TJ Parker: Hims' compounded GLP-1 pill is a 'financial hail Mary' with no evidence it works — and Trump Rx is the real deal

identifies a number of these uh these sort of bizarre scenarios. So, we'll dig into it quickly.

Let me tell you about Sentry. Sentry shows developers what's broken and helps them fix it fast. That's why 150,000 organizations use it to keep their apps working. And without further ado, let's bring in TJ Parker

to the TVP Ultradom. Welcome to the show. How are you doing?

I am great. How are you?

I'm good. Uh complicated day in the news. Where should we start first? What? What? What story?

Air cooled Porsches.

Air cooled Porsches. Are they still cool in the age of AI or am I going to be able to vibe code one?

I think uh they're going to be cooler in the age of

There we go.

I like it.

Yeah. What about in healthcare?

Yeah. Big big week. Uh want to talk about Let's just jump straight into the the WGO Nova Nordis hymns drama. What uh

what's been your reaction? How have you been tracking the story up until this week? all that good stuff.

Yeah. I think maybe to jump back to how we got here and I think folks are probably pretty familiar with this, but the hymns of the world were obviously compounding the injectable for quite a long time. Um, but the origination of that was that those injectables were in short order. or they were on back order and so they were allowed to compound them as a stop gap for the manufacturers to get sufficient supply

and that was basically real in the early early phases of this right and

important because if someone's overweight and they want to lose weight quickly being overweight is dangerous healthy not not good for your lifespan all

so that's why the FDA is set up in that way but the question is like how long does that go

basically hims got addicted to compounding

yeah and that was maybe call it 18 months ago or so where that was kind of that peaked and then uh the FDA did issue a warning letter to HIMS back in the fall when the shortage ended telling them to stop mass compounding. So they have commented on this before but their level of enforcement has been lacking.

Mhm. Um, I think the stark difference with what happened yesterday is that the WGOI pill has a specific technology called snack that they actually paid $2 billion for the IP specifically for that technology to allow for you to be able to actually absorb the peptide and have the drug be effective. And HIMS explicitly has stated they didn't use that technology. Instead, they're using liposomaal absorption, which it maybe works, maybe it doesn't, but there's certainly not just like insane It's You're insane. You're selling a a a drug that you claim works that has no

like

approval testing,

right? Is this zero studies, zero approvals? So, this is where it's super different from the injectables where

they weren't changing the formulation, right? It was very similar to the branded drug.

We can talk about the challenges of IP and a bunch of things, but it's different in the sense that here there's no evidence that this drug works at all. And so the most likely scenario is they're selling a, you know, a $50 drug that doesn't work that still has a bunch of side effects because it still has the drug that just doesn't get absorbed through your GI. So it's it's it's very different. It's not an IP issue. It's really an efficacy and and safety issue, which is why I think you saw the FDA come out much faster and a much more explicit way pretty immediately after the launch yesterday. Why would hymns do something that seems completely nonsensical and bad for patients and bad?

Well, I I have a quote here from them. Uh, compounding is a safe, legal, and long recognized practice within the American health care system. So, that's their stance.

Okay. but ignoring the fact that they're inventing a new delivery mechanism via liposomaal for

and are selling it as a product claiming

that's why they're getting push back. Yeah.

Yeah. I mean I think the situation is you have a $5 billion market cap company

where half of their revenue is these compounded GLP ones where that market is quickly contracting on them. They're doing a bunch of buybacks. They've invested a ton in incremental capex. It's like a recipe for disaster if that revenue starts to fall away.

Um, and it feels

do they think the pill the pill is just going to do they is the expectation that the pill is going to effectively eat the injectable market because a lot of people would rather take a pill than you know you know have have to do injection even if it's once a week.

Yeah. I think if you look at the archetype of who I believe to be the HIMS customer, they're buying the injectable because it was the cheapest place to get it. now you have a branded drug that's half the price of their injectable. Like I think it's partially the the route of administration. I think partially that it's just half the price.

Um and so it's it's hard to imagine that they're not going to have a significant issue with churn

and people switching from the injectable. Partially yeah because of the the ease of use but also just literally half the price which was their entire value prop

prior to Novo is not expecting are they able to mass produce this already? Like are they

they have no shortage issues? is they've been ramping up production for quite some time.

Um I think they were quite prepared for the launch and so you have none of the shortage dynamics and frankly like pills are exponentially easier to manufacture than than their injectable pen specifically which is where the shortages came from.

Y

um so there's no similar rationale. I think it's also comparatively reasonable that you don't want to force a bunch of patients off the injectable product. So there is like a reasonable safety argument that that has to be like a very

thoughtful and calculated wind down. Now I think they've uh they're onboarding new customers that doesn't totally hold water compared to the behavior. Um but in this instance it feels more like a financial hailm given I think what the market dynamics are going to do to them over the next 12 months.

What about the alternative scenario or playbook? like I remember HIMS as being sort of like a front end to uh drugs that they didn't compound and it was a place to get hair loss medication and and sort of name brand drugs that I felt like just it was online pharmacy like why doesn't that model work in the age of peptides and GLP1s? Why can't you just be the the you know the digital doctor that prescribes then you go pick it up at your local pharmacy? a couple reasons and I think if you look at their competitive set you know the biggest one being row obviously that's how they've managed through this right they have not remained reliant on compounded drugs as the shortage has gone away they've ramped up their access points to branded therapies they're that's exactly what they're doing and executing I think when you're in the position of him it's hard to not get addicted to a $250 product with 90% gross margins when if you're selling access to the branded drug at most you're going to make $10 to $15 $1 on $150 product. Um, and so I think they to some degree don't realize the business they're in. Like in a traditional retailer and distribution business, which is really the business that they're in, they're not a manufacturer.

Um, that's a scale, low margin business where price, convenience, like all the things that make Amazon successful make you successful. um they have sort of morphed into a manufacturing business without any of the IP,

any of the R&D costs, like any of the things that come along with being a manufacturer. And I think it's an addictive addicting place to be because the margins are quite a bit better than than being a retailer.

Yeah. Can you explain more about this uh the the warning letter that the FDA uh shared addressed to him and her health September 9th, 2025? You can find this on FDA.gov. Uh they're they're they're they're saying uh it says the FDA has observed that your website offers various compounded drugs including simaglutide as described alone that your compla your claims are concerning uh concerning your compounded semiglutide products are false or misleading. Um how how would a company normally respond to a uh a warning letter from the FDA? It's not it's not fully shut down. It's not a lawsuit. It's more of a corrective by the FDA. Is that correct?

Yeah. I think historically in combating specifically, the FDA has lacked material enforcement.

Mhm.

And so in many ways, I think what you're seeing here is that there's a skepticism that they'll actually enforce. And so it's business as usual.

Don't take the warning letter seriously.

Y

I think with that overlay, I think the reason the FDA still sends letters like that is if they do have a material safety issue,

which is what has happened with compounding in the past. you had 60 people die of menitis in 2012

um from a compounding pharmacy doing scale compounding. They have a a paper trail of telling them that you were out of compliance.

Um and so, you know, I think this will probably be a different situation. I think one important point is the FDA does not enforce IP. So, they're not going to get involved in

actual quote unquote IP theft. That's for the courts.

Got it. Um, but they do enforce safety and efficacy, which is why I think they address this so much faster because they believe it's an efficacy issue. Um, not solely an IP infringement issue, which would again be be left to the courts.

Yeah. Uh, what about Walmart? Are they a potential way out of this? You need scale. I don't know how advanced they are, but uh, you know, you have an exper you have experience with Amazon. Walmart just hit a trillion dollar market cap. It seems like the business is doing well. Um, they were not disrupted. they need more technology. Is there something where a partnership could uh allow him to sort of go get out of the compounding business and go more to the scaled low margin business but still be growing?

Yeah, it it feels like just given the reputation that that would be hard to imagine happening. I think they have built obviously a lot of compelling customer experiences. They built really good tech. Um, but I think just given the overhang from these regulatory challenges, it's hard to imagine a large acquirer is going to get comfortable with that um kind of retrospective and presumably ongoing liability.

Mhm. Yeah.

Uh, switching gears, Trump RX, what uh what's what's up with that?

Yeah, I feel like I should take a victory lap here. I think I the first time I was on here was to talk about the executive order for Trump RX. Um, and I think my point at that moment in time was that the real thrust of that EO, which was not super clear then, but is how I interpreted it, is that it was an effort to eliminate this this discrepancy between super high list prices and the net prices that insurers and PBMs actually pay, right? So, for these GLP1s, they had these $1,000 $1,200 list prices, but in reality, if you were a PBM, you were paying 200 bucks, 300 bucks. And I think that's exactly what you saw here where there's a number of branded drugs which before if you were a consumer paying out of pocket you had to pay that high list price. They've gotten the manufacturers to come to the table and offer a consumer directed net price. So really if you are paying out of pocket for a bunch of these drugs you're saving 60 70% compared to what was available to you a year ago. Um, now some of that could just be the GOP market forces, but that wouldn't have touched a number of the products that have moved onto Trump RX. I think given the selection, it's maybe like 25 actual brands that haven't gone generic that have low net prices that are on there right now. It's not the most exciting thing in the world, but I do think you're going to see manufacturers just start to launch new products at net, and that will completely unwind the value of the current supply chain, middlemen, PBMs, all those things. So, I think it's net good. Um, but I think it's like the early days of what could materially change how these things go to market and the pricing that's associated with that.

So, it's not just good marketing for the midterms.

No, I mean, I think it is good marketing. I think uh everyone has quoted these ridiculous list prices as the actual price. It's been like a pet peeve of mine forever and they are now quoting much lower kind of list prices. So, I think that is going to be perceived as a win for the midterms, but the drugs aren't actually cheaper than like a payer would have paid a year ago, but they are cheaper than a consumer could have gotten access to a year ago. So, I think it's net good and um I think hopefully a trend that will accelerate and change the pricing dynamics uh more dramatically.

Can I ask about AI doctors?

That's what I was going to ask about my mind thinking the same thing. Uh we've talked to a couple companies that have come on and and talked about consumer level AI doctor doctor in your pocket you you know you got a mole you take a picture of it tells you what you know you say I feel sick it'll tell you go get some blood work done or something. Some of them have partnered with certain states to get real doctors involved. There's a whole bunch of different models at the same time they're facing pressure from open AI and you know they're launching a health product. Uh how do you think that market plays out? What are you optimistic about? How how much does it can actually improve American health care? There's always a lot of talk about like if you just talked, you know, primary care doctor was available more frequently, we'd be way healthier. And I don't know that there's that many people that are like, well, I never thought to Google I should sleep, diet, and exercise. So now that I can chat GBT and I'm I'm healthy. But walk me through your whole philosophy on like AI chat bots in consumer healthcare. Yeah, I mean I think first of all it's obviously goodness, right? I think people are really going to GPTs to get advice on their health and I think it's something like seven or eight% of chat GPT's volume is health related, health specific. So clearly that's net good. I think in many ways it replaces people going to Google to do the same thing. It's much more efficient. It's definitely more effective. So that's all good. I think the my thesis on the end state of that and where it really unlocks a bunch of value is when it is fully aware of all your medical history. Um and so that's pretty critical. Um and chatbt has launched a version of that though it's pretty light on the actual data integration.

Um and then more specific

they acquired they acquired some company I think to help with that wasn't it the the it was a

there's a company it wasn't called

it was a

it was a company that was like trying to I think

yeah torch it was the what was the name of the company they had before it was not not future

forward

forward health yeah

y

so clearly they're thinking about all this stuff

yeah there's a fundamental regulatory framework where if you're a provider you can access a much broader set of data to deliver care to the consumer if you're a technology company they're accessing via this thing called tefka where very few providers are contributing data to that and so there's a lot of nuance to this but the the punch line is that if you are purely a technology company, your access to the breadth of data necessary to be useful is much more limited.

So you basically need to be a provider that employs actual medical doctors.

You need to be a provider actually providing care to that customer. Yeah.

Yeah. And so, so we had one of these companies, Lotus, on the other day, and if he's in an investor pitch, and people are like, "Hey, like I AI Doctor is cool, but ChachiBT is doing this. Claude's doing this. There's other companies that are

uh or or Claude might, you know, do something like this. There's other companies that are it's super competitive space. They're saying, "Okay, but OpenAI is not going to have doctors on staff and is not going to actually be licensed and uh able to actually deliver."

Yeah. doesn't prohibit them from doing interesting things with partner Zervia MCP or some other approach that uh can mimic you know some of the things that we built at General Medicine and some other folks are building um but in and of themselves whether it's Claude or Chat GPT or Apple Health any of these guys their their ability to provide similar levels of care is just going to be constrained I also think like the probably the more salient point is I think where this becomes really magic is where all of these conversations get actually distilled to your provider before your appointment. So instead of having to repeat all the things you've already said and like go back through your medical history, like you're you sort of show up to the appointment, your provider's been prepped based on everything you've already chatted about and can actually start to like deal with what they might want to do in that appointment. Um, so that's where we've seen it be the most interesting and useful and I'm sure other folks will end up in a similar spot.

Um, but I think like the combination of GPT all the way through to the visit, informing the visit and then informing the care is super powerful. What's the textbook example of like medical history being valuable? Because maybe I'm just like in a weird spot, but I usually just say like no, I don't I haven't done anything. But like I I don't know like if you like I I don't know. I actually haven't broken any bones. But like assuming like I was like I broke my arm when I was five. Like does that really like increase cancer risk? Like how are these things actually flowing through? Like what's the textbook?

I think the average American is on prescription medication.

Okay. So they show up and they're like, "Oh, you're already on this medication. Why did that?

So yeah, I mean I'll give you like a a tangible example that like Elliot experienced in our GPT which is

he's been having this plantto fasciitis issue on one foot and I hope he doesn't mind that I'm sharing his PHI.

Yeah.

And the show actually

Yeah. The GPT was able to decipher that the same thing on the other foot in like 2006 or something like from like 20 years ago.

Okay.

Um which is where like you just he didn't even remember having the issue. It was not relevant to him. Okay.

Um, and I think there's more like substantive examples where you might have had a series of lab tests over the last 5 years.

Any one of them is not problematic, but the trends that are being exposed when you can

see that trend is pretty, you know, compelling.

Okay.

Um, there's also just like you can recommend all sorts of screenings based on when you've actually done those screenings and what hasn't hasn't been done, that kind of thing.

Yeah. Yeah. No, that that makes a ton of sense. Jordy, anything else? Is it dangerous that OpenAI hooked a biolab up to there? We're gonna have the founder uh of GKO, who they uh they partnered with on on the on the AI Bolab, but what are your thoughts?

You want to vibe code some some uh

some drugs,

some studies?

Seems like a fun experiment, you know, but what could possibly go wrong?

We'll clip it when it happens. when the world ends. The one final clip.

We're like, TJ called it.

TJ called it.

Anyway,

doomer.

Yeah, there will be victory laps if the apocalypse happens. For sure.

Last last question. Uh, how have you been processing the all the EV manufacturers having to basically take these massive impairment or sorry, just car manufacturers in general taking these massive hits? It was Stellantis is down something like 20% after the company announced it's taking a $26 billion hit and writing down their electric vehicle business. Uh did you did you predict this as well?

You know, I'm I'm still loving my Raptor R, which gets about 11 miles per gallon. So, I think you know how I feel about the situation.

There you go.

Yeah,

that's great. I'm trying to get Jordy to get one.

You're buying your You're buying your carbon You're buying your carbon offsets, though, right? Of course.

Yeah. Yeah, for sure. For sure.

Thank you.

Awesome.

Well, thank you so much for coming on the show.

Great to catch up.

Great to catch up as well.

I'm sure there'll be a lot more here. So, we'll have you back soon.

Pleasure as always.

Have a good weekend. Let me tell you