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Why Brand-Name Cant Match Price Structural Barriers: Public Company Obligations: Must maximize shareholder return Quarterly earnings pressure Executive compensation tied to profits Cant dramatically reduce price without stock impact Sunk Costs: Billions invested in development Need to recoup investment Justify to shareholders and board Complex Distribution System: PBMs demand rebates Wholesalers take cut Pharmacy margins Cant easily change system Market Dynamics: Limited competition (patent protection) Can charge premium prices Demand exceeds supply No pressure to reduce Eli Lilly unlikely to reduce tirzepatide prices significantly while patents protected

Some diabetes drugs used in conjunction with Synjardy can add an increased risk of hypoglycemia (low blood sugar)

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