With expanding indications, global demand, and strategic realignment across pharma, GLP-1 receptor agonists are at the center of a major industry shift. Once confined as a treatment for type 2 diabetes, GLP-1 agonists have rapidly emerged as one of the most consequential drug classes in modern medicine and now sit at the intersection of metabolic science, public health policy, and commercial strategy.

As these therapies reshape treatment approaches for obesity and potentially a range of other chronic conditions, they’re also prompting questions about access, long-term outcomes, and the future of innovation in chronic disease care. Pharmaceutical Executive spoke with Cheryl Reicin, international chair, life sciences, Mintz, about the market and how drugmakers and investors are looking to the future regarding GLP-1s.

During the conversation, Reicin explained that while the GLP-1 boom has driven intense competition, high valuations, and diverse deal structures in pharma, companies face challenges, including supply chain complexities, regulatory hurdles, evolving market dynamics, and the strategic balancing act between innovation and risk amid a rapidly changing global landscape.

Reicin provided an example of the evolving market dynamics of GLP-1s, saying, “While the GLP-1 drugs initially propelled both of these companies (Eli Lilly, with Mounjaro/Zepbound; Novo Nordisk, with Ozempic/Wegovy) into the No. 1 and No. 2 market cap positions of Big Pharma, both were well aware that one-trick ponies don’t last forever in this industry and have been investing not only in the next generation of the GLP-1 drugs but in other therapeutic areas as well.”

Valuation, risk, and investment

The surge in GLP-1 drug development is redefining the nature of dealmaking across the biopharma sector. As blockbusters approach patent expiration and cash-rich pharmaceutical companies seek the next wave of innovation, deal flow has evolved into a competitive and creative environment.

Reicin emphasized that while valuations remain high in the GLP-1 space, the post-COVID-19 decline in venture capital and public market funding has added a new layer of complexity to partnership negotiations.

There are operational complexities as well. With a consistent demand for GLP-1 therapies surging globally, along with pressure on the production infrastructure that supports them, one of the largest challenges manufacturers face is maintaining production level at scale while also keeping consistency. It’s the one hurdle that’s prompting a wave of cross-border investments and strategic partnerships within the industry.

"R&D is a cross-border global game—great innovation and science, wherever it is conducted, is valuable," says Reicin, who pointed to the international nature of discovery and production in the GLP-1 market.

But that global footprint also brings risk.

"Demand for GLP-1s materially outpaces supply, and cross-border transactions and foreign investments play a critical role in scaling production and expanding market access,” Reicin explains.

To meet that challenge, companies are initiating aggressive infrastructure investments around GLP-1 production. Reicin highlights recent examples such as Novo Holdings’ acquisition of Catalent and AstraZeneca’s $4.5 billion investment in a new US manufacturing facility in Virginia, deals driven by urgent needs to secure supply chains while also accelerating time to market. However, partnerships crossing regulatory, political, and intellectual property borders, particularly in regions such as China, also introduce added layers of uncertainty.

“The political, tariff, intellectual property protection vulnerability, and other concerns that accompany partnering with China allow for an interesting and uncertain future,” Reicin tells Pharm Exec. “But with that comes opportunity for those willing to take calculated risks.”

Oral GLP-1s: Expanding the patient base

With an uptick in global production, the clinical side of the GLP-1 market is also undergoing a transformation with the emergence of oral formulations. The new method of delivery aims to expand access while also reshaping patient experience for individuals who may have previously avoided injectable therapies.

“I think having the oral options, we could attract a lot of new patients to this space," says Madeline Verbeke, senior clinical advisor at MMIT, also interviewed by Pharm Exec. "We have patients who have that fear or aversion to needles, and this kind of opens up the door for them.”

She also notes that even patients without a needle phobia are likely to prefer the convenience of an oral pill.

However, injectables may still retain an advantage in terms of efficacy.

“We’ve seen that injectables are more efficacious than orals,” Verbeke acknowledges. “But I do think there’s a place for orals in the market, both clinically and just efficacy-wise.”

The challenge, Verbeke explains, is in targeting the right patient population, particularly those for whom moderate weight loss and convenience may outweigh the maximal clinical effect. The variation between these formats holds the potential to affect pricing, payer strategy, and access, setting the stage for a new era of competition and stratified treatment pathways.

Affordability and access

While clinical innovation is expanding the potential GLP-1 patient base, with approvals over the last year also in cardiovascular and kidney disease and sleep apnea, the question of access remains deeply unresolved, especially in the US market. The high price point of GLP-1 therapies has led to inconsistent coverage across insurance providers and significant out-of-pocket costs for many patients.

“There’s so many people who could benefit from GLP-1s,” says Verbeke. “If we can have them become more accessible and less expensive, even just making the requirements to get the drugs a little clearer, I think that will help a lot.”

Verbeke points to a growing trend of alternative access models, which include manufacturers offering reduced cash prices through direct-to-consumer programs.

To combat prices, some patients turn to compounding pharmacies as a workaround, despite the growing concerns regarding safety and regulatory standards. Payer behavior also adds complexity, with many insurers continuing to impose restrictions on GLP-1s for obesity, while some are more flexible when the drug is prescribed for related conditions.

“We see a lot of payers being a bit more restrictive with the obesity coverage versus these obesity-related conditions,” Verbeke notes, adding that diagnoses such as obstructive sleep apnea or major adverse cardiovascular events can sometimes improve coverage access.

The balance between affordability, payer policy, and long-term outcomes remains fragile. As the market evolves, payers, regulators, and manufacturers will be forced to confront the question of who gets access to these transformative therapies, and at what cost?