The Rise of the Out-of-Pocket (OOP) Obesity Market

The obesity market is unlike any other in pharma. In 2024, global spending on prescription anti-obesity medications (AOMs) such as Wegovy and Zepbound/Mounjaro exceeded $30 billion, with projections reaching $100 to $200 billion by 2030¹. But this growth is not just about blockbuster drugs – it reflects an unprecedented level of patient-led demand and willingness to pay OOP, especially outside of the US and in markets used to reimbursement. As public payers debate or decline reimbursement and private insurers flip-flop on coverage, patients are increasingly taking matters into their own hands and self-funding treatment. In the UK alone, where reimbursement is tightly restricted, over 2 million people are paying out of pocket as of July 2025 – almost seven times more than those receiving NHS-funded care for AOMs (Figure 1).

This patient-led momentum means that, outside of the US and Japan, the OOP market takes on a new significance versus the traditional, medically led reimbursement model. The market’s rapid expansion underscores a shift in healthcare dynamics, where patients’ consumer-like demand is reshaping access models and accelerating innovation. And the ecosystem is evolving to meet them where they are. E-script platforms and online clinics are enabling consultation, diagnosis and prescription at scale. The pipeline is also responding in kind to meet some of these consumer-like needs: of the 180+ clinical-stage obesity drugs in development, more than 40% are oral², designed for convenience.

The obesity OOP market is also redefining geographic prioritisation for pharma, with the Middle East being elevated to the top ex-US markets. The UAE and Saudi Arabia combine high prevalence and willingness to pay with streamlined regulatory pathways. Lilly’s launch of Mounjaro in the UAE just two months after its US debut exemplifies how OOP dynamics are elevating the region’s strategic importance in global launch planning.

The significance of the ex-US OOP market is set to remain in the future not only in “traditionally OOP” markets like Brazil and India (high volume markets) where GLP-1s are not even reimbursed for diabetes, but in “traditionally reimbursed” markets too. While reimbursement may expand with the future availability of lower cost off-patent semaglutide, it is likely to still be limited to a subset of the eligible population, such as those with BMI >35 or 40+ with comorbidities leaving a large proportion OOP. The global OOP market for AOMs is here to stay; challenging and re-thinking traditional access strategies is essential for success.

Knowing the Patient & What Matters to Them

Understanding The Patient

In the OOP channel, patients are active decision-makers rather than passive recipients of care. They weigh up price, convenience, and perceived value, often making trade-offs that differ from traditional payer logic. While payers assess value through clinical and economic frameworks, patient preferences are driven by simple, tangible attributes: how much weight will they lose, how quickly, how tolerable is the experience and how much will it cost them (Figure 2).

Price Elasticity as an Intrinsic Function of the OOP Market

Affordability and price elasticity are defining features of the OOP market that in turn must become key considerations for pricing strategy. In contrast to reimbursed markets, OOP pricing approaches must reflect patient purchasing power and account for demand elasticity. The OOP segment behaves more like a fast-moving consumer goods (FMCG) category differing from the more stable dynamics of reimbursed markets, which follow established value-for-money frameworks and predictable payer systems.

The use of limited time/introductory offers by Novo Nordisk and Lilly (Figure 3), mimicking supermarket promotions, illustrates that price elasticity matters. Consumer behaviour, such as remarkably low persistence rates and dose rationing (measured by “click counting” of pens), and consumer experience shared on social media* indicate significant price sensitivity for some. Many patients are willing to accept less dramatic weight loss outcomes if the cost is lower – a trend that explains the success of compounders in the US offering semaglutide at reduced prices, or at lower doses at even lower prices³. Conversely, when branded products are priced competitively, factors such as convenience, formulation, brand perception become key differentiators. In the US, cash-paying patients have a 12-month persistence rate of 13%, while insured individuals see rates of 36%⁴.

*32% of negative social media AOM experiences expressed cost concerns (social media listening conducted by IQVIA⁵)

As oral Wegovy and orforglipron (Novo Nordisk and Lilly, respectively), new branded competitors (Boehringer Ingelheim, Amgen, AstraZeneca, Roche) and off-patent semaglutide enter the market from 2026**, pricing agility will be essential. But with it comes the risk of a race to the bottom. Unlike traditional pharma, where manufacturers retain most of the economic value, the FMCG model often sees margins erode as value shifts to the patient. Entering a price war may drive volume, but it can also destroy long-term value. Protecting margin and brand equity must remain central to strategy.

Innovators must think beyond traditional pharma orthodoxy and adopt FMCG-style tactics, without triggering a price war. Not just at initiation, but across the entire patient journey – dynamic pricing, promotional strategies, brand differentiation are all key to staying competitive and helping to minimise patient switching.

**Off-patent semaglutide from 2026 in Brazil, Canada, Turkey, South Africa, India, China, and possibly Saudi Arabia & United Arab Emirates, with rest-of-world expected from early 2030s

Rethinking Evidence: What Matters to the OOP Patient

In this environment, the traditional hierarchy of evidence is being upended. Unlike payers, who demand rigorous clinical endpoints and health economic models, patients are driven by clarity, simplicity, and perceived value. Patients want to know: “Will this help me lose weight quickly and safely?”. They are influenced by clear headline claims based on clinical evidence, but they don’t need dense data tables. That’s why messaging like “nearly 50% more weight loss than Wegovy”*** resonates. Real-world outcomes beyond weight loss, such as body image, mobility, and social confidence, also give AOMs broader appeal and can influence long-term adherence. This is particularly true in the maintenance setting after patients achieve weight loss goals; better value maintenance options are needed that involve lower dosing and integrate effective lifestyle interventions.

***Headlines that were published based on results of Lilly’s Ph3b SURMOUNT-5 clinical trial, showing tirzepatide provided 47% greater relative weight loss compared to semaglutide

Healthcare professionals still play a role in prescribing and treatment decision-making, but the patient is now a key decision-maker. This calls for wraparound patient support to improve compliance and outcomes (see IQVIA blog “Digital Solutions for Obesity: Revolutionising Care and Management”), as well as a more “consumer-centric” evidence strategy: blending traditional tolerability and efficacy data with emotionally resonant, easy-to-digest proof points that speak directly to patient goals and preferences.

Executing a Frictionless P&MA Strategy

Successfully executing an OOP P&MA strategy in the obesity space requires more than just understanding the patient and a price & evidence rethink; it also demands a deep understanding of the OOP access system of a market. Each country presents its own mix of regulatory frameworks, prescriber dynamics, and OOP readiness. So how can pharma make access as frictionless as possible for the patient?

Engage the OOP Stakeholder System

Unlike more established and long-standing therapeutic areas like oncology, the obesity management ecosystem is rapidly evolving with multiple novel elements to grapple with. Success requires understanding and engaging all stakeholders in this ecosystem.

Obesity care spans a wide spectrum of comorbidities - diabetes, cardiovascular disease, sleep apnoea, and more - each managed by different specialists. Add to that the diversity in prescriber types across geographies, and the complexity multiplies. For example, pharmacists can prescribe AOMs in Brazil, parts of Canada, and some US states. In contrast, GPs prescribe in Germany and Australia, while prescribing was restricted to specialists in France up until May 2025.

Digital health providers are emerging as a critical stakeholder, offering new pathways that bypass traditional barriers. The rise of e-prescriptions and online platforms ahead of the market rate is streamlining access, eliminating the need for in-person visits to the GP or specialist in many cases. Even outside the US, e-pharmacies are growing; online dispensing of AOM volume for England’s distant selling pharmacies increased by 13.2% in 2024 vs 3.8% for brick-and-mortar pharmacies⁶.

However, this shift is far from uniform across markets. Regulatory environments vary significantly, with some countries imposing stricter controls (Figure 4). For example, Switzerland bans online pharmacies, while Spain and Italy restrict online prescription purchases. Additionally, the structure of the online channel itself is often complex, with varying degrees of digital integration across prescription, dispensing and delivery – some services are fully virtual, while others still rely on offline components for key steps in the patient journey.

However, it is important to remember that engaging with the right stakeholders only enables so much. Affordability remains the ultimate barrier to access. Obesity disproportionately affects lower socioeconomic groups, and even the most seamless digital solutions must contend with cost constraints for those who need treatment most.

Intra- and Inter-Market Trade-Offs

Pharma companies must consider the impact of an OOP strategy for obesity in markets where both reimbursed and non-reimbursed channels exist, especially for reimbursable indications like Type 2 Diabetes treated by the same molecule under different brands (e.g., Wegovy vs Ozempic) or the same brand (e.g., Mounjaro in Europe). In these hybrid markets, pharma must carefully navigate the interdependencies between channels and assess the pricing implications and come up with innovative solutions.

For example, if launching the AOM into the OOP channel first, in many markets the OOP list price could set a ceiling for the reimbursed channel with steep discounts required to gain access. The ability to offer significant discounts and separate list from net price and apply a differentiated pricing strategy by indication or channel varies by market. Where two indications are involved, this indication-based pricing by channel creates risks of off-label use and can jeopardise payer perception, raise budget impact concerns and negatively impact price negotiations for the reimbursed indication and potential future indications. Figure 5 spotlights Lilly’s recent success in Germany, where strategic channel management helped navigate these complexities.

Inter-market trade-offs add further pressure, as actions in one country can influence others. OOP pricing policy should be mindful of parallel trade, not just across the EU, but also in the US, where patients might head to places like Canada for cheaper AOMs, especially with off-patent semaglutide there from 2026. In countries like Norway, Canada and Greece, international reference pricing (IRP) applies to both reimbursed and OOP prices, limiting flexibility. Even where OOP prices are not formally included in IRP calculations, they can still inform payer expectations through informal benchmarking. The recent announcement that Lilly⁷ will raise the UK list price of Mounjaro by up to 170% (from £122 to £330 for the highest dose) underscores the global dynamics at play. As the increase does not affect reimbursed pricing, this highlights how OOP prices are responding to international pricing pressures, namely the US government's Most Favored Nation (MFN) proposed policy, which aims to benchmark US drug prices against those in other countries.

Such shifts demonstrate that OOP pricing, typically seen as outside formal policy frameworks, is not immune to global market forces. Pharma must therefore balance short-term commercial gains with long-term pricing sustainability – across both channels and geographies.

Future Outlook

In most ex-US markets, even where reimbursement is possible, the OOP channel is expected to remain the dominant source of volume for the foreseeable future. Reimbursed and OOP models will likely coexist long term, with OOP continuing to play a critical role in patient access. In markets like India, where reimbursement is not expected, OOP will remain the only viable route, reinforcing the need for tailored strategies across geographies.

To succeed, companies should master the complexities of the OOP model (Figure 6) by building patient insights, partnering with digital and retail health providers, and assessing DTC models for broader use. Agility is essential as pricing and competition shift rapidly. With off-patent semaglutide and new oral brands emerging from 2026, pharma should leverage FMCG pricing expertise, invest in real-time tracking of patient persistence and switching behaviours, and target drivers of engagement and loyalty beyond price.

References

1) IQVIA webinar: Obesity in 2025 and beyond

2) IQVIA Analytics Link; clinicaltrials.gov

3) Reuters (August 2025): Noom launches low dose of compounded weight-loss drug for $119 | Reuters

4) IQVIA LAAD

5) IQVIA blog: Social Maturity: how have social media conversations about Obesity management and AOMs evolved with the market in two key countries?

6) NHS BSA dispensing data, December 2024, items dispensed

7) Reuters (August 2025): Lilly to hike UK price of Mounjaro weight-loss drug by 170%