While the TrumpRx deals only cover Lilly and Novo for now, the agreements are good for any cardiometabolic biotechs waiting in the wings, according to a new 2026 preview report from PitchBook.
New drug pricing plans for Novo Nordisk and Eli Lilly’s GLP-1 obesity treatments have cleared the runway for new entrants, with the regulatory bumps and grooves for insurance coverage smoothed out to open up a new patient population and bring in ever more investors, according to a new report from PitchBook.
In its annual exit report, the analysis firm said the addition of the approved GLP-1 drugs to Medicare and Medicaid with Most Favored Nation pricing expands the addressable market for the therapies by 7 to 15 million people. It also charts a new course for patients after they faced insurance denials for treatment.
While the TrumpRx deals only cover Lilly and Novo for now, the agreements are good for any biotechs waiting in the wings, PitchBook said.
“Expanded CMS coverage strengthens the case for broader GLP-1 label indications and reinforces long-term cardiometabolic franchise strategies,” the firm said. “Later entrants are positioned to benefit from a clearer regulatory pathway for obesity pharmacotherapy and a larger patient and prescriber base, which may accelerate adoption curves for differentiated products.”
With that said, PitchBook noted that Lilly and Novo are even more entrenched as the market incumbents with the deals in hand and manufacturing logistics already resolved. Any newcomers will still have to face those hurdles.
Nevertheless, the metabolic space will head into 2026 buoyed by exciting M&A developments, too. Specifically, the Pfizer-Novo bidding war to buy Metsera, which ultimately ended with Pfizer’s $10 billion takeover. While this week-long drama underscored the “escalating strategic urgency in this space,” PitchBook notes that there are 120 assets in development across 60 companies, and therefore plenty of potential deals to be made.
“As competition for late-stage assets intensifies, acquirers may move upstream, targeting earlier-stage, higher-risk platforms that offer novel biology or delivery modalities,” PitchBook wrote.
Appetite for Risk Rises
Overall, venture capital activity in biopharma bottomed out in the second quarter, but it seems to have returned in the third, PitchBook reported. This should continue into 2026, with additional rate cuts expected in the new year that could increase investors’ appetite for risk, the firm wrote.
Besides obesity, hungry Big Pharmas have been buying into CAR T cell therapy, antibody-drug conjugates and small molecules.
Thanks to the rise in larger deals—Cidara Therapeutics, Verona Pharma and Avidity Biosciences being recent examples—exit values have risen, even as deal counts remain muted. PitchBook named three companies with exit potential for 2026: the obesity-focused Verdiva Bio, Kailera Therapeutics and genetic medicine biotech ReCode Therapeutics.
On the policy front, PitchBook noted that the initial TrumpRx agreements have helped alleviate some concerns, but that 2026 will see the direct-to-consumer option open to patients for the first time.
“Despite headline price reductions, it remains uncertain whether the TrumpRx model will meaningfully lower patient out-of-pocket cost, although the benefit to pharma companies is clear as they avoid the potential for heavy import tariffs,” PitchBook said. “At a high level, the TrumpRx initiative underscores a growing push to bypass pharmacy benefit managers and improve price transparency.”
