Weight loss
With the introduction of glucagon-like peptide-1 (GLP-1) weight loss drugs to the
UK market from 2023, this has been the fastest growing category for CloudRx and Webmed.
The two main drugs available in the UK are Wegovy (semaglutide), from Novo Nordisk,
and Mounjaro (tirzepatide), from Eli Lilly. Both developed their weight loss drugs
from GLP-1 drugs used to manage type 2 diabetes and both are delivered by injection
pens. Wegovy was approved by the MHRA in 2021 and recommended by the National Institute
for Health and Care Excellence (NICE) in March 2023, but was only commercially launched
in the UK in September 2023, at which time it became available on the NHS. Mounjaro,
which is a combination of GLP-1 and glucose-dependent insulinotropic polypeptide (GIP),
was approved by the MHRA in November 2023. The KwikPen delivery mechanism was approved
by the MHRA in January 2024 and became commercially available in the UK in February
2024.
Although Wegovy had a head start in the market, trial results show that Mounjaro results
in greater weight loss over a comparable period. Novo Nordisk’s initial STEP 1 trial
showed that patients lost on average 14.9% of body weight over 68 weeks on the maximum
2.4mg dose. The SURMOUNT-1 tirzepatide trial showed 15.0%/19.5%/20.9% weight loss
at 5mg/10mg/15mg over 72 weeks. The more recent SURMOUNT-5 trial, run by Eli Lilly,
compares tirzepatide and semaglutide with 20.2% and 13.7% average weight loss respectively
over 72 weeks. Wegovy has developed a higher dosage (7.2mg), which on the STEP UP
trial showed 18.7% loss over 72 weeks and this is now available in the UK, creating
a more competitive position versus Mounjaro.
Both drugs are available on the NHS but with different, and strict, prescribing criteria.
Wegovy: Earlier availability, but only via specialist NHS clinics
Wegovy is available from specialist weight loss clinics only after referral by a GP.
The clinics are multidisciplinary and may include clinicians, dietitians, psychologists,
physical activity support and prescribing clinicians. They assess whether medication,
intensive lifestyle support, psychological support or bariatric surgery referral is
appropriate. Patients need a minimum BMI of 35 (32.5 if from certain ethnic minorities)
and at least one weight-related health condition. Wegovy can only be prescribed for
a maximum of two years and is intended to be used in conjunction with dietary changes
and exercise.
Mounjaro: Long-term plan to reach 3.4m patients
In October 2024, NHS England (which covers 84% of the UK population) outlined its
plans to make Mounjaro available to patients, but due to restricted budgets and staffing
availability, it proposed a limited initial roll-out to 220,000 patients over three
years and a long-term plan to reach all NICE-eligible patients over the following
nine years. It clarified this in March 2025 with its formal interim commissioning
guidance. There is no maximum prescribing period for Mounjaro.
It set the following criteria for the three-year roll-out:
- Year 1: patients need a minimum BMI of 40 and at least four co-morbidities;
- Year 2: a BMI of 35–39.9 and at least four co-morbidities; and
- Year 3: a BMI of >40 and at least three co-morbidities.
There has already been strong take-up of Mounjaro on the NHS. In the year-ended 31
March 2026, the NHS spent £400m more on Mounjaro KwikPens than in the prior year.
Emerging evidence of long-term demand
Patients take the drugs via a weekly injection pen, starting on a minimum dose for
four weeks and moving up in dosage every four weeks until the maximum tolerated effective
dose is reached. Once the patient stops taking the drug, studies have shown that at
least two-thirds of weight is likely to be regained as appetite returns. Many doctors
view obesity as a chronic condition, like high blood pressure or cholesterol, and
therefore would expect patients to take a maintenance level of the drug once the target
weight has been achieved. There is not yet enough data to ascertain what the best
maintenance regime is. Some people move down to lower dosages at the same weekly frequency
while others space out their jabs to make them last longer.
Private clinics democratise availability
The NICE-eligible population of 3.4m is only a fraction of the more than 66% of the
UK population (c 45.9m people) who are overweight (BMI >25) or obese (BMI ≥30). As
the ability to access the drugs on the NHS is currently very limited, and looks likely
to remain that way, the private market has exploded. This includes both online and
in-person weight loss clinics and has become a very competitive market (see below
for discussion on pricing).
The GPhC has had to step in to tighten regulation to ensure that only overweight or
obese patients are prescribed the drugs. The updated guidance emphasises that for
high-risk medicines, the prescriber cannot base prescribing decisions on the information
provided in an online questionnaire alone. Instead, the prescriber has to independently
verify the information the person provides, either through timely two-way communication
with the person, accessing the person’s clinical records, or contacting the person’s
GP, their regular prescriber, or a third-party provider. Medicines used for weight-management
and medicines requiring physical examination before a prescribing decision is made
have been added to the list of high-risk medicines requiring extra safeguards before
being prescribed. Before providing medicines for weight management, the prescriber
now has to independently verify the person’s weight, height and/or body mass index.
The updated guidance also says there should always be a means of having two-way communication
between the person and the prescriber for all online prescribing, so both the person
and the prescriber can discuss the possible treatments, ask questions and get further
information, and make informed decisions. We note that Webmed offers online prescribing
of weight loss drugs as well as fulfilment, whereas CloudRx only fulfils prescriptions
written by private clinics.
Approval of pills widens the addressable market
The pill version of Wegovy was approved in the US at the end of last year and launched
in January 2026. It has had rapid take-up and has since been approved in the UK (11
June), where it is now available on private prescription. In the OASIS-4 trial, average
weight loss of 16.6% was achieved over 64 weeks.
Eli Lilly’s version (Foundayo, based on a different molecule called orforglipron)
was approved in the UK on 10 August, after being approved in the US in April. In the
ATTAIN-1 trial, at the highest dose, average weight loss of 12.4% was achieved over
72 weeks.
Both pills are designed to be taken daily, with Wegovy’s pill having to be taken on
an empty stomach every morning.
Novo Nordisk provided an update (7 June) on uptake of the pill in the US. Since the
launch on 5 January, three million prescriptions have been written for the pill, with
one million in the first 12 weeks and two million in the subsequent 10 weeks. The
majority (more than 80%) was for people new to GLP-1 therapy, which indicates that
the availability of the pill appears to be widening the addressable market rather
than acting as a substitute for the injection pen. In addition to providing an option
for patients unwilling to inject the drug, it is possible that the pill will be useful
for maintenance after a target weight has been achieved. The pill also has the benefit
of not needing cold storage. Although some private clinics are already advertising
introductory offers, it is not clear what the maintenance level pricing will be, but
there is an expectation that it is likely to be slightly below the injection pen pricing.
Cost of the drugs limits gross margins
In the private market, the cost of either drug is relatively expensive. Wegovy is
available at a cost of c £199 for a four-week supply of the maintenance dose (2.4mg).
The list price for the maintenance dose of Mounjaro (10mg or 15mg) is £330 for a four-week
supply. This relatively high monthly outlay means that it is more difficult to add
material mark-up to the cost, and the mark-up on delivery costs will only be a small
percentage of the overall order value. It is also a highly competitive market, with
many providers offering discounted pricing to attract customers, and many customers
switching providers to take advantage of these offers. While weight loss was the fastest-growing
category for the pro forma group in CY25, the pricing dynamics make it the lowest
category by gross margin.
Women’s health
The main area covered by this category is hormone replacement therapy (HRT). While
HRT is supposed to be available on the NHS, many women find it difficult to access
due to GPs not taking their concerns seriously. In addition, when it is available,
the NHS does not have the resources to truly personalise the prescription, as this
requires more lab work to assess the level of hormones before and after treatment,
and the NHS may not offer the full range of hormone options. Many women have turned
to private clinics to get access to personalised treatment plans. Prominent HRT expert
Dr Louise Newson’s Newson Health has been a customer of CloudRx for several years,
contributing 27% of revenue in CY25.
Exhibit 7 below shows the strong growth in HRT prescribing on the NHS (data is not
available for private prescribing). We would expect the private market to have seen
similar growth as awareness has increased.
| Exhibit 7: HRT prescribed items and identified patients, FY16–25 |
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| Source: NHS Business Services Authority |
In terms of duration of use, many women will reduce HRT and stop taking the medication
after several years. But there is no clinical restriction on continuing it indefinitely
and this is increasingly being considered the norm for HRT treatment.
Mental health
The main condition treated in this category is ADHD. Increasing recognition of the
condition, particularly among girls and women who have historically been underdiagnosed,
has resulted in strong demand for ADHD medication over the last nine years. In the
year to 31 March 2025 (FY25), ADHD drugs were prescribed to 326,000 people via NHS
England, up from 107,000 in FY16 (CAGR 13%). As ADHD drugs are controlled substances,
private prescribers must report prescriptions to the NHS. The number of prescriptions
reported in FY24 was 398k, up from 28k in FY19 (CAGR 69%; the number of patients is
not available).
There are currently very long waits on the NHS for an initial consultation, and if
diagnosed with the condition, there is typically a further wait to start treatment.
Under the NHS’s Right to Choose policy, the NHS can fund access to private providers
for the initial diagnosis. Once diagnosed, the patient can request that they are switched
to shared care, which means they would be able to access medication via the NHS. Not
all private providers participate in these schemes.
Many patients who want a timely diagnosis and control over their treatment start the
process via a private clinic. After initial diagnosis, the patient will start titration,
the process where the medication is introduced at a low dosage and increased in increments
to assess efficacy and side effects. Each step requires a consultation. Once on the
correct medication at the optimum dosage, the patient will still need to see the doctor
twice a year to review the medication. The patient also has the ongoing cost of the
medication via the private prescription provided by the doctor. In some cases it is
possible to switch to shared care if the patient’s GP agrees, at which point the NHS
would prescribe the medication on an ongoing basis. Most people diagnosed with ADHD
who take medication will need to take it for the rest of their lives, providing recurring
demand for privately prescribed medication.
Men’s health
This category includes medication for hair loss, erectile dysfunction and testosterone
replacement therapy (TRT). In many cases, the drugs are not available on the NHS or
customers prefer a more discrete approach. For example, the NHS will only fund TRT
if the patient has testosterone deficiency. Those who would benefit from TRT but do
not meet the strict NHS criteria may be able to access support from private clinics.
Demand for TRT has grown in recent years due to increased awareness and studies supporting
its safety.
General
This category contains any medication that does not fit in the categories above. It
includes areas such as dermatology, allergies, digestion and first aid. With the rise
in private GP practices, this includes prescriptions that may be one-off in nature.
It also includes OTC medications and vitamins.
Veterinary
Many pets have chronic conditions requiring ongoing medication, and no NHS equivalent
exists. For drugs prescribed by a veterinary clinic, customers can buy the drugs from
the clinic or request a prescription that they can use at their drug provider of choice.
Drugs purchased online can cost less than half the price charged by veterinary clinics.
In recent years, the veterinary clinic market has undergone consolidation, with around
60% of veterinary practices owned by several private-equity owned groups. This prompted
a Competition and Markets Authority review, which concluded that the 60% market share
held by the groups is not permitted to increase. Other remedies to improve competition
include the requirement that a prescription must be provided in paper form at the
end of a consultation or in electronic format with 48 hours. This provides customers
with the ability to choose where they purchase their pet’s medication.
The Veterinary Medicines Directorate (VMD) register lists 169 regulated online veterinary
medicine retailers. In the table below, we show the main providers in the veterinary
online pharmacy market. Three of six are linked to the large veterinary groups, two
are linked to other areas in the pet market (insurance, retail) and one is an online
provider of human medication that has branched out into veterinary medicine (Pharmacy2U).
| Exhibit 8: Large online pharmacies supplying veterinary medicines |
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| Source: Edison Investment Research, www.whoownsyourvet.co.uk |
Molecule sees scope to use Hyperdrug as a vehicle to integrate with independent veterinary
practices in a similar way to CloudRx. This would provide independents and their customers
the opportunity to avoid the large providers, provide a more convenient service for
customers and the opportunity for veterinary practices to earn commission.
