned into something far more transformational. Mass compounding stepped i= n and ultimately introduced real competition, which didn=E2=80=99t just exp= and access, it exposed how the system actually functions when it=E2=80=99s = under strain. That moment revealed just how dependent access is on a very s= pecific structure that most patients never see, and previously, never cared= to see. At the same time, there are parallel forces building around this. Trump RX = is no longer just a policy idea, it is being implemented, with most major U= S drug manufacturers now participating in some form. Alongside that, Mark C= uban=E2=80=99s Cost Plus Drug Company continues to challenge traditional pr= icing and distribution with a more transparent model. These developments ma= y look separate, but they are all applying pressure to the same system at t= he same time. None of this is happening in isolation, and that=E2=80=99s what makes this = moment so interesting. We are starting to see the early stages of what look= s like direct to consumer pharma, where the path from patient to provider t= o medication becomes more direct, with fewer intermediaries involved. As that shift begins to take shape, it raises bigger questions around acces= s, pricing, and who the system is ultimately designed to serve. GLP-1 medic= ations are not only changing outcomes for patients, they are exposing the u= nderlying structure of healthcare to the masses. The reason is simple, so m= any people need these medications and so many have been denied access for o= ne reason or another. The demand is so strong that people are now engaging = with the system in a way they never have before, starting to untangle what = has long felt like an impenetrable web. It=E2=80=99s a rare moment, and a r= are opportunity. At the same time, what these medications are doing at the = individual level is just as profound. They are increasingly looking like lo= ngevity drugs, fewer heart attacks and strokes, less inflammation, reduced = cancer risk signals, meaningful diabetes improvement, and the list keeps gr= owing. The impact of that alone is massively transformative and cannot be o= verstated. I=E2=80=99ve been digging into this more in recent conversations, and I=E2= =80=99m curious how others are thinking about it. Are we looking at a tempo= rary disruption, or the early stages of a permanent shift in both how we ac= cess care and how we think about long term health? Unsubscribe https://substack.com/redirect/2/eyJlIjoiaHR0cHM6Ly9vbnRoZXBlbi5= zdWJzdGFjay5jb20vYWN0aW9uL2Rpc2FibGVfZW1haWw_dG9rZW49ZXlKMWMyVnlYMmxrSWpveU= 56TTJNakl6T1Rnc0luQnZjM1JmYVdRaU9qRTVNVFF5TVRNNU5Dd2lhV0YwSWpveE56Y3pPRGN5T= 0RVM0xDSmxlSEFpT2pFNE1EVTBNRGc0TlRjc0ltbHpjeUk2SW5CMVlpMDBPREE0T1Rreklpd2lj= M1ZpSWpvaVpHbHpZV0pzWlY5bGJXRnBiQ0o5LjJ6VzlFemZBOERSeFlVR1FSNlFXVnN1Yk9PZXV= FT3lZcUhVTHc2OGVvVmciLCJwIjoxOTE0MjEzOTQsInMiOjQ4MDg5OTMsImYiOnRydWUsInUiOj= I3MzYyMjM5OCwiaWF0IjoxNzczODcyODU3LCJleHAiOjIwODk0NDg4NTcsImlzcyI6InB1Yi0wI= iwic3ViIjoibGluay1yZWRpcmVjdCJ9.OgsAcTInJGsyi3vqTN2aVdmI4moM49e1I6bErW3bTEw= ? --a8bbe427cdaa24e58183169b08896b99123ca519065db09b6507635444b6 Content-Type: text/html; charset="utf-8" Content-Transfer-Encoding: quoted-printable The GLP-1 Moment Is Brea= king the Healthcare System Wide Open3D""
I’ve said this a number of times, but it keeps proving itself= out.
͏     ­͏     ­͏  = ;   ­͏     ­͏     ­= 47;     ­͏     ­͏     = ­͏     ­͏     ­͏  =   ­͏     ­͏     ­T= 7;     ­͏     ­͏     &= #173;͏     ­͏     ­͏   =   ­͏     ­͏     ­͏= ;     ­͏     ­͏     &#= 173;͏     ­͏     ­͏   &= #8199; ­͏     ­͏     ­͏=     ­͏     ­͏     = 73;͏     ­͏     ­͏   &#= 8199; ­͏     ­͏     ­͏ =     ­͏     ­͏     = 3;͏     ­͏     ­͏   = 199; ­͏     ­͏     ­͏ &= nbsp;   ­͏     ­͏     ­= ;͏     ­͏     ­͏   Q= 99; ­͏     ­͏     ­͏ &n= bsp;   ­͏     ­͏     ­= ͏     ­͏     ­͏   ̳= 9; ­͏     ­͏     ­͏ &nb= sp;   ­͏     ­͏     ­&= #847;     ­͏     ­͏    = ; ­͏     ­͏     ­͏ &nbs= p;   ­͏     ­͏     ­&#= 847;     ­͏     ­͏    = ­͏     ­͏     ­͏  = ;   ­͏     ­͏     ­= 47;     ­͏     ­͏     = ­͏     ­͏     ­͏  =   ­͏     ­͏     ­T= 7;     ­͏     ­͏     &= #173;͏     ­͏     ­͏   =   ­͏     ­͏     ­͏= ;     ­͏     ­͏     &#= 173;͏     ­͏     ­͏   &= #8199; ­͏     ­͏     ­͏=     ­͏     ­͏     = 73;͏     ­͏     ­͏   &#= 8199; ­͏     ­͏     ­͏ =     ­͏     ­͏     = 3;͏     ­͏     ­͏   = 199; ­͏     ­͏     ­͏ &= nbsp;   ­͏     ­͏     ­= ;͏     ­͏     ­͏   Q= 99; ­͏     ­͏     ­͏ &n= bsp;   ­͏     ­͏     ­= ͏     ­͏     ­͏   ̳= 9; ­͏     ­͏     ­͏ &nb= sp;   ­͏     ­͏     ­&= #847;     ­͏     ­͏    = ; ­͏     ­͏     ­͏ &nbs= p;   ­͏     ­͏     ­&#= 847;     ­͏     ­͏    = ­͏     ­͏     ­͏  = ;   ­͏     ­͏     ­= 47;     ­͏     ­͏     = ­͏     ­͏     ­͏  =   ­͏     ­͏     ­T= 7;     ­͏     ­͏     &= #173;͏     ­͏     ­͏   =   ­͏     ­͏     ­͏= ;     ­͏     ­͏     &#= 173;͏     ­͏     ­͏   &= #8199; ­͏     ­͏     ­͏=     ­͏     ­͏     = 73;͏     ­͏     ­͏   &#= 8199; ­͏     ­͏     ­͏ =     ­͏     ­͏     = 3;͏     ­͏     ­͏   = 199; ­͏     ­͏     ­͏ &= nbsp;   ­͏     ­͏     ­= ;͏     ­͏     ­
Forwarded this email? Su= bscribe here for more

The GLP-1 Moment Is Breaking the Healthcare Sy= stem Wide Open

<= /tr>
On The Pen GLP-1 News
 
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<= table role=3D"presentation" width=3D"38" border=3D"0" cellspacing=3D"0" cel= lpadding=3D"0">
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READ IN APP3D""
 
=

I’ve said this a number of times, but it k= eeps proving itself out. GLP-1 medications are not just transforming lives,= they’re transforming our healthcare system in a way we haven’t= seen in decades, and it’s happening faster than most people realize.=

What started as a shortage story, and one that On The Pen = covered closely, turned into something far more transformational. Mass comp= ounding stepped in and ultimately introduced real competition, which didn&#= 8217;t just expand access, it exposed how the system actually functions whe= n it’s under strain. That moment revealed just how dependent access i= s on a very specific structure that most patients never see, and previously= , never cared to see.

<= span style=3D"color: #ffffff;text-decoration: none;">Subscribe

At the same time, there are parallel forces building around = this. Trump RX is no longer just a policy idea, it is being implemented, wi= th most major US drug manufacturers now participating in some form. Alongsi= de that, Mark Cuban’s Cost Plus Drug Company continues to challenge t= raditional pricing and distribution with a more transparent model. These de= velopments may look separate, but they are all applying pressure to the sam= e system at the same time.

None of this is happening in iso= lation, and that’s what makes this moment so interesting. We are star= ting to see the early stages of what looks like direct to consumer pharma, = where the path from patient to provider to medication becomes more direct, = with fewer intermediaries involved.

As that shift begins to= take shape, it raises bigger questions around access, pricing, and who the= system is ultimately designed to serve. GLP-1 medications are not only cha= nging outcomes for patients, they are exposing the underlying structure of = healthcare to the masses. The reason is simple, so many people need these m= edications and so many have been denied access for one reason or another. T= he demand is so strong that people are now engaging with the system in a wa= y they never have before, starting to untangle what has long felt like an i= mpenetrable web. It’s a rare moment, and a rare opportunity. At the s= ame time, what these medications are doing at the individual level is just = as profound. They are increasingly looking like longevity drugs, fewer hear= t attacks and strokes, less inflammation, reduced cancer risk signals, mean= ingful diabetes improvement, and the list keeps growing. The impact of that= alone is massively transformative and cannot be overstated.

I’ve been digging into this more in recent convers= ations, and I’m curious how others are thinking about it. Are we look= ing at a temporary disruption, or the early stages of a permanent shift in = both how we access care and how we think about long term health?

<= /div>

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