Issue #33·

The FDA just turned 365 insulin shots into 52. Here's what that means.

The first weekly insulin just got FDA approval, and it might be the biggest shake-up in diabetes care since, well, insulin itself. Meanwhile, a drug class everyone left for dead just showed signs of life, Big Pharma made a major psychedelics bet, and someone is fighting pancreatic cancer with electricity.

Top Story Today

One Shot a Week: The Insulin Revolution Just Landed

The FDA approved Novo Nordisk's Awiqli, the first-ever once-weekly insulin, cutting annual injections from 365 to roughly 52 for adults with type 2 diabetes. Across four randomized, active-controlled trials enrolling approximately 2,680 patients, the weekly shot matched daily insulins on blood sugar control while showing comparable or lower rates of dangerous hypoglycemia. With many insulin patients missing doses regularly, the convenience leap could meaningfully improve real-world outcomes. Novo Nordisk plans a U.S. launch in the second half of 2026, and Eli Lilly is already developing a rival.

Why it matters: This is the biggest convenience advance in insulin's 100-year history, and it sets up a commercial showdown between Novo Nordisk and Eli Lilly in the massive diabetes market, the same two companies already battling over GLP-1 blockbusters.

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Policy & Pricing

The Drug Pricing Bill Pharma Read Before Congress Did

The White House released a public most-favored-nation drug pricing proposal urging Congress to codify existing voluntary MFN agreements. The legislation would benchmark U.S. drug prices to what other developed nations pay, potentially slashing costs on biologics and specialty drugs. But analysts have flagged a major catch: the real strategy may involve raising foreign prices rather than lowering American ones.

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Clinical Trials & Discovery

The COPD Drug Class Everyone Wrote Off Just Showed a Pulse

AstraZeneca's tozorakimab hit its primary endpoint in two Phase 3 COPD trials, a disease that has been a graveyard for biologic drugs. The kicker: it worked broadly across patient types, not just narrow subsets, potentially unlocking $3 to $5 billion in peak sales and reopening a massive respiratory market that rivals had abandoned.

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Novocure Is Zapping Pancreatic Cancer With Electricity (and It Might Be Working)

In one of oncology's most hopeless battlegrounds, Novocure posted Phase 2 data showing a 74.4% disease control rate in metastatic pancreatic cancer using electric fields paired with chemo and immunotherapy. Median survival reached 9.7 months. It's a small trial, but in a disease where almost nothing works, the signal is hard to ignore.

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Deals & M&A

Otsuka Drops $1.2 Billion on an MDMA Analog in Major Psychedelics Bet

Two years after the FDA rejected Lykos' MDMA therapy for PTSD, Otsuka agreed to acquire Transcend Therapeutics and its non-hallucinogenic MDMA analog for $700 million upfront plus up to $525 million in milestone payments. The drug sidesteps every problem that sank Lykos: no trip, no mandatory therapist, and clean Phase 2 data published in JAMA Psychiatry. Phase 3 recruitment is already underway.

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