What after GLP drugs: How big pharma are gearing up for the next game-changer after the weight-loss drug boom

When Danish drug maker Novo Nordisk A/S started testing higher doses of Semaglutide, an anti-diabetic and anti-obesity medication, in 2024 to extend weight-loss outcomes, its American rival Eli Lilly & Company was pushing an oral obesity treatment through regulators.

Around the same time, Amgen Inc. of the US, still without an approved obesity therapy, trod a different route, backing a long-acting treatment needed to be injected just once every few months to check the disorders.

These moves were not about replacing today’s GLP-1 blockbusters like Novo Nordisk’s Ozempic and Wegovy or Lilly’s Mounjaro, which will go off-patent in the coming months and years after driving record valuations for their makers. GLP-1 is short for Glucagon-Like Peptide-1, a class of medications mimicking a natural hormone to regulate blood sugar, reduce appetite and promote weight loss.

As competition intensifies in obesity and Type 2 diabetes therapies and the first generation of GLP-1 matures, Big Pharma and its Indian units are moving past the idea of a single, dominant product to replace GLP-1 products. Drug makers are building broader, multi-layered metabolic portfolios that combine oral and injectable therapies, precision-targeting obesity, diabetes and related conditions for the long term.

For India, its disease burden makes the transition both a medical and commercial imperative. Economic Survey 2025–26 cautioned that rising obesity levels were set to boost long-term healthcare demand because obesity-linked conditions increasingly require continuous outpatient care rather than episodic hospital treatment.

Data from the National Family Health Survey-5 (2019–21) show that 24% of Indian women and 23% of men are overweight or obese. The Indian Council of Medical Research-India Diabetes study puts the number of people living with diabetes in India at around 101 million, among the highest globally.

Together, obesity and diabetes are driving a growing share of outpatient visits, chronic drug use and healthcare spending. National Health Accounts data from the Ministry of Health & Family Welfare show that non-communicable diseases now account for over 55% of India’s disease burden, with metabolic disorders taking up an increasing share of health expenditure.

Such numbers in India and elsewhere underline why drug makers are thinking beyond first-generation therapies. Market estimates place the global GLP-1 market in 2025 at over $60 billion as treatment expanded from specialist endocrinology to primary care and long-term disease management.

High costs, low Persistence

Alongside Novo Nordisk, Lilly and Amgen, companies, including AstraZeneca Plc., Roche Holding AG and Pfizer Inc., are building their own metabolic drug portfolios focused on GLP-1 and multi-hormone therapies which, sooner or later, will enter the Indian market.

As global drug makers build deeper pipelines around obesity and metabolic diseases, analysts caution that the Indian GLP-1 market remains at an early stage, marked by high treatment costs, low patient adherence to drugs and price sensitivity.

According to Sheetal Sapale, Vice President of Commercial Research at Business2Business platform Pharmarack, early prescribing momentum around tirzepatide, another diabetes and obesity medication, has been supported by its cardiovascular benefits while weight-loss outcomes of Tirzepatide and Semaglutide remain broadly comparable.

Sapale notes that demand has been driven as much by awareness and social media interest as by clinical outcomes, and cautions that side effects and the need for sustained lifestyle changes could limit long-term adherence.

These constraints are likely to cap how far the market can scale in the near term. Vishal Manchanda, Senior Vice President of Institutional Research at Systematix Group, estimates that the annual cost of GLP-1 therapy per patient is likely to eventually settle around Rs 25,000, down from the Rs 1 lakh branded therapies now cost.

“At the peak, we could see a few million patients in India on GLP-1 therapies, but uptake will be shaped as much by convenience and compliance as by price,” says Manchanda.

Blockbusters

To be sure, the first generation of GLP-1 drugs scaled apace globally. Ozempic was first approved in December 2017 and went on to become one of the most widely prescribed injectable therapies, laying the foundation for Semaglutide’s expansion into obesity care.

Wegovy, a higher-dose formulation of Semaglutide designed specifically for chronic weight management, followed in June 2021. Lilly’s Mounjaro entered the market in May 2022.

The commercial impact was swift. Novo Nordisk’s Semaglutide franchise, spanning Ozempic, Wegovy and oral formulations, generated over $20 billion in global sales in 2024. Lilly’s tirzepatide, marketed as Mounjaro for diabetes and Zepbound for obesity, crossed $10 billion in global sales within two years of launch, making it one of the fastest build-ups seen for a chronic therapy.

In India, the market is newer, but moving fast. According to Grand View Research, the India GLP-1 receptor market, which includes drugs such as Semaglutide and Tirzepatide, is estimated to have generated revenue of around $117.5 million in 2025 (Rs 970–1,000 crore), highlighting early but growing adoption. Of course, out-of-pocket costs are high and patient persistence is limited.

Mounjaro was launched in March 2025 in India for Type 2 diabetes and obesity and has seen strong uptake, with cumulative sales estimated at around Rs 600 crore within months of launch, driven largely by early adopters. Wegovy entered the Indian market in June 2025 at a premium price point, resulting in slower initial volumes.

Pricing has begun to adjust. As competition intensified, Novo Nordisk cut Wegovy’s price in India by roughly one-third, reducing the monthly cost of higher doses from the Rs 24,000 range to closer to Rs 16,000, and lowering starter doses to Rs 10,000–11,000.

The price correction reflects growing pressure on innovator brands to defend market share as affordability and the need for long-term patient persistence draw greater attention.

That pressure is expected to intensify as domestic drug makers prepare to enter the GLP-1 market following the expiry of Novo Nordisk’s key Semaglutide formulation and delivery patent in India in March 2026.

Dr Reddy’s Laboratories is preparing to launch Semaglutide in India, select emerging markets and Canada, having received marketing authorisation in India, with rollouts planned over the coming quarters. Sun Pharma has also secured approval from the Drugs Controller General of India to manufacture and market a generic Semaglutide injection for chronic weight management, to be sold under the brand Noveltreat.

M.V. Ramana, CEO of Branded Markets (India and Emerging Markets) at Dr Reddy’s Laboratories, says: “Semaglutide across multiple markets is an important focus area for us. This is not a category limited only to weight loss. There is growing evidence across diabetes, obesity, cardiovascular and other indications. It is a class of compounds that will remain relevant.”

While GLP-1 drugs have delivered strong weight-loss outcomes, concerns around gastrointestinal side effects, muscle loss and long-term persistence are pushing drug makers to design therapies that are more durable, better tolerated by the human system and easier to use.

This has led companies to explore multi-hormone drugs, combining GLP-1 with GIP, glucagon or amylin, muscle-preserving add-ons, oral options beyond injectables, and broader use across diabetes, cardiovascular, kidney and liver diseases. GIP stands for Gastric Inhibitory Polypeptide, a hormone secreted by the small intestine that stimulates insulin secretion.

GLP-1 drugs work by mimicking a naturally occurring gut hormone that regulates blood sugar and appetite, helping patients feel fuller for longer and reducing food intake. Many of the newer therapies are build on this mechanism by combining GLP-1 with other hormones involved in metabolism.

Lilly's plans

Lilly is organising its post-GLP-1 pipeline around precision medicine, multi-pathway therapies and a broader disease footprint as competition mounts.

Winselow Tucker, President and General Manager of Lilly’s India chapter, says the company’s next wave of innovation is focused on “tailoring therapies to patient subgroups through biomarkers and precision medicine to maximise patient impact.”

Lilly’s research pipeline includes multiple incretin-based molecules in clinical development across a range of diseases. Incretins are metabolic gut hormones released after meals to stimulate insulin secretion.

“Lilly is a leader in incretin development, and we have a portfolio of several incretin molecules in our pipeline that are currently in clinical development potentially for a variety of diseases,” says Tucker.

The company is also advancing work on multi-hormone combinations as part of its longer-term metabolic portfolio. “By 2030, cardiometabolic diseases like obesity, diabetes and cardiovascular disease could affect one third of adults globally,” Tucker warns.

Lilly is sequencing oral and injectable therapies based on patient needs and real-world use. “With distinct mechanisms, formulations and routes of administration, oral and injectable therapies may serve different patient preferences and clinical scenarios,” says Tucker.  

Novo's new interest

A similar approach is visible at Novo Nordisk, which is deepening its focus on next-generation metabolic therapies, multi-hormone combinations and expanded indications as competition builds in obesity and diabetes therapies, including in India.

Vikrant Shrotriya, Managing Director of Novo Nordisk India, says the company’s priority is to ensure that cardiometabolic innovations for chronic diseases are “available, accessible and sustainable for people in India.” He says the company is prioritising its recombinant-DNA-based GLP-1 portfolio, advanced manufacturing, quality and safety standards, competitive pricing, partnerships with local players and access through digital collaborations.

Novo Nordisk is working on higher doses of injectable Semaglutide. Shrotriya cites results from its Phase-3b STEP UP trial, where a 7.2 mg dose delivered 21% weight loss in people with obesity, with one-third of participants losing 25% or more of their weight than they did with a placebo.

A central pillar of Novo Nordisk’s longer-term strategy is the development of multi-hormone therapies. Shrotriya says combinations such as GLP-1 and amylin, a peptide hormone, represent the next major phase of metabolic care, particularly in India, where obesity and diabetes coexist in nearly 70% of patients.

Globally, Novo Nordisk invested more than 52 billion Danish krone ($7.5 billion) in research and development in 2024 and over 129 billion DKK ($18.7 billion) in production capacity, reflecting the scale of expected demand for metabolic therapies.

Amgen's plans

Amgen, which does not yet have a GLP-1 drug on the market, is approaching the obesity market opportunity from a different starting point.

An Amgen spokesperson says the company is developing both oral and injectable medications using incretin and non-incretin gut hormones.

MariTide, a long-acting molecule antibody-peptide conjugate combining a GLP-1 peptide with a monoclonal antibody targeting the glucose-dependent receptor, is central to Amgen’s cardiometabolic portfolio.

With patient adherence a key concern, the spokesperson notes that more than 50% of patients discontinue treatment within one year, and that therapies effective at initiation often become unsustainable over time.

Beyond obesity, Amgen is expanding MariTide into Type 2 diabetes treatments, heart failure, atherosclerotic cardiovascular disease, kidney disease and obstructive sleep apnea. In the longer term, Amgen is also prioritising an integrated cardiometabolic franchise rather than relying on a single blockbuster.

It’s clear that the market for treatment of diabetes and obesity is set for a sea change as drug makers accelerate efforts to replace their blockbusters with a more layered portfolio of long-term therapies.

@neetu_csharma