People with obesity are angry that obesity isn’t recognized as a disease. And users who can’t afford it say they’ve been abandoned by Big Pharma.

This is why Lilly’s decision to change its coupon terms hit patients so hard. “Not only were patients probably not aware that there was a time limit in the first place, but they moved the ball, so to speak,” Michelle Mello, a professor of Law and of Health policy at Stanford University, said. “They moved a goal-post up to create the dependence and then pulled the rug out even more quickly.”

Underneath that rug is a steep bill: Even when Mounjaro is approved for the treatment of obesity, it will cost about $13,000 a year.