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A Tsunami of New GLP-1s May Hit the Market — What Does That Mean for Costs?

Updated July 2024

These days, many of the most frequently asked questions that we receive focus on GLP-1 medications––the popular and highly effective weight loss drugs you’ve been hearing about in the news. GLP-1s are a type of incretin mimetic, medications that affect gut hormones and cause weight loss.

Beyond their effectiveness, price point is a widespread concern for stakeholders throughout the healthcare industry, as well as for chronic disease patients who might hope to use them. Ozempic®, for example, costs an estimated $10,000 a year per person, placing significant financial strain on payers as demand grows.


“Not all employers and insurers are covering GLP-1s for weight loss because they aren’t seeing the return on investment, yet,” says Omada Clinical Strategy Associate Hope Chang, PharmD, AAHIVP. “The upfront costs are too high. So the question is, when will the prices dip to the point where these medications are widely covered for weight loss?”


Michael Thompson, chief executive of the National Alliance of Healthcare Purchaser Coalitions, told the Wall Street Journal that the “huge cost burden on health plans” is a key issue employers are wrestling with amid surging demand for GLP-1s. In fact, the University of Texas System has seen costs for GLP-1s more than triple to about $5 million a month. Now, it’s ending coverage for Novo Nordisk’s Wegovy and Saxenda for its employees and others covered by its health plans, citing the “current rate of prescription drug expenditures” in a university benefits newsletter.

However, cost concerns aren’t slowing down the GLP-1 market, which is expected to reach $55.8 billion by 2023. While brands like Ozempic©, Wegovy©, Mounjaro©, and Trulicity© are currently ruling the space, only Wegovy has FDA approval for weight loss; pharmaceutical companies are scrambling to get more weight loss drugs approved by the FDA and put more GLP-1s on the market.  Will more supply to meet growing demand for these medications bring prices down? And just how many GLP-1s are there? 

We broke down the list of GLP-1s by FDA approval stage, and spoke with Chang about what more GLP-1s could mean for costs. 

*Note: This list is based on Omada internal research completed in July 2023, and may quickly become out of date. 

FDA-Approved GLP-1s for weight loss

*Mechanism of action (MoA) refers to how a molecule, such as a drug, functions to produce a pharmacological effect, such as its impact on cell growth or the modulation of a protein.

Semaglutide

Brand Name: Wegovy (SQ)
MoA: GLP-1 agonist
Company: Novo Nordisk

Liraglutide

Brand Name: Saxenda (SQ)
MoA: GLP-1 agonist
Company: Novo Nordisk

Tirzepatide

Brand Name: Zepbound
MoA: GLP-1 agonist + GIP
Company:  Eli LIlly

FDA-Approved GLP-1s/Incretins for diabetes, often used off-label for weight loss

Semaglutide

Brand Name: Ozempic (injection), Rybelsus (oral)
MoA: GLP-1 agonist
Company: Novo Nordisk

Tirzepatide

Brand Name: Mounjaro
MoA: GLP-1 agonist + GIP (hormone that stimulates insulin secretion)
Company: Eli LIlly

Dulaglutide

Brand Name: Trulicity
MoA: GLP-1 agonist
Company: Eli Lilly

Liraglutide

Brand Name: Victoza
MoA: GLP-1 agonist
Company: Novo Nordisk

Before we dive into the incretin mimetics coming down the FDA-approval pipeline, let’s do a quick review of the drug development process. “While the time frame varies, it commonly takes anywhere from 10-15 years for a medication to reach the market,” Chang says.

Why does it take so long? What’s happening in the process?

Phase 1 involves small-scale clinical trials that focus on safety. 

Phase 2 comprises slightly larger studies focused on efficacy, or making sure the medication does what researchers thought it would do.

Phase 3 clinical trials are the ones we likely hear and read about, as they are often the last step before FDA approval. These are large studies (typically randomized controlled trials) that are used to confirm findings from phase 1 and 2 trials. With a larger population, researchers can confirm the medication safely offers the treatment benefit to the intended population. 

Phase 4 actually comes after a medication is FDA approved, and continues to track its safety (i.e. long- term side effects) in the general (non-study) population.   

 

*Each table below reflects the drugs in the relevant FDA phase of development.

Phase 3: GLP-1s/Incretins for weight loss that could be coming soon

Cagrilintide + Semaglutide

Brand Name: CagriSema
MoA: GLP-1 agonist + amylin analogue
Company: Novo Nordisk

Pegapamodutide

Brand Name: n/a
MoA: GLP-1 + glucagon
Company: OPKO

Retatrutide

Brand Name: n/a
MoA: GLP-1 agonist + GIP
Company: Eli Lilly

Semaglutide

Brand Name: Semaglutide 7.2mg
MoA:GLP-1 agonist
Company:Novo Nordisk

Semaglutide

Brand Name: Oral Semaglutide 50 mg
MoA:GLP-1 agonist
Company:Novo Nordisk

Orforglipron

Brand Name: n/a
MoA:GLP-1 agonist
Company:Eli Lilly

(Survodutide) BI 456906

Brand Name: n/a
MoA:GLP-1 + glucagon
Company:Boehringer Ingelheim

Mazdutide

Brand Name: n/a
MoA:glucagon-like peptide-1 receptor (GLP-1R) and glucagon receptor (GCGR) dual agonist
Company:Eli Lilly / Innovent

Phase 2: GLP-1s/Incretins for weight loss coming down the pike

Dapiglutide

Brand Name: n/a
MoA: GLP-1 agonist + GLP-2 agonist
Company: Zealand

Pemvidutide

Brand Name: n/a
MoA: GLP-1 + glucagon
Company: Altimmune

Bamadutide (SAR425899)

Brand Name: n/a
MoA: GLP-1 agonist
Company: Sanofi

maridebart cafraglutide AMG133

Brand Name: n/a
MoA: GLP-1 agonist + GIP antagonist
Company: AmGen

CT-388

Brand Name: n/a
MoA:  GIP/GLP Glucagon receptor agonist
Company: Carmot Therapeutics

CT-868

Brand Name: n/a
MoA:  GIP/GLP Glucagon receptor agonist
Company: Carmot Therapeutics

GSBR-1290

Brand Name: n/a
MoA:  GIP/GLP Glucagon receptor agonist
Company: Structure Therapeutics

VK-2735

Brand Name: n/a
MoA:  GIP/GLP Glucagon receptor agonist
Company: Viking Therapeutics

Ecnoglutide

Brand Name: n/a
MoA:  GIP/GLP Glucagon receptor agonist
Company: Sciwind

Phase 1: GLP-1s/Incretins with a ways to go

NN9277

Brand Name: n/a
MoA: GLP-1 agonist + glucagon
Company: Novo Nordisk

AMG 786

Brand Name: n/a
MoA: Not disclosed
Company: AmGen

ZP8396

Brand Name: n/a
MoA: Amylin analog
Company: Zealand

ZP6590

Brand Name: n/a
MoA: GIP analog
Company: Zealand

AZD6234

Brand Name: n/a
MoA: Amylin analog
Company: AstraZeneca

BL 1820234

Brand Name: n/a
MoA: NPY2 receptor agonist
Company: Boehringer Ingelheim

YH25724

Brand Name: n/a
MoA: GLP-1 agonist + FGF21 agonist
Company: Boehringer Ingelheim

Unknown

Brand Name: n/a
MoA: GLP-1 agonist + GIP
Company: Novo Nordisk

Once weekly oral semaglutide

Brand Name:
MoA: GLP-1 agonist
Company: Novo Nordisk

SemaDapa

(weekly oral semaglutide/dapagliflozin)

Brand Name: n/a
MoA: GLP-1 agonist + SGLT2 inhibitors
Company: Novo Nordisk

Amycretin

(oral medication)

Brand Name: n/a
MoA: GLP-1 agonist + amylin analogue
Company: Novo Nordisk

Insulin + semaglutide

Brand Name: n/a
MoA: Insulin + GLP-1 agonist
Company: Novo Nordisk

DACRA QW II

Brand Name: n/a
MoA: Dual amylin and calcitonin receptor agonists (DACRA)
Company: Eli Lilly

What it all means for drug prices & healthcare costs

A lengthy list of drugs in the FDA-approval pipeline may not necessarily translate into all, or even most of these contenders making it to market. Only about one-third of experimental drugs that pass phase one and two will progress to phase three; and only 25 to 30% of experimental drugs make it past phase three. 

“I don’t even pay attention until phase three,” jokes Chang. Still, even if we are to assume all or most of these drugs secure FDA approval, Chang cautions against believing that will automatically bring costs down. 

“What I hope is that with more GLP-1s there will be more competition that will drive prices down, but what we’ve seen historically is that’s not always the case,” Chang says. Let’s look at insulin, a life-saving medication discovered over 100 years ago. And yet we saw the consumer price of insulin increase in the last decade. Now, thanks to new legislation imposing limits on out-of-pocket costs for patients, we started to see the price come down.

Chang also noted that the current obesity-approved GLP-1s are all injectable, which typically means longer patents. That can delay the process of generic versions (biosimilars) of FDA-approved GLP-1s from coming to market. Which, if it occurred, might drive down prices due to competition.

How Omada is handling GLP-1s

Omada has actively supported members with diabetes on GLP-1s since 2019. Rather than rushing to write prescriptions, we’ve initiated program enhancements for members taking GLP-1s, in response to the growing interest and demand. In line with FDA guidelines and research on GLP-1s, our approach emphasizes sustained, long-term weight loss through supporting behavior and lifestyle changes alongside medication. 

Highlights include: 

  • Specialized training for our health coaches and specialists on how to help members taking GLP-1s for weight management

  • Proprietary, clinically-based educational materials for members taking GLP-1s

  • Adding a moderated GLP-1-specific peer group to Omada’s in-program community offerings

  • Services to support employers and PBMs with administering coverage policies

Dr. Carolyn Bradner Jasik, Omada’s Chief Medical Officer, put it best in a press release announcing the launch of our GLP-1 support program: "The evidence is clear that GLP-1 medications without comprehensive behavioral support puts patients at risk for weight regain once the medication is stopped. A prescription alone does not change habits, but adding sustained support from a behavior change program can."


Learn more about GLP-1s.