How GLP-1 drug patents worsen healthcare disparities

Using patent thickets to drive extended exclusivity

Currently, glucagon-like peptide-1 (GLP-1) receptor agonists rely on two active pharmaceutical ingredients -- semaglutide and tirzepatide. However, they are marketed across five brands FDA-approved to treat either diabetes (Ozempic, Rybelsus, Mounjaro) or aid in weight loss (Wegovy, Zepbound).

Although these GLP-1 products differ in delivery method, dosing schedule or approved use, they all rely on identical peptide sequences and similar dosage strengths. This allows manufacturers to tailor marketing and insurance coverage while also layering additional patents across each product, creating what is more commonly known as patent thickets.

By repackaging the same core molecule into multiple branded variants, companies can segment the diabetes and obesity markets and then reinforce that segmentation with fresh patent filings on each device, formulation tweak or indication. This strategy creates overlapping exclusivity periods for essentially the same drug, deterring generic competition and preserving high list prices.

For semaglutide alone, which was first FDA-approved as Ozempic in 2017, I-MAK identified 320 U.S. patent applications and 154 granted patents, including two compound patents now extended from a March 2026 expiration to December 5, 2031. Beyond the core patents, 49 follow-on patents cover minor modifications such as new delivery devices, dosing regimens and formulations, pushing Novo Nordisk's exclusivity to 2042 and effectively deterring generic competition for decades.

First approved as Mounjaro in 2022, Eli Lilly's tirzepatide assets follow a similar script: 53 applications, 16 granted patents and a principal patent lasting until 2036, supplemented by device, formulation and method-of-use patents that extend protection through 2041.

By weaving these patent thickets with patent term extensions, both companies maintain monopoly pricing well beyond original patent and market exclusivity terms.

Financialization metrics

Through 2024, cumulative U.S. sales of Ozempic, Rybelsus, Wegovy, Mounjaro and Zepbound hit $71 billion, with forecasts projecting an additional $400 billion by 2030, bringing the 13-year total to roughly $470 billion​.

By comparison, most blockbuster biologics take 10–15 years to surpass $50 billion in lifetime sales. In 2024 alone, these five products accounted for over 40% of Novo Nordisk's global revenue and nearly 30% of Eli Lilly's.

Yet, shareholder payouts outpace research and development (R&D). From 2020–2024, Novo Nordisk spent 41% more on dividends and buybacks than on R&D, signaling a shift from "public health needs" toward "shareholder enrichment," the report states.

Lilly's late-2024 announcement of a $15 billion buyback program and a 15% quarterly dividend hike further solidifies the emphasis on investor returns over pipeline investment.

As a result, investors have added about $697 billion in market value to Novo Nordisk and Eli Lilly since their first GLP-1 launches, an increase almost 10 times larger than the roughly $71 billion those drugs have sold for so far.

High pricing deepens access gaps

With list prices around $1,000 per month for patients, GLP-1 drug manufacturers seem to prioritize wealth over health. Despite obesity affecting more than 40% of U.S. adults, Medicare Part D refuses to cover these medications for weight loss. And only 13 state Medicaid programs offer obesity coverage as of August 2024, leaving millions without affordable access.

These barriers disproportionately affect Black Americans. For instance, nearly 50% of Black adults live with obesity (including 60% of Black women), and the diabetes rate among Black adults is 12.1% versus 6.9% for Whites. Yet in 2023, Black patients received just 12% of GLP-1 prescriptions while White patients accounted for 85%.

The report notes that racial and economic health inequities are amplified by social determinants of health, from provider bias and pharmacy access gaps to the scarcity of specialized care providers.

Policy recommendations

I-MAK's report outlines the following four-pronged reform agenda to curb financialized patent practices and promote equitable access:

1. Reform the patent system. Tighten the thresholds for novelty and non-obviousness to prevent follow-on patents for trivial modifications and expedite post-grant review processes so that abusive filings can be challenged and invalidated as early as possible.
2. Expand access for GLP-1 therapies. Recognize obesity as a disease across Medicare, Medicaid and private insurers, and include semaglutide and tirzepatide in the 2027 drug-price negotiation framework to reduce out-of-pocket costs for millions of beneficiaries.
3. Encourage generic competition. Establish streamlined FDA approval pathways and support compounded semaglutide production to bring lower-cost alternatives to market well before existing patents expire, and fund public-sector manufacturing initiatives to ensure a competitive supply.
4. Adress structural barriers to access. Expand culturally competent care models, enhance provider training on bias reduction and strengthen pharmacy networks and telehealth services in underserved urban and rural areas to eliminate pharmacy deserts.

Without policy action, GLP-1 therapies risk becoming another breakthrough that benefits shareholders first and patients last. Tightening patent rules, mandating broader coverage and fostering competition are foundational to ensuring these life-changing drugs fulfill their promise for all patients -- not just those who can afford them.

Alivia Kaylor is a scientist and the senior site editor of Pharma Life Sciences.