What's next for GLP-1 innovation: A primer on the race reshaping pharma and chronic disease care

Few categories in modern medicine have captured the imagination of patients, physicians, and investors as quickly as GLP-1 receptor agonists (GLP-1s). Originally developed for diabetes management, these drugs, popularized under brand names such as Ozempic, Wegovy, Mounjaro, and Zepbound, are redefining how we think about obesity, metabolic health, and even chronic disease prevention. And increasingly, GLP-1s are no longer just about controlling blood sugar. They have become cultural touchstones, economic disruptors—and, as we'll discuss today, the centerpiece of a high-stakes race to innovate among pharmaceutical giants, biotech innovators, payers, and digital health platforms. In this post, we'll go deep on that race to innovate and its implications. There's a lot to unpack, so we've structured our thoughts into three distinct sections—feel free to peruse the whole post or jump forward to specific areas of interest using the links below:

1. We'll start by sharing our key insights and predictions about where the innovation race is heading—and what it means for the industry

2. From there, we'll overview what the race has looked to date (including key differentiators between major competitors Eli Lilly and Novo Nordisk)

3. Finally, we'll go deep on the five vectors of innovation that will define the innovation race moving forward:

   1. Drug design and formulation

   2. Expanded indications

   3. Manufacturing and supply chain

   4. Digital integration and adherence

   5. Cost and coverage

GLP-1 innovation: Key insights and predictions

1. GLP-1s are more than a blockbuster drug class, they signal a profound reordering of how chronic disease is managed, financed, and even understood. What began as treatments for diabetes and obesity has rapidly expanded into prevention of cardiovascular disease, slowing kidney decline, tackling liver disease, and even tentative explorations into neurodegeneration. 

   
   

2. For all the excitement, the story is still unsettled. The competition between Eli Lilly and Novo Nordisk dominates headlines, but behind them a wave of challengers, from Amgen to upstart biotechs, are probing new mechanisms and formulations. At the same time, payers are quietly rebelling: benefit budgets are strained, employers are pulling coverage, and policymakers are questioning how to sustain access to drugs that may be lifelong therapies for millions. Patients, meanwhile, are caught in the middle, hopeful for transformative benefits, but wary of affordability, side effects, and whether the early hype can translate into durable health outcomes. 

   
   

3. The next decade of GLP-1 innovation will look less like a straight sprint and more like a messy, multidimensional race. Success won’t be measured only by who invents the most powerful molecule, but by who can build the ecosystem around it: scaling manufacturing without shortages, pricing with an eye toward sustainability, integrating digital engagement to improve adherence, and embedding these drugs into broader models of chronic care. The promise is vast, but so are the risks, from scientific overreach to economic backlash. In the end, the winners may be those who balance scientific breakthroughs with trust, access, and long-term value. 

   
   

4. The market size will continue expanding. With obesity, diabetes, cardiovascular disease, liver disease, and possibly neurodegenerative disease all becoming viable markets, the total addressable market is likely to reach or exceed USD 100-150 billion globally (perhaps more depending on healthcare policy). 

   
   

5. We will increasingly see multiple winners rather than a single dominant brand. While Novo Nordisk and Lilly seem best positioned now, emerging agents, oral options, dual/triple agonist molecules may capture niches or even displace certain uses of the first wave of GLP-1s. 

   
   

6. Pressure to bring down costs will continue to grow. As demand continues to surge, the market is bracing for change, from the arrival of generics and biosimilars for older drugs, to the rise of cheaper oral small molecules that are easier to produce and scale. Manufacturers are also racing to make production more efficient, while payers and employers tighten reimbursement to control ballooning budgets.

   
   

7. Regulation and policy will tighten. Governments will increasingly demand favorable cost-benefit evidence, may cap prices, may restrict access, or enforce demonstration of long-term safety more rigorously. 

   
   

8. Care models will continue to become more integrated. Success won’t just be about the pill or injection—it will be about how treatment is delivered. Digital coaching, behavioral support, weight maintenance programs, and payer/health system alignment will be increasingly core to outcomes and reimbursement. 

From then to now

Although they have surged in demand (and public awareness) across the past couple of years, GLP-1s have actually been around for several decades at this point. And they have moved through distinct eras: discovery in the 1980s, broad development in the 2010s, rapid growth and consumerization in the early 2020s, and the current phase, which we believe will be defined by innovation and expansion. Consumer demand is accelerating, oral formulations are nearing the market, Medicare negotiations are set to reshape pricing, pivotal trial readouts in Alzheimer’s and chronic kidney disease could unlock entirely new indications, and the market is forecast to top $100 billion by 2030. This high-stakes environment puts enormous pressure on stakeholders to innovate quickly while also preparing for what comes next: reinvention as biosimilars and new competitors disrupt the landscape.

GLP-1 innovation to-date: A duel at the top

The GLP-1 market to-date has largely been a two-horse race between Novo Nordisk and Eli Lilly. Novo Nordisk secured first-mover advantage with Ozempic and Wegovy. Its strategy hinges on broadening indications (heart failure, CKD, NASH, Alzheimer’s) and pioneering oral formulations. But persistent supply bottlenecks for its key active ingredient, semaglutide, have slowed growth. 

Eli Lilly has since surged ahead with tirzepatide, branded as Mounjaro for diabetes and Zepbound for obesity. Stronger efficacy, fewer side effects, and more reliable supply have given Lilly a U.S. lead in prescription volume as of early 2025. Its direct distribution model via LillyDirect and partnerships with telehealth firms have also further expanded its edge. 

GLP-1 innovation in the future: Where the race is playing out

The race to innovate is hardly over. If anything, pressure is only intensifying as Novo and Lilly continue to jockey for dominance, and as new challengers look to tap into this burgeoning market. The next phase of competition will be less about who has a GLP-1 and more about who can build a better mousetrap. What’s shaping up is a multi-front race across formulation, manufacturing, digital integration, and reimbursement. Here are the vectors of innovation that players are currently focused on:

GLP-1 innovation vector (1): Drug design and formulation 

Next-generation molecules aim to improve both efficacy and convenience. To start, drugmakers are experimenting with dosage. A 2025 study found that tripling semaglutide’s dose to 7.2 mg led to roughly 19% weight loss over 72 weeks, compared to 16% at the standard dose, a meaningful gain, though with higher rates of side effects. The data suggest there’s still headroom for efficacy within existing molecules. 

Oral GLP-1s are probably the most anticipated innovation within this category, given their convenient, non-invasive nature relative to current injectable formulations. Novo’s oral Wegovy is expected to receive an FDA decision in late 2025, with Lilly’s oral Zepbound close behind in 2026. Novo and Lilly aren’t the only players in the field: candidates like orforglipron (a non-peptide oral GLP-1) and Viking’s VK2735 (being developed in both oral and injectable forms) promise to broaden access and lower cost pressures. An oral high-dose version of Rybelsus (25–50 mg) is also in late-stage study. 

Meanwhile, dual agonists, which target and activate both the GLP-1 (Glucagon-like peptide-1) receptor and the GIP (glucose-dependent insulinotropic polypeptide) receptor, and triple agonists (targeting the GLP-1+GIP+Glucagon receptors) are also showing promise. While GLP-1 drugs alone deliver powerful effects on blood sugar, appetite, and weight loss, the body’s energy balance and metabolism are controlled by multiple hormonal pathways. By activating additional receptors, dual and triple agonists can tap into a broader set of levers at once, offering the chance for greater weight reduction, improved glycemic control, and (possibly) fewer side effects compared to GLP-1 monotherapy. As a dual agonist, tirzepatide (GLP-1 + GIP) continues to outperform semaglutide in weight loss and metabolic control, setting a new bar for combination therapies. Novo Nordisk is looking to challenge Eli Lilly on this front; Novo's amycretin (GLP-1 + amylin) has shown 22–24% weight loss in early studies—potentially a new benchmark if Phase 3 results confirm. 

A crowded field of next-generation contenders is also pushing forward: Amgen's AMG 133, Roche's GLP-1/GIP co-agonists, AstraZeneca's cotadutide, and Phase 2 candidates like HRS9531 and MariTide (a GLP-1 agonists plus GIP antagonist) are all showing early promise in obesity treatment. Pipeline drugs like Viking’s VK2735 and Amgen’s AMG 133 could raise the bar further by innovating on both biology and delivery, such as new receptor targeting strategies, novel molecular designs, and more patient-friendly dosing schedules. Long-acting injectables designed for monthly dosing (as opposed to the current standard of weekly) are also advancing. 

GLP-1 innovation vector (2): Expanded indications 

One of the biggest differentiators in the next few years will be how far GLP-1s can extend beyond diabetes and obesity. Therapies that prevent cardiovascular events, kidney disease, liver disease, sleep apnea, or even neurodegeneration could unlock massive new markets.

The innovations in drug design and formulation that we just covered, including dual and triple agonists or conjugates with other hormonal pathways, are helping driving this expansion by delivering greater weight loss and metabolic benefits while reducing side effects through synergistic mechanisms. And regulatory approvals already reflect this shift: Wegovy is approved to lower cardiovascular risk, Ozempic slows kidney disease progression, and semaglutide is cleared for metabolic dysfunction–associated steatohepatitis (MASH) with fibrosis. Trials are also ongoing in Crohn’s disease, ulcerative colitis, and IBS. 

Other fronts are advancing quickly:

• Zepbound won FDA approval in 2024 for obstructive sleep apnea, and NIH-funded studies are testing GLP-1s for opioid use disorder.  

• Meta-analyses have eased concerns by finding no significant rise in psychiatric side effects.

• Neurology is particularly high stakes: the EVOKE and EVOKE+ Phase 3 trials of semaglutide in early Alzheimer’s disease, due in 2025–26, will be the first large-scale cognitive readouts. Early Parkinson’s and Huntington’s studies remain mixed but suggest disease-modifying potential. 

• Preclinical work also points to applications in reproductive health (e.g., PCOS-related fertility improvements) and oncology, where observational studies link GLP-1 use to lower risks of obesity-related cancers. 

GLP-1 innovation vector (3): Manufacturing and supply chain

After more than a year of severe shortages, both semaglutide (Ozempic/Wegovy) and tirzepatide (Mounjaro/Zepbound) have recently come off the FDA’s shortage list—an encouraging signal that supply is stabilizing. However, demand continues to run hot. Prescription growth remains in the double digits, and many pharmacies still report intermittent stock-outs, particularly for higher doses and new starts. The imbalance between capacity and demand has narrowed but not disappeared. 

Oral and long-acting formulations could also dramatically expand GLP-1 uptake, further increasing demand. Moreover, oral peptides come with a catch: they require much higher quantities of active ingredient than injectables to achieve similar efficacy. If these versions prove both effective and popular, they could exacerbate supply pressures—just as manufacturers are starting to close the gap between demand and production.

To get ahead of future shortages and address ongoing stock-outs, manufacturers are racing to expand production at an unprecedented scale. Eli Lilly has committed nearly $50 billion to new U.S. facilities, while Novo Nordisk has invested $11 billion to acquire and upgrade Catalent manufacturing sites. Both are building redundancy into their supply chains to prevent bottlenecks like those that plagued early launches. Contract partners such as Samsung Biologics and device suppliers like West Pharma are critical to meeting delivery demand, as are innovations in biomanufacturing, synthetic biology, and peptide optimization, which aim to lower costs and increase output.

The bottom line: the supply crunch is easing, but the arms race in manufacturing is just getting started. In the world of GLP-1s, “enough” supply may always be a moving target. 

GLP-1 innovation vector (4): Digital integration and adherence

Pharma is increasingly moving closer to patients. LillyDirect and Novo’s CenterWell pharmacy services offer direct-to-consumer (D2C) access, while partnerships with Amazon, Ro, and LifeMD are making GLP-1s easier to order. 

Consumer platforms like Weight Watchers and Noom now integrate GLP-1 prescribing into coaching and nutrition programs, reframing them as part of holistic lifestyle care. These wrap-around services cater not only to consumers, but are proving increasingly key to improving adherence and demonstrating value to payers such as employers who are grappling with the cost implications of these drugs.  

With recent FDA enforcement against misleading direct-to-consumer prescription drug advertising, telehealth and DTC platforms that advertise GLP-1 products will likely need more careful legal / regulatory oversight of their ad claims, especially around benefit claims and safety disclosures. Compounding pharmacies selling GLP-1 copycats are at higher risk of enforcement actions or cease-and-desist orders. 

GLP-1 innovation vector (5): Cost and coverage  

As noted above, employers and payers are increasingly grappling with how much GLP-1 coverage they can sustain. After a surge in 2023–24, growth in coverage has effectively stalled. In fact, high-profile examples of payers pulling back on coverage are stacking up: North Carolina’s state health plan dropped GLP-1s after spending $100 million, Ascension eliminated all weight-loss drug coverage, and Mayo Clinic capped lifetime GLP-1 benefits at $20,000. Surveys suggest one in three employers currently covering the drugs are considering scaling back. The message is consistent: consumer and patient demand remains sky-high, but affordability concerns are forcing payers to rethink their approach. 

Every employer survey we reviewed flagged GLP-1s as a top driver of rising health spend for 2026. Coverage for diabetes treatment has been relatively stable, with nearly 60% of employers now offering it. But obesity is another story. While 2024 saw an expansion in weight-loss coverage, the reversals have been striking. For payers and employers, this is the moment to test value-based contracts as a way to balance access and cost. For pharma, the warning is clear: cash-pay channels may absorb some demand, but affordability remains the Achilles’ heel of this market. 

Looking ahead, the pullback is likely to spark a wave of financing innovation. Employer coalitions could pool risk, subscription models may spread costs more predictably, and outcomes-based contracts could tie payments to real-world health improvements. How quickly these approaches mature will help determine whether GLP-1s become a sustainable part of the benefits landscape—or remain a flashpoint in the fight over drug affordability. 

Price points themselves will also likely continue to shift. Medicare’s Maximum Fair Price negotiations for semaglutide, set to conclude in 2025, could reshape pricing dynamics nationwide. CMS is set to publish its first round of negotiated Medicare drug prices in 2025, with implementation beginning in 2027. Overlaying this, Trump’s Most Favored Nation (MFN) push aims to cut U.S. drug prices by up to 80%, reflecting the reality that Americans pay up to four times more than patients in OECD countries. Whether his policies—which have been pushed through executive order, as opposed to formal rule making or legislation—will actually lower prices domestically remains to be seen. But pharmaceutical firms are already making adjustments overseas: Eli Lilly recently raised its UK GLP-1 prices by 170% to offset possible MFN-related revenue losses and maintain current pricing levels in the U.S.  

Additional cost pressures loom from potential tariffs on imported drugs, while biosimilar competition is a longer-term certainty—semaglutide patents are expected to expire in 2031–32, with tirzepatide protections extending into 2036 and beyond. Taken together, these forces point to a future where U.S. list-price revenue growth faces structural constraints. For pharmaceutical manufacturers, the imperative is to diversify revenue streams beyond U.S. pricing. For payers, the expectation should be that international reference pricing will eventually become embedded in the American system. 

Risks, barriers, & challenges in the GLP-1 innovation race

The GLP-1 market is on track to remain pharma’s fastest-growing category through the 2030s. Yet growth in volume of use does not guarantee growth in revenue for any given player in the market. And even with the immense amount of innovation and R&D dollars being poured into this market, additional challenges remain: 

• Side effects and tolerability concerns remain substantial. Higher doses often yield stronger efficacy but also greater gastrointestinal issues, tolerability drop-outs, etc. Adherence and real-world outcomes will determine whether payers sustain coverage or retreat further 

• Long-term safety: The newer indications (e.g., Alzheimer’s, liver disease) mean older populations, comorbidities, polypharmacy. We don’t yet have decades of data. 

• Regulatory hurdles: Approval for novel indications (Alzheimer’s, neurodegenerative diseases) requires very high bar: long follow-ups, clinically meaningful endpoints, safety. Similarly, for dual/triple agonists, regulatory agencies will demand evidence of incremental benefit vs risk over existing agents. 

• Off-label use, misuse, patient expectations: As public demand surges, there is risk of overpromising, misuse (e.g. weight loss by people not meeting guidelines), and safety/ethical issues, especially in direct-to-consumer contexts. 

Parting thoughts

History offers a cautionary note. Miracle drugs have risen before, statins transformed cardiovascular care, opioids promised freedom from pain, and biologics redefined autoimmune treatment. Each reshaped medicine, but also brought unintended consequences: overprescribing, affordability crises, and backlash when the costs or risks became undeniable. GLP-1s could prove different, ushering in a new era of preventive metabolic health, but they could just as easily follow the familiar arc of initial euphoria, overextension, and correction. The line between revolution and reckoning is thin.