The Future of Obesity Medicines

A recent landmark study around weight-loss medicine could spark near-term growth opportunities in pharmaceuticals.

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Mark Purcell: Welcome to Thoughts on the Market. I'm Mark Purcell, Head of Morgan Stanley's European Pharmaceuticals Team. 

Terence Flynn: And I'm Terence Flynn, Head of the U.S. Biopharma Team. 

Mark Purcell: And on this special episode of Thoughts on the Market, we'll give you an update on the global obesity challenge. It's Thursday, the 10th of August, and it's 1 p.m. in London. 

Terence Flynn: And 8 a.m. in New York. 

Terence Flynn: Now, a year ago, we came on the show to discuss our views on the global obesity challenge, and the problem has since received significant media attention. We believe that the narrative around obesity has indeed changed, with a more empathetic media tone, exponential social media growth and increased recognition across health care professionals and policymakers. Mark, what exactly happened over the last year? 

Mark Purcell: Well, Terence I mean the uptake of obesity medicines in the US has been much stronger than we anticipated. In fact, obesity drug demand has outstripped supply, as you said, driven by social media activity, but also a rapid expansion in reimbursement. When we look back, about 12 million individuals suffering with obesity were covered by insurance and employee opt-ins for the first generation of these appetite suppressing medicines. For newer, higher efficacy GLP-1 medicines, about 40 million lives are covered, and that is more than the estimated number of individuals living with diabetes in the US, which is projected to be about 37 million. 

Terence Flynn: Great. Thanks, Mark. Now the greater focus on weight management has spilled over into an increasingly weight centric approach to treating diabetes. What changes are you seeing and how are they impacting the industry? 

Mark Purcell: Terence you're absolutely right. Look, for many years, treatment guidelines for diabetes focused on blood sugar control only. Just before the pandemic, there was an increasing focus on controlling cardiovascular risks as w ell, such as preventing heart attacks. In the past 12 months, there's been increased focus on weight management for diabetes, which can help prevent the progression of diabetes and potentially reverse the course of the disease if you catch it early enough. It's estimated about 40% of GLP-1 prescriptions in the US are for patients early in the course of their disease. These dynamics have driven a profound acceleration in the uptake of GLP-1 medicines in diabetes, and we now project GLP-1 sales in diabetes alone to exceed $56 billion in 2030. 

Terence Flynn: Mark, I know this SELECT trial has been a focus and this was the first large randomized trial to test whether long term treatment with a weight loss drug can meaningfully improve patients cardiovascular health. Now, this trial appears just to be the tip of the iceberg when it comes to market expansion. Maybe you could walk us through your thoughts on the recent data. 

Mark Purcell: Yeah, thanks Terence. I mean, SELECT is a really important obesity landmark study. It addresses the question does weight management save lives? The trial was designed to show a 17% reduction in the risk of heart attacks and strokes and cardiovascular deaths in non-diabetic individuals suffering from obesity who are treated with GLP-1 medicines. And we just got the data top line the other day, and in fact, these medicines are showing a 20% reduction in heart attacks, strokes and cardiovascular death. As you said, I mean, this is just the tip of the iceberg when it comes to new growth opportunities for weight loss medicines, with positive data to be presented at the American Heart Association meeting in November, the SELECT data and also data in heart failure, and then next year we get exciting data in obstructive sleep apnea, in chronic kidney disease and also in peripheral arterial disease. Back to you, Terence. What is your outlook for the size of the obesity market in the US and globally over the next 5 to 10 years? 

Terence Flynn: Thanks, Mark. As you mentioned earlier, the uptake of obesity medicines in the US over the last year has been stronger than we anticipated. There have been some supply chain shortages that have capped an acceleration uptake in the US, and delayed the rollout of these medicines outside of the US. But a number of companies are making significant manufacturing investments today which will help improve supply on a global basis, but also create barriers to entry in the future. We're projecting that sales of the new obesity medicines in the US would have exceeded $7 billion this year, if the supply challenges had not been an issue. But if we extrapolate these strong early dynamics in the US, we project the global obesity market could reach over $70 billion in 2030. Our prior estimate was over $50 billion. 

Mark Purcell: And Terence, are there any regional differences between Europe and the US and possibly other parts of the world? 

Terence Flynn: Now, the majority of the upgrade, Mark, to our forecasts really centered on our US assumption. And this reflects the limited rollout of these drugs in other countries, in part due to supply constraints I mentioned, but also lack of visibility with respect to demand and payer dynamics across different regions. In the future, we do expect this to change, as I mentioned, given improving supply dynamics, improving reimbursement and the rollout of newer oral options that could also help improve global access. 

Mark Purcell: So where are we in terms of GLP-1 obesity medicine prices, when it comes to the consumer and when it comes to insurance reimbursement? 

Terence Flynn: Yeah, thanks, Mark. I mean, the injectable GLP medicines right now for diabetes are priced at about $900 to $1000 per month here in the US, but net prices are more in the $500 per month range. Now, in obesity, these drugs do cost somewhat more, but over time prices could converge lower. Now, insurance coverage, as you mentioned, Mark, is still a work in progress with over 40 million people now covered. But in our view, the SELECT data, in conjunction with legislation, could really help to expand coverage further. Going back to you, Mark, what's next in the pipeline for these GLP-1 medicines? 

Mark Purcell: The key focus is if the industry's pipeline at the moment are combination approaches and new ways to deliver these medicines. We've previously drawn parallels between how the high blood pressure market evolved in the 1980s and how we expect the obesity market to develop in the future, where combining different mechanisms can lead to better and more consistent treatment approaches. In obesity, targeting liver fat and lean body mass, these are things that can improve the quality of weight loss. There are a number of oral treatment approaches in development as well now, which we expect to broaden the appeal of GLP-1 medicines to a new audience, so really, it's an exciting time in the obesity global challenge. 

Mark Purcell: Terence, thanks for taking the time to talk. 

Terence Flynn: Great speaking with you, Mark. 

Mark Purcell: And thanks for listening. If you enjoy Thoughts on the Market, please leave us a review on Apple Podcasts and share the podcast with a friend or colleague today.