The anti-obesity medication (AOM) market is entering its most challenging period to date. There are multiple drugs in late stage trials that could reshape clinical practice and payer strategy through 2027 and beyond. While injectable GLP1 related therapies dominate today’s market, the next wave of drugs aim to address convenience (oral vs injection, no need to take on an empty stomach), and an improved clinical profile (more fat loss vs muscle loss). They are being studied for obesity, diabetes and more targeted conditions like obesity plus knee osteoarthritis. New drugs and new indications could impact pricing in two ways: lowering prices due to competition and increasing prices through brand innovation. Both have the potential to increase demand and will require revamping utilization management frameworks.
Near-term (2026): Oral GLP1s and combination therapies
On April 1, 2026, the U.S. Food and Drug Administration approved orforglipron (Foundayo, Lilly) Foundayo is indicated for adults with obesity or overweight with at least one weight‑related comorbidity. Unlike injectable GLP‑1s, Foundayo is a small‑molecule (non‑peptide) drug taken as a pill without food or water restrictions. Lilly noted that Foundayo demonstrated clinically meaningful weight loss in Phase 3 trials, with a safety profile generally consistent with the GLP‑1 class. There are no dosing restrictions and the medication doesn't require refrigeration. Foundayo will be available on Lilly Direct by April 6, followed by retail stores. The employer pricing is still to be determined, but estimated monthly costs for cash‑pay patients are $149 for the lowest dose and up to ~$349 per month for higher doses. Lilly will offer coupons to decrease patient cost sharing to ~$25 per month for commercially insured members. The pharmacy benefit manager (PBM) formulary, coverage and utilization management strategies are still being worked out. The impact on employers’ net costs isn't yet known.
Also expected by late 2026 is Novo Nordisk’s CagriSema, a fixed-dose injectable combining semaglutide with an amylin analog. Head-to-head data suggest CagriSema may not lead to more weight loss than tirzepatide (Zepbound).
Amylin drugs have been on the market to treat diabetes for about 20 years and were studied for obesity in the mid-2000s. Early trials showed meaningful (5–7%) weight loss, but frequent injections and poor tolerability limited adoption. Advances in peptide engineering make amylin a potential addition to a once-weekly GLP1 treatment.
Medium-term (2027): Next-generation injectables
Lilly’s retatrutide, a medication that leads to weight loss through three hormonal pathways, could help people lose more weight. It’s expected to be approved in the second half of 2027. Another drug in advanced trials is survodutide, which acts on two hormonal pathways. Early results suggest it's less differentiated clinically. Adding more hormonal pathways to weight loss drugs can increase energy expenditure and alter fat metabolism. Survodutide is important because it’s made by Boehringer Ingelheim. This is the first potential major competitor to Eli Lilly and Novo Nordisk, which currently dominate the weight loss market. Tirzepatide and semaglutide could also gain approval for additional conditions in 2027, including chronic kidney disease and diabetic retinopathy.
Longer term (2028+): More combinations
Research is happening to add monoclonal antibodies to GLP drugs. These antibodies are known for their potential to enhance weight loss and maintain lean muscle mass in patients with obesity. Other use cases include autoimmune disease, where semaglutide and other agents are being studied as adjunctive treatments for autoimmune disease. MariTide is a drug that targets two hormone receptors and could be given once monthly, every-other-month, or quarterly, according to Amgen, the manufacturer.
Employer implications
Employers and payers should prepare now for higher demand for oral AOM, evolving PBM exclusion strategies and member demand for broader coverage as convenience improves. Even with utilization controls, pipeline momentum suggests sustained cost and access challenges through the next several years. As the market changes, the list and net prices for current drugs are going down because of direct-to-patient pressures, the government’s push for price transparency and the removal of rebates, and with increased product competition. However, we expect new brand-name drugs and consumer demand to drive increased utilization for the foreseeable future.
Utilization growth projections
- Oral GLP-1s are expected to increase GLP-1 utilization by 5–15%, based on PBM estimates
- The use of GLP-1 drugs is expected to grow 20–30% overall in the next two years
- Market share and utilization estimates may not fully account for cash-pay (direct to consumer) versus commercially covered prescription volume
These advances are expected to increase demand as the next wave of products are likely to be more convenient or offer incremental clinical improvements over existing drugs. Price reductions for the currently available drugs will also increase demand — as price goes down, utilization goes up. New anti-obesity drugs could offer additional clinical benefits and increase pressure to decrease net prices. But the costs of obesity therapy are likely to remain a challenge for employer-sponsored health plans.
