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Those prices and spending numbers do not account for rebates, and states typically receive substantial rebates on brand drugs

Some are making all of them

In large obesity trials using full doses, once-weekly semaglutide and tirzepatide led to substantial average weight loss and improved metabolic markers in adults with obesity.[13] For example, the STEP 1 trial of once-weekly semaglutide in adults with overweight or obesity and the SURMOUNT-1 tirzepatide obesity trial both showed strong weight-loss effects when combined with lifestyle changes

The pharmacists mix, change, or combine ingredients to create a customized medication

It is a likely reason why the weight loss and liver fat numbers in trials look stronger than older single- or dual-pathway compounds