Patent Monopolies Drive Record Profits
Novo Nordisk and Eli Lilly have transformed GLP-1 receptor agonists into unprecedented profit machines. These blockbuster drugs, approved for diabetes and weight loss, generate billions while leaving many patients unable to afford treatment. According to I-MAK’s April report, strategic patent extensions have cemented market dominance while deepening treatment access disparities for Black Americans and other underserved populations.
Patent Thickets Create Decades of Exclusivity
GLP-1 receptor agonists currently use just two active ingredients—semaglutide and tirzepatide—but are marketed across five FDA-approved brands. Ozempic, Rybelsus, and Mounjaro treat diabetes, while Wegovy and Zepbound target weight loss. Despite sharing identical peptide sequences and similar dosage strengths, manufacturers have created extensive patent networks around each product.
For semaglutide alone, I-MAK identified 320 U.S. patent applications and 154 granted patents. The core patents, originally set to expire in March 2026, now extend until December 2031. Furthermore, 49 additional patents cover minor modifications like delivery devices and dosing regimens, pushing Novo Nordisk’s exclusivity to 2042.
Eli Lilly’s tirzepatide follows the same playbook with 53 applications and 16 granted patents extending protection through 2041. These “patent thickets” effectively block generic competition for decades beyond original patent terms.
Shareholder Enrichment Trumps R&D Investment
The financial success of these medications is staggering. Through 2024, cumulative U.S. sales reached $71 billion, with projections of an additional $400 billion by 2030. In 2024 alone, these five GLP-1 products accounted for over 80% of Novo Nordisk’s U.S. revenue and nearly 50% of Eli Lilly’s.
Despite this windfall, shareholder returns increasingly outpace research investment. From 2020-2024, Novo Nordisk spent 41% more on dividends and buybacks than on R&D. Eli Lilly’s recent announcement of a $15 billion buyback program and 15% dividend increase further demonstrates prioritizing investor returns over healthcare innovation.
Investors have added approximately $697 billion in market value to these companies since their first GLP-1 launches—almost 10 times more than the drugs’ actual sales.
Access Gaps Deepen Health Inequities
With monthly list prices around $1,000, GLP-1 medications remain inaccessible to many. Despite obesity affecting more than 40% of U.S. adults, Medicare Part D refuses to cover these drugs for weight loss. Only 13 state Medicaid programs offer obesity coverage as of August 2024.
These barriers disproportionately impact Black Americans, who face higher obesity and diabetes rates. Nearly 50% of Black adults live with obesity (including 60% of Black women), and their diabetes rate is 12.1% compared to 6.9% for white adults. Yet in 2023, Black patients received just 12% of GLP-1 prescriptions while white patients received 85%.
Social determinants of health, including provider bias and pharmacy access gaps, further amplify these racial and economic disparities.
Policy Solutions to Ensure Equitable Access
I-MAK’s report outlines four essential reforms to address these issues:
Reform the patent system: Tighten novelty thresholds to prevent patents for trivial modifications and expedite review processes to challenge abusive filings.
Expand insurance coverage: Recognize obesity as a disease across Medicare, Medicaid, and private insurers, and include these medications in the 2027 drug-price negotiation framework.
Encourage competition: Create streamlined FDA approval pathways for alternatives and support public-sector manufacturing initiatives.
Address structural barriers: Expand culturally competent care, enhance provider training on bias reduction, and strengthen pharmacy networks in underserved areas.
Clinical trials show semaglutide reduces major cardiovascular events by up to 20% in high-risk patients, while emerging research suggests possible applications for fatty liver disease, sleep apnea, and polycystic ovary syndrome. These broader health implications make the access gap particularly concerning—breakthrough treatments with multiple therapeutic applications remain unavailable to millions who could benefit most from their metabolic, cardiovascular, and systemic effects.
Without meaningful policy action, breakthrough GLP-1 therapies risk remaining inaccessible to those who need them most. Addressing patent abuse, mandating broader coverage, and fostering competition are essential to ensuring these life-changing medications fulfill their promise for all patients—not just those who can afford them.
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