GLP-1 Pricing Deals Clear Path for Future Competitors, Metabolic Space Heats Up

Novo Nordisk and Eli Lilly's recent pricing agreements for their GLP-1 obesity treatments have set the stage for potential new entrants in the cardiometabolic space, according to a 2026 preview report from PitchBook. The deals, part of the TrumpRx initiative, are expected to expand the addressable market and streamline the regulatory pathway for future competitors.

Expanded Market and Regulatory Clarity

The addition of approved GLP-1 drugs to Medicare and Medicaid under Most Favored Nation pricing is set to increase the addressable market by 7 to 15 million people. This expansion not only opens up new patient populations but also addresses previous insurance coverage challenges.

PitchBook's analysis suggests that while Novo Nordisk and Eli Lilly have solidified their positions as market incumbents, the agreements pave the way for new biotechs in the pipeline. "Expanded CMS coverage strengthens the case for broader GLP-1 label indications and reinforces long-term cardiometabolic franchise strategies," the firm stated. The report also highlighted that later entrants could benefit from a clearer regulatory pathway and a larger patient and prescriber base, potentially accelerating adoption of differentiated products.

M&A Activity and Investment Trends

The metabolic space has seen significant M&A activity, exemplified by the recent Pfizer-Novo bidding war for Metsera, which concluded with Pfizer's $10 billion acquisition. This high-profile transaction underscores the "escalating strategic urgency" in the cardiometabolic field.

PitchBook's report indicates that there are currently 120 assets in development across 60 companies, suggesting ample opportunities for future deals. The firm predicts that as competition for late-stage assets intensifies, acquirers may shift their focus to earlier-stage, higher-risk platforms offering novel biology or delivery modalities.

Venture capital activity in biopharma, which reached a low point in the second quarter, showed signs of recovery in the third quarter. This trend is expected to continue into 2026, with anticipated rate cuts potentially increasing investors' risk appetite. Beyond obesity treatments, Big Pharma companies have shown interest in CAR T cell therapy, antibody-drug conjugates, and small molecules.

Policy Implications and Future Outlook

While the initial TrumpRx agreements have alleviated some industry concerns, 2026 will introduce a direct-to-consumer option for patients. PitchBook notes that despite headline price reductions, it remains unclear whether the TrumpRx model will significantly lower out-of-pocket costs for patients. However, the benefit to pharmaceutical companies is evident, as they avoid potential heavy import tariffs.

The report emphasizes that the TrumpRx initiative reflects a growing push to bypass pharmacy benefit managers and improve price transparency in the pharmaceutical industry. As the landscape continues to evolve, companies like Verdiva Bio, Kailera Therapeutics, and ReCode Therapeutics have been identified as having exit potential in 2026, signaling ongoing dynamism in the sector.