GLP-1s and the Rise of Consumer-Led Pharma: What the Obesity Market Signals for the Future of Access
GLP-1s like OZEMPIC / WEGOVY (semaglutide) and MOUNJARO / ZEPBOUND (tirzepatide) are demonstrating what happens when demand is driven directly by the patient, and not the payer or provider. It is not only shaking things up for the pharmaceutical companies and their service partners, but is also challenging healthcare innovators and other health system actors on how healthcare could be delivered in the future.
This evolution demands strategic rethinking on how to:
- Enable access
- Deliver continuity of care
- Embed preventative approaches
- Achieve long-term outcomes
Demand outpaces supply: when the consumer leads
The rise in patient demand was triggered by pivotal trial results showing a 10–20% weight loss, along with downstream benefits e.g., cardiovascular improvements and sleep apnoea. In markets such as the US, this demand exceeded supply, and resulted in widespread compounding to meet patient needs, (compounding now since banned by FDA). Similar shortages in the EU led the EMA to issue guidance to avoid off-label use of the drugs (especially for cosmetic weight loss) as well warning patients of the risk of falsified drugs being sold online. [3, 4, 5]
The cost of these drugs is notable, with an out-of-pocket payment of approximately $1,100/patient/month in the US and €150–300/patient/month in Europe for the self pay setting.
Payers hesitate, the self-pay market moves
Despite the preventative health benefits of GLP-1s, many European health systems have adopted conservative access criteria. Strict eligibility, budget impact concerns, and inconclusive cost-effectiveness assessments have limited wide-scale public reimbursement.
For example, NICE (UK) has approved routine use of semaglutide and tirzepatide, but for a more restricted population than their approved labels. Both drugs were found to be cost-effective for patients with a BMI >= 35 kg/m2 with at least one weight related comorbidity. However, for patients with a BMI < 35 kg/m2 the drugs lacked cost effectiveness and so are not recommended for this population. In France, the Transparency Committee concluded that semaglutide offered no additional clinical value to treat obesity (ASMR V) and is currently not reimbursed. In Germany WEGOVY is not reimbursed due to it being considered a lifestyle drug, consistent with similar drugs in the past. [6, 7, 8]
Such payer hesitancy also exists in the US. According to the Pharmaceutical Strategies Group’s recent survey of Health Plans, 43% said they have not covered and will not consider covering GLP-1s for obesity; just 22% said they currently provide coverage. The reasoning behind this is two-fold: firstly, plans are concerned over the total cost impact given the size of the population and cost of the drugs. Secondly, a significant proportion of plans consider obesity as a lifestyle condition rather than a chronic disease. To manage widespread off-label usage, payers are using prior authorisation and BMI measures to control access. [9]
The payer constraints in both the EU and US have created a structural gap that is rapidly being filled in some countries by online prescribing platforms, retail pharmacy programs, and consumer wellness providers coupled with out-of-pocket payments. In some of these channels, patients can be consulted virtually by a health care professional, secure prescriptions, and receive medications via delivery or in-pharmacy pickup. In effect, obesity treatment is becoming a self-pay service, displacing the system-led, reimbursed model typical of chronic disease management.
Risks and consequences: inequities and missed benefits
Clearly this change poses strategic challenges on how best to market and get the drug to the patient along with all the supporting apparatus required e.g., diagnostics, monitoring, supply, counselling. Access and continuation of therapy are also now more closely associated with individuals’ ability to pay, and therefore run the risk of creating health inequalities. [10]
It's also possible that consumers opt for narrowly focused, short term, ‘medicalised’ weight loss solutions, foregoing comprehensive support programs and thereby putting the longer-term health benefits at risk. Indeed, weight regain after GLP-1 therapy appears to be a common occurrence. As such many HCPs would like to see GLP-1 therapy as a component of more comprehensive weight loss programs e.g., those that include nutritional planning, mental wellbeing and physical activity. [11]
The shift to consumer-first doesn’t diminish the need for structure but instead challenges us to rethink how it can be provided. Assuming the consumer led trend is here to stay, attention should focus on how to optimise the opportunity. This should include:
- The provision of a consumer focused, decentralised care approach
- Affordable access
- Integration of private and public health care pathways
- Comprehensive support to ensure health benefits are realised
As mentioned above, markets are already responding with direct-to-consumer provision models. Also, the recent Executive Orders by the Trump Administration to reduce drug prices are likely to encourage this trend (“cutting out the middlemen”). [12]
Getting information to the consumers: a media-led market
Social media has played and continues to play an important source of information for consumers of GLP-1s. Influencers and celebrities have shaped public opinion and played a role in generating demand. However, these channels present substantial compliance risks with the possibility of exaggerating claims, spreading of incorrect safety information, usage etc. TikTok notably cracked down on the promotion and marketing of obesity medications on its platform. However, a simple search on other platforms indicates that a lot of informal information continues to be shared at scale. [13]
Pharmaceutical companies are also having to navigate a complex space in awareness campaigns. The recent controversy in Spain, where Novo Nordisk's obesity awareness campaign was pulled over concerns of indirect promotion, underscores the sensitivity of consumer-facing engagement in this space. [14]
For manufacturers and their service partners, this presents a challenge and an opening. The market needs trusted, accessible, and compliant information. Those who build it can position themselves as responsible stewards of long-term weight management solutions.
What comes next: designing for the consumer future
GLP-1s may be leading the shift, but they won’t be the only ones. Other pharma companies have additional obesity drugs coming through their pipelines. This competition may soften the affordability barrier, especially as differentiation around better side effect profiles, reduced dosing frequency, longer term outcomes etc., play a more decisive role.
More generally, the expectations that are being set in this area may start to impact how other drugs are accessed and used. For chronic therapies: simplified prescribing, access, delivery, wraparound support, availability of the right information may all be areas that will be challenged on how they are delivered and experienced.
Forward-thinking pharmaceutical and biotech firms must ask:
- If public reimbursement remains limited, how can we build a private access model that supports outcomes?
- Who do we need to partner with to deliver holistic patient support at scale?
- How do we responsibly inform and engage patients in a media environment we don’t fully control?
GLP-1s are not just a commercial case study, they are a signal. Now is the time to understand it, engage with it, and help shape it into something equitable, sustainable, and impactful.
Contact
If you are interested in discussing any of the issues above for your company/drug program, please contact me through my email address dniven@nivenbiopharma.com. Feel free to also visit my website at www.nivenbiopharma.com for more information.
Sources:
- GLP-1 Agonists Weight Loss Drugs Market Size, Share and Trends, Grand View Research, 2025
- Consumers will pay for weight loss drugs out of pocket, Leventhal, Emarketer, Jun 2025
- WEGOVY, MOUNJARO Summary of Product Characteristics, EMA June 2023, Feb 2024 respectively
- FDA Says No More Compounded GLP-1s Like Ozempic or Wegovy, Upham, Everyday Health, May 2025
- EU actions to tackle shortages of GLP-1 receptor agonists, EMA, June 2024
- Semaglutide for managing overweight and obesity, NICE, September 2023; Tirzepatide for managing overweight and obesity, NICE, December 2024
- Analogues du GLP-1 et obésité : nous prenons des mesures pour sécuriser leur utilisation en France, ASNM, June 2025
- Germany Confirms No Reimbursement Status For ‘Lifestyle’ Drug Wegovy, Bruce, Citeline, March 2024
- Trends in Drug Benefit Design Report, Pharmaceutical Strategies Group, Spring 2025
- Discontinuation and Reinitiation of Dual-Labeled GLP-1 Receptor Agonists Among US Adults With Overweight or Obesity, Rodriguez et al, JAMA, January 2025
- GLP-1s Potentially ‘Transformative’ but Could Lead to ‘Distorted’ Obesity Care: WHO. Manalac, BioSpace, December 2024
- Trump’s Drug Pricing Executive Order: Uncertainty for Pharma Leaders, Niven, Biopharma Over Coffee, May 2025
- Weight-loss promoters are reeling after TikTok crackdown, Washington Post, May 2024
- Sanidad pide aclaraciones a la empresa de Ozempic por su campaña sobre la obesidad, Martín, El Periódico, June 25
