Obesity’s Next Billion Doses: New patient demands, more differentiated treatments and increased access complexity

A market redefined by complexity

The success of Wegovy and Zepbound/Mounjaro proved that demand for effective obesity treatments could outstrip supply even at premium prices, while redefining obesity as a treatable disease. But what is emerging now goes far beyond a single product boom - it is the convergence of overlapping markets, patient flows, and business models. 

Generics will massively expand access in several of the most populous markets while next-generation incretins redefine care in others, amid shifting reimbursement rules, direct-to-consumer channels, and cross-indication use. The result is the probably most complex commercial and clinical landscape pharma has ever faced - one that exposes the limits of traditional forecasting.

Future drug and portfolio complexity

The next generation of products will stretch across mechanisms, formats, and disease areas.

• Semaglutide generics are expected in India, Brazil, China, and Canada from 2026, driving affordability, potentially massive uptake that is likely to expose quality and supply challenges.

• In Western markets, innovation continues at pace: oral semaglutide (25 mg) orforglipron, CagriSema are anticipated to launch within the next year and retatrutide, and MariTide are among those likely to launch before mid-2028.

• Novo Nordisk’s acquisition of Catalent will boost injectable manufacturing capacity, while Lilly’s orforglipron signals the scalability of small-molecule orals and Amgen’s MariTide will offer monthly injectable dosing.

Differentiation is expanding across a range of areas - efficacy, safety, form factor, mechanism of action, comorbidity label expansion and novel market access initiatives. The market is likely to be big enough to allow for a large number of targeted drugs. Airfinity’s HCP survey analysis shows that while efficacy and cardiometabolic outcomes remain the top priority, preferences are finely balanced between longer-acting injectables and oral therapies - suggesting both formats will compete closely on convenience, not just performance.

Access to further survey insights is available through Airfinity, contact obesity@airfinity.com for more information.

Market and access dynamics

Behind the science lies a fragmented and fast-evolving commercial landscape.

• A continued rise self-pay and uncertain compounding market adds volatility, with parallel supply chains and varying visibility of true patient volumes.

• Markets such as India, Brazil, China, and Canada will see earlier generic entry, driving growth through affordability and local production, while the US and Europe remain innovation-led and patent-protected until 2031–32.

• Reimbursement heterogeneity - partial coverage for comorbidities such as MASH, OSA, and CKD, alongside expanding employer coverage - makes access highly dynamic.

• China is emerging as both a volume and innovation hub, with domestic firms developing and in-licensing incretin assets. Mazdutide, licensed from Eli Lilly to Innovent Biologics for the Chinese market, was recently approved and shown to outperform semaglutide in Phase 3 trials - signalling China’s growing role in global obesity innovation.

These shifting payer, pricing, and policy environments are creating multi-channel markets where patients can move between branded, compounded, and generic products within a single treatment journey. Capturing these dynamics requires simulation approaches that reflect real-world switching and policy evolution, not static market segmentation.

Patient flow and behavioural complexity

As obesity becomes increasingly managed as a chronic disease - a shift likely to accelerate as the Lancet Commission’s recommendations gain wider adoption - Airfinity’s models suggest treatment pathways will diversify into induction, maintenance, and re-treatment phases. Patients will cycle between therapies, dosing regimens, and payment models, often switching between payers as coverage and affordability evolve.

Meanwhile, the expansion of weight management therapies into novel and adjacent indications - from cardiometabolic prevention to liver, kidney, and potentially neurodegenerative diseases - overlapping patient populations and mixed reimbursement pathways are emerging, making forecasting adoption and persistence increasingly complex.

The endgame: Navigating at speed

The obesity market is now defined by unprecedented scale, speed, and interdependence. Scientific innovation, manufacturing capacity, and policy decisions are evolving at different paces - yet each is reshaping the others in real time.

By the early 2030s, as patents expire in the West and production efficiency rises elsewhere, the divide between access and innovation will begin to narrow. But until then, success will depend on understanding how these layers interact - from manufacturing bottlenecks to patient switching patterns.

The next billion doses is less of a science race. The winners will be the companies best able to anticipate the changes, take well calculated risks early on and most importantly move and make decisions at pace at all levels. This is a market dynamic where yesterday’s operating model is not going to cut it.