The U.S. obesity-drug market is confronting an uncomfortable reality for pharmaceutical giants: affordability, not innovation alone, is shaping patient behavior. Speaking at the J.P. Morgan Healthcare Conference, Mike Doustdar estimated that as many as 1.5 million Americans are currently using compounded versions of GLP-1 drugs. The disclosure highlights how unapproved but lower-priced alternatives have captured a meaningful share of demand, even as branded therapies dominate headlines and clinical narratives.

Price Sensitivity Exposes a Structural Market Gap

According to Doustdar, compounded GLP-1 drugs—often sold online and marketed directly to consumers—have thrived because they addressed an unmet economic need. Monthly prices around $199 stand in stark contrast to branded GLP-1 therapies, which can run several hundred dollars per month without insurance coverage. For many patients, particularly those excluded from reimbursement, the choice has been less about safety trade-offs and more about basic affordability.

This dynamic underscores a broader challenge facing drugmakers: the U.S. healthcare system’s fragmented coverage structure leaves large segments of demand underserved. Compounders moved faster than pharmaceutical companies to capture these consumers, revealing a blind spot in early pricing and access strategies across the obesity-care landscape.

Novo Nordisk Walks a Fine Line on Access and Safety

Novo Nordisk has consistently warned about the risks associated with compounded and counterfeit GLP-1 drugs, emphasizing quality control and patient safety. Doustdar drew a clear distinction between legitimate telehealth providers and online pharmacies—which Novo supports—and a separate cohort of sellers offering unsafe, knock-off products.

The company’s concern is not merely commercial. Compounded drugs, while legal under specific circumstances, bypass the rigorous manufacturing and oversight standards applied to branded medicines approved by the FDA. From a regulatory standpoint, the proliferation of near-copies raises questions about enforcement capacity as demand for weight-loss treatments accelerates.

Strategic Repricing Signals Competitive Pressure

In early January, Novo launched a daily oral version of Wegovy in the U.S. at a starting cash price of $149 per month. The move reflects a strategic pivot: rather than relying solely on insurers, the company is courting cash-pay patients who have already demonstrated willingness to seek alternatives.

This pricing shift signals how competitive the GLP-1 market has become. With rivals expanding capacity and compounders filling access gaps, Novo’s decision suggests that defending market share now requires flexibility on both formulation and price—an adjustment that could pressure margins but expand the total addressable market.

What This Means for the Obesity Drug Market

The rise of compounded GLP-1s is a case study in how consumer behavior can disrupt even the most sophisticated pharmaceutical franchises. For investors, the lesson is nuanced. Branded players still command clinical trust and scale, but pricing power is no longer absolute. Regulatory enforcement, insurance reform, and manufacturer pricing discipline will jointly determine whether compounded drugs remain a parallel market or fade as access improves.

Looking ahead, obesity care appears set for a two-track evolution: premium, regulated therapies alongside lower-cost alternatives filling systemic gaps. How quickly large drugmakers adapt may define competitive outcomes through 2026 and beyond.