GLP-1 drugs on WHO Essential Medicines List: what’s the impact? 

Essential medicines are those that treat priority healthcare needs and are made available and affordable to the public. The World Health Organization (WHO) pioneered this list with around 200 medicines, and almost fifty years later, the list is only growing, with over 500 drugs making the cut to help meet the medical needs of people across the world. This year, GLP-1 agonists, which have gained a lot of buzz in recent times for treating metabolic conditions, were added to WHO Essential Medicines List, in hopes that this could make them more accessible. 

How does the addition of GLP-1 drugs to the WHO essential medicines list affect prices? 

While GLP-1 agonists were already on the map before, as they became popular for their effectiveness in treating type 2 diabetes and significantly promoting weight loss in obesity, their inclusion in the WHO essential medicines list clears the path towards equitable access. These drugs roughly cost around $700 to $800 per month in the U.S., according to UChicago Medicine. 

“Essential medicines treat the priority healthcare needs of the population, and by their inclusion on the essential medicines list, the WHO signifies that global access is key,” said Amy C. Reichelt, neuropharmacologist and senior consultant at the biotech consultant firm Cade Group. 

“Due to this move, the WHO is recognizing the benefits of GLP-1 receptor agonists beyond just the management of blood glucose in type 2 diabetes but extending their recognition of their benefits on body weight and adiposity, heart, and kidney outcomes in high-risk type 2 diabetes,” said Reichelt. 

The main GLP-1 that has been introduced is semaglutide, famed for being the active ingredient in Ozempic and Wegovy, developed by Danish drugmaker Novo Nordisk. It is prescribed to adults with type 2 diabetes who also have obesity and comorbidities, such as cardiovascular diseases or chronic kidney diseases.  

Semaglutide works like any GLP-1 agonist. GLP-1 is a hormone that is produced by the proglucagon gene in cells of the small intestine. These cells line the gastrointestinal (GI) tract and express hormones like GLP-1 and peptide YY (PYY), both linked to appetite. 

The hormone binds to its receptor, which is expressed in various cells, including in the pancreas, kidneys, heart, and skin. This hormone boosts insulin production in the body. But in people with type 2 diabetes, the insulin response is impaired. 

So, by mimicking the hormone to stimulate insulin production in the body, diabetes can be better managed, which is what GLP-1 agonists do. When blood sugar levels increase, say, after a meal, these drugs can lower the blood sugar by causing the body to generate insulin, thereby controlling type 2 diabetes. They also suppress appetite and heighten feelings of fullness by sending signals to the brain that regulate hunger and satiety, aiding in weight loss. 

While semaglutide is the most prominent of them all, dulaglutide and liraglutide, as well as the dual GLP-1/GIP agonist – GIP plays a similar role to GLP-1 – tirzepatide, present in Lilly’s Mounjaro and Zepbound, also join the list as “therapeutic alternatives.” Even biosimilars, which are drugs that are highly similar to biologics with regard to their quality, safety, and efficacy, were listed. 

Hayley Miller, medical director of California-based Nurx Weight Management, thinks that the WHO is sending a clear message that governments and health systems need to prioritize access. 

“Hopefully, this will help to bring prices down, support local production, and expand availability. In time, it could make these life-saving treatments more affordable and available to the patients who need them most,” said Miller. 

Echoing these thoughts, Reichelt explained that this can nudge countries to add to their own roster of essential medicines. More than 150 countries have national essential medicines lists framed around the WHO Model List. Once a drug is on the list, countries are more likely to tender for it, negotiate prices, and budget for it, especially in primary care. 

“While listing doesn’t cut prices by itself, it’s the key policy domino. The WHO’s 2025 update also explicitly frames price and generic competition as priorities to expand access to GLP-1/GIP therapies, which encourages payers and manufacturers toward affordability deals,” said Reichelt. 

Diabetes care to ramp up in low- and middle-income countries 

Around 830 million people across the globe live with diabetes, according to the WHO in 2022. This is more than four times the figures back in 1990. And its prevalence has only been soaring; more rapidly so in low- and middle-income countries.  

So, the need for cheaper options remains critical, now more than ever. And although the WHO stopped short of adding GLP-1 agonists to treat obesity alone to the list, they can be prescribed to treat type 2 diabetes associated with obesity. Obesity is the chief risk factor for developing type 2 diabetes, as excess body fat leads to insulin resistance. When the body doesn’t respond well to insulin, this results in high blood sugar, a typical hallmark of type 2 diabetes.  

According to Diabetes UK, around 90% of people with newly diagnosed type 2 diabetes are obese or overweight. The WHO plans to back the use of GLP-1 drugs to treat obesity in adults for the first time, it had declared in a memo earlier this year, in a separate decision from their feature in the essential medicines. 

“Metabolic disease is a spectrum with obesity, prediabetes, and type 2 diabetes all interconnected. The WHO’s recognition may focus on type 2 diabetes, but it’s the first step toward broader use of these therapies across metabolic health,” said Miller. “Hopefully, this will drive policy changes, lower prices, and expand access, while also marking an important shift: seeing obesity as a disease that deserves proactive, evidence-based treatment.” 

The WHO essential medicines list has long been a champion for equitable healthcare access and removing financial barriers in several countries. When medicines to combat AIDS were added to the essential medicines list in 2002, it was regarded as a breakthrough in the “prevention through care” public health strategy at the time. Increased access to antiretrovirals – medicines to treat human immunodeficiency virus (HIV) infections like AIDS – has seen a dramatic fall in AIDS-related deaths – by 69% since its peak in 2004 until now – a major victory for the community. Now, 77% of people living with HIV have access to care. 

Similarly, hopes run high for the likes of semaglutide being added to the list.  

Do GLP-1 generics stand a chance? 

“High prices of medicines like semaglutide and tirzepatide are limiting access to these medicines,” the WHO has stated. Now, generics have a swifter way into the market. Generics are affordable versions of medicines that contain the same active ingredients and are as effective as the original versions.  

Indian generic developer Dr Reddy’s Laboratories proposed to launch the cheaper copycat versions of Wegovy and Ozempic in 87 countries next year. Aside from facilitating access, many drugmakers want a piece of the pie, as the global obesity therapies market is expected to hit $150 billion in sales over the next decade.  

However, it will not be easy, as patents for these medicines have not expired yet. Dr Reddy’s Laboratories was slapped with patent infringement by Ozempic developer Novo Nordisk this year. The semaglutide drugs are protected by patents, and in countries like the U.S., those patents don’t expire until 2031. So, generic entry into the American market will have to wait. However, in China, Canada, and Brazil, copies can make their way in from next year, explained Reichelt. 

“Listing on the WHO essential medicines list adds pressure for price negotiations and may encourage local manufacturers where patents allow. Mounjaro and Zepbound patents in the U.S. run to around 2036, so broad generic entry is further out; Essential Medicines List status won’t override that, but it can catalyze tendering and price deals in the meantime,” said Reichelt. 

New GLP-1 agonists beat Ozempic and Wegovy in studies 

And of course, generics development aside, biopharmas are creating more GLP-1 agonists that could outperform Ozempic and Wegovy. Dual and triple agonists, such as retatrutide, which targets GLP-1, GIP, and glucagon – a hormone that raises blood sugar – are in the clinic. They are “delivering very large weight-loss signals in trials,” pointing to broader metabolic indications, Reichelt noted. 

Moreover, small molecule GLP-1s like orforglipron have demonstrated superiority to semaglutide in late-stage clinical trials. Reichelt believes that this “could simplify manufacturing and scale.” 

Eli Lilly’s candidate orforglipron lowered A1C – a common blood sugar test for diabetes – by 2.2% compared to 1.4% with oral semaglutide at the highest doses in a head-to-head trial, the company announced two days ago. 

“Head-to-head trials are a gold standard for comparing potential treatments,” said Kenneth Custer, executive vice president and president of Lilly Cardiometabolic Health. “At the highest dose, orforglipron helped nearly three times as many participants reach near-normal blood sugar versus the highest dose of oral semaglutide. These results, combined with orforglipron’s once-daily oral dosing and broad scalability, reinforce its potential as a foundational treatment for type 2 diabetes.” 

Besides, combination drugs like CagriSema hit phase 3 goals – although not as impressive as hoped. The Novo drug is made up of semaglutide and the amylin analog cagrilintide, and has the potential to be yet another breakthrough in diabetes care. 

Now, GLP-1s are being trialed in type 1 diabetes studies and for treating cardiovascular diseases. With these drugs flooding the market as well as their addition to the WHO list, development costs could come down. And while this class of therapies failed to secure a spot on the WHO list two years ago, they are now joined by the CFTR modulator Trikafta for cystic fibrosis, a genetic disorder that affects the lungs, as well as the blockbuster cancer drug Keytruda. The developers of both these drugs, Vertex Pharmaceuticals and Merck, have previously received backlash for the high price tags on these therapies. 

With the entry of GLP-1 agonists into the WHO essential medicines list, curtailing prices will become a priority – although cheaper generic alternatives seem unlikely at the moment. 

Miller expressed that this represents a significant shift in the global health community’s approach to metabolic diseases. “[It] further proves that GLP-1 therapies have transformed the treatment landscape for conditions like type 2 diabetes and heart disease.” 

She said: “This acknowledgment confirms that these therapies are not optional but rather essential, life-saving treatments. It also emphasizes that addressing metabolic health is crucial for reducing chronic diseases worldwide, making access to these treatments a global health priority.”