The pharma world has spent the last couple of years acting like GLP-1’s can’t lose. There are tons of Americans with obesity. Drugs like Wegovy and Zepbound cause dramatic weight loss. New indications keep adding to the pie. Projections suggest obesity drugs could approach $100 billion in annual sales within the next 10 years. But here’s a potentially problematic question, though. Millions of Americans will want GLP-1’s. What if they aren’t willing (or able) to pay what these drugs cost, and many quit after using them for a short time? We may see increased GLP-1 utilization with less revenue growth. Or maybe less revenue overall.

I was reviewing focus-group tapes with former and current GLP-1 users. Among patients who quit taking GLP-1s, a recurring theme emerged: they felt better after stopping. They consistently said, “no more nausea, no more constipation, and no more injections. I emailed the moderator to ask her opinion, and she wrote back, “I was surprised at the people who said they felt better after stopping the medications”.

It left me wondering…is the GLP-1 market overhyped?

Early signals are starting to surface.

Look at what happened in Massachusetts. Multiple commercial plans stopped covering GLP-1s for weight loss. The Massachusetts Health Policy Commission projected that 112,000 commercially insured lives would no longer use GLP-1s for weight loss in Q1 2026. That’s a 52% decrease from 2025. They project these lower utilization numbers will drive down spend on GLP-1’s in 2026.

This isn’t just a reimbursement risk we are theorizing about. This is what could happen.

Many employers are also getting frustrated with rising costs. According to a 2026 survey by the Business Group on Health. Approximately 8/10 employers believe GLP-1s are driving higher medical costs. While 67% of employers cover GLP-1s for weight management, only 72% plan to continue covering them in 2027. 10% said they probably won’t continue to offer coverage.

One employer survey showed GLP-1 weight loss drugs accounted for an average 11.4% of total annual claims for employers that offered coverage in 2025. That’s a lot of dollars going to one area of benefit spending. The drugs may work. But many employees could qualify for long-term treatment. Even at steep discounts, they can cost your company a fortune.

So you have a great drug that may not be cost-effective to offer your entire population.

People aren’t sticking with them.

Another thing that pharma loves is when patients take their drugs long term. Obviously, someone who takes a drug for 5 or 10 years is worth more to a company than someone who takes it for 6 months. Patients have not been adhering to these drugs long term.

A 2026 study analyzed over 201,000 patients with obesity. They started taking either semaglutide, tirzepatide, or liraglutide. Patients had a 55% chance of stopping their medication within 12 months. Across all obesity patients. Patients who took semaglutide had a 57% chance of discontinuing their drug. Tirzepatide was 43%.

So here’s the takeaway.

If we acquired 10 million new GLP-1 patients and half stopped within a year, we would need to acquire tons of new patients to replace those who left. At some point we will have to acquire more than we lose. That doesn’t leave us with unlimited growth upside.

Adverse Events Will Cost Us Sales But Not As Many As You Think.

GI effects are known to occur with GLP-1s. Among patients treated for weight reduction with Zepbound, about 56% experienced GI side effects vs. 30% on placebo. About 4.8%- 6.7% of patients permanently stopped taking Zepbound because of side effects, depending on the dose.

But I don’t think adverse events are the reason most people stop taking GLP-1s. A recent article from Nature Reviews Endocrinology. Listed reasons why patients stopped using GLP-1’s. These included GI effects, cost, not feeling the drug was effective enough, and uncommon side effects.

There are many barriers that will cause patients to stop using these drugs.

Cost.

Prior Auth.

Not covered.

Injections.

Side effects.

Long-term therapy.

Expectations.

All of these add up to friction that can deter people from staying on their meds.

Net Prices May Be The Story No One Wants To Hear.

We should monitor how many patients are taking GLP-1s. But what are we charging them? As mentioned above, Massachusetts net prices have dropped 43% from 2019 to Q1 2026. After utilization started to spike in 2023, prices have decreased by an additional 18%. We are starting to see this trend with manufacturers as well.

Lilly saw worldwide sales increase 48% in Q2 2026. Volume grew 60%, but realized prices dropped 13%. Zepbound grew 46% to $4.93 billion. Mounjaro grew 91% to $9.94 billion.

The market doesn’t seem to be slowing down, right? Maybe we will see volume outpace price declines in the near future. But at some point, manufacturers will have to give these drugs to more patients at a lower price point.

Novo has already predicted that prices will continue to come under pressure from competitors and payers. They forecasted sales in 2026 to be down 5%-13% at constant currency. Even as GLP-1 continues to grow.

Remember, GLP-1 utilization can rise, but sales can fall.

What About Cash Pay?

Many manufacturers have tried to circumvent this issue. They lower prices and sell directly to consumers. Telehealth companies and cash-pay pharmacies have opened another avenue for obesity drugs.

Novo stated that DTC sales account for about 30% of US Injectable sales. That’s pretty high. However, if you’re paying $150-$350 a month for your medication. That can add up to a lot over time. It’s cheaper than what you would pay for a $1000+ drug. But still expensive for many. We may see prices continue to drop, which will open the market to more people. But also reduce our sales.

Here’s the Other Side Of This Argument.

Don’t get me wrong, I don’t think we’ll see a crash in GLP-1 sales anytime soon. People still want to take these drugs. Lilly’s sales show that. Zepbound grew 46% in Q2 2026. Mounjaro grew 91%. Novo is also seeing growth in GLP-1 utilization in 2026. Their Wegovy pill is starting to pick up, too.

Government coverage could also drive more utilization. Medicare recently launched its GLP-1 Bridge program, which will allow eligible patients to receive GLP-1’s for $50 out of pocket. Starting July 2026. This could increase utilization even more.

If we see more oral options come to market. We could attract more patients who don’t want to inject themselves. More indications could also lead to better payer coverage. As we see these drugs used for more than just weight loss. Will people stop using GLP-1’s? No. Will revenue growth slow? Possibly.

My Scenario.

I believe we will see slower growth in GLP-1 sales over the next few years. I would give that a 70%-80% probability. I would also give it a 30%-40% chance that we will see a year-over-year dip in sales. In the US market, specifically for obesity. Due to lower prices and less coverage from commercial plans. And patients stopping their medication.

I don’t believe we will see a crash in demand for these drugs. These are just my thoughts on what I believe could happen. Not official predictions. We will likely see more patients using GLP-1’s in the next 5 years.

It’s just that we’ll make less money off each one.m More people are using GLP-1s, and less revenue is coming from them. That could be the paradox we face.

Companies will have to lower prices to ensure coverage. Patients will have to pay less to stay on their medication. Competition will only drive prices lower. On top of that, we will need to keep filling the pipeline with new patients.

We all knew GLP-1’s would be effective. Now we know people want them. Next, we will learn how much money they can actually make. Which may not be as much as we thought.