HH Kim, CEO and President of MetaVia, asks what the next generation of GLP-1 drugs might look like. 

Over the past two decades, only a few biotech sectors have experienced a hype cycle as rapid and publicly frenzied as the obesity drug sector. In just over a year, GLP-1s have transformed from a medical oddity into a cultural obsession, prompting billions of dollars in investments, unprecedented prescription numbers, and a surge of pipeline activity across big pharma and biotech start-ups. 

As is often the case with rapid ascents, the descent is now imminent. Insurance pushback, patient drop-off, and sky-high out-of-pocket costs are all now threatening to shatter manufacturer expectations. Commentary about a “GLP-1 bust” has already circulated, even as Novo Nordisk and Eli Lilly continue to reach new valuation highs and obesity-focused M&A reaches new inflection points like Roche’s multibillion-dollar bet on 89bio (1). The story is not whether the obesity market is over, rather it is what will differentiate the next generation of obesity drugs.

Insurance matters

Although insurance is one aspect that is commonly considered towards the later stage of drug development, it is quietly reshaping the market boundaries for GLP-1s in the US. While obesity and type 2 diabetes share metabolic roots, insurance companies treat them as different worlds. 

For example, type 2 diabetics often have their GLP-1 therapies widely covered by payers, reducing patient costs to around $30 per month. In contrast, when it comes to obesity alone, patients typically pay about $1,000 or more out of pocket each month (2). 

This disparity has created a misleading narrative: that GLP-1 pricing is universally unaffordable. In reality, affordability depends on diagnosis, not the drug class. The distinction is important because 70-80% of patients with obesity also have prediabetes or type 2 diabetes. Unfortunately, much of today’s obesity discussion neglects what could become the largest market: patients at the intersection of weight management and glucose dysregulation. 

The next generation of drugs will succeed not simply by reducing weight but by addressing the metabolic continuum, from obesity to type 2 diabetes to metabolic dysfunction-associated steatohepatitis (MASH), in ways that align with how payers actually reimburse treatment.

Tolerability is key

While insurance coverage is a powerful indicator of the next generation of obesity drugs, so is tolerability. Moving the needle in tolerability and drop-off rates offers a significant opportunity for differentiation. It has been reported that up to 30% of patients stop using GLP-1s within three months (3). This is mainly due to gastrointestinal side effects, slow multi-step titration schedules, and difficulty reaching or maintaining the optimal therapeutic dose. 

Today’s market-leading injectable GLP-1/GIP agents require five or more titration steps over approximately six months. While this lengthy process is clinically necessary, it poses commercial challenges. It delays the time to see benefits, raises the cost of care, and increases the risk of dropout.

Beyond weight loss – multi-indication metabolic medicine
 

The conversation around obesity drugs has largely overshadowed a broader and equally transformative trend: the emergence of multi-indication cardiometabolic medicine. Over the next decade, the most significant advances are likely to come from therapies that address not only obesity but also type 2 diabetes, MASH, and related cardiovascular risks. 

The industry is seeing that agents capable of safely modulating both glucagon and GLP-1 pathways, for instance, could offer more durable weight-loss outcomes, improve hepatic liquid processing, and effective glucose control for diabetic and prediabetic patients. At the same time, combination therapies, especially oral combinations, are expected to become a key competitive arena as companies work to overcome the constraints of today’s injectable treatments.

Strategic partnerships and M&A

Recent activity across the industry indicates that major pharmaceutical companies not yet deeply invested in obesity are beginning to reassess their strategy. Competitive bidding around recent biotech acquisitions shows strong demand for differentiated metabolic assets. Early-stage biopharma companies are being acquired much earlier in the process compared to other therapeutic areas. 

At the same time, combination approaches, especially oral regimens targeting MASH and broader metabolic disease, are emerging as a key area for collaboration. As the field moves beyond the first generation of obesity, partnerships will play an increasingly critical role in supporting large-scale clinical programmes and outcomes.

The GLP-1 era isn’t ending – it’s evolving

The first wave of GLP-1 therapeutics demonstrated that metabolic diseases can be treated far more effectively than once believed. The industry should be proud of the accomplishments and lives that have been changed. The second wave will determine which therapies deliver faster and more durable results, while addressing both obesity and the broader metabolic landscape. It will improve tolerability and adherence, align with payer economics, and meaningfully improve outcomes for the millions living with obesity linked to type 2 diabetes. 

Over the next decade, actual progress in cardiometabolic medicine will be driven not by hype, but by differentiation. Companies that recognise this, whether through novel dual agonists, combination approaches, or more accessible delivery formats, will meet a market that is still in the early stages of reaching its full potential.

References

1. Fierce Biotech. Roche becomes MASH player via $3.5B for 89bio and its phase 3 drug. (Cited 18 Sept 2025).

2. Accomplish Health. GLP-1 Medications: Healthcare Costs and Coverage Impact 2025. (Cited 9 Feb 2025).

3. Mercer. GLP-1 Discontinuation Affirms need for holistic weight-loss plan. (Cited 24 July 2024). 

About the author

Prior to becoming CEO and President at MetaVia, Mr Kim served as General Counsel and Senior Vice President at Dong-A ST and Dong-A Socio Group. He has been a board member since 2021, held senior legal roles across the group, serves as a director of AnaPath Services GmbH, and holds law degrees from Soongshil University and Washington University School of Law. 

From DDW Volume 27 – Issue 2, Spring 2026 – Read the digital issue here