Oral glucagon-like peptide-1 (GLP-1) drugs are accelerating replacement of insulin. GLP-1 drugs have been gaining popularity for the treatment of type 2 diabetes (T2D) due to once-weekly injections vs thrice-daily for insulin, replacing insulin in 8% (or 35mn) of global diabetes prescriptions in 2023. This is expected to accelerate to 12% (or 62mn) by 2026F due to developments in oral GLP-1 drugs, including a new drug launch in 2H24 and expected positive clinical trial readout in 1H25.
Negative for insulin makers. With insulin slowly being replaced in the context of diabetes treatment, insulin makers with high reliance on insulin sales have taken a hit, some with share prices falling over 50% in the past three years. With the introduction of high efficacy oral GLP-1 drugs expected in 2H24, insulin sales are expected to continue experiencing a cut of -3.4% CAGR from 2023-26F. Additionally, oral GLP-1 patents will expire in China in 2026. Cheaper generics are expected to bring oral GLP-1 cost down from 7.5x that of insulin to 1.3x, increasing GLP-1 uptake and putting insulin makers at a higher disadvantage.
Insulin pump makers would take a deeper cut on sluggish insulin sales. Insulin pumps are small devices used for periodic insulin delivery. In 2018, 2.8mn adults in the US used insulin pumps, half of which are T2D patients. On 1 Jan 2025, US insurance coverage plans will set new coverage terms and are expected to increase GLP-1 coverage, dealing a deeper cut to insulin sales. Insulin pump makers will also be negatively impacted by the sluggish insulin sales.
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