INSIGHTS
Inside Rock Health
Shryans Goyal
Venture Fellow
 With help from:
Tatiana Bouri
Bill Evans
Sean Day
August 17, 2026

The next GLP-1 investment cycle: Building the infrastructure to support sustainable health outcomes

Rock Health Capital invests in remarkable businesses at the intersection of healthcare and technology. We want to support early-stage companies building ongoing GLP-1 support infrastructure to achieve sustainable health outcomes. If that sounds like you, please reach out!

The GLP-1 boom has paved the way for new direct-to-patient (DTP) access channels, but the most compelling investment opportunities ahead may sit beyond drug access. The earliest GLP-1 businesses like Medvi, Ro, Hims & Hers, and Noom solved a specific problem: getting patients on therapy. They move patients who are actively seeking treatment through eligibility screening, a telehealth visit, and a pharmacy handoff with as little friction as possible. But the defensibility of that model may be less certain as patient eligibility widens and Lilly and Novo Nordisk increasingly compete directly for consumers.

DTP channels solved access for patients who already knew they wanted the drug and had the means to pay for it. Left out by these models are patients who should be on therapy but are prevented from starting, and those who do start but do not stick with it.

On the first, cost remains a significant barrier. Studies continue to show that cost is the biggest deterrent for people hoping to start a GLP-1 Another barrier to patients getting on the therapy is lack of awareness based on their conditions as GLP-1s are now approved to tackle health issues beyond diabetes and obesity. Clinicians will increasingly need to spot candidates for GLP-1s rather than patients knowing to ask.

On the second, the falloff is steep. An analysis of more than 125,000 patients found that 47% of patients with and 65% without type 2 diabetes discontinued within twelve months. The numbers vary by dataset and definition, but the reality is the same: a large portion of the prescribed population is not actually taking the drug a year later.

At Rock Health Capital, we believe three things about the future of GLP-1 innovation:

  • Patients will benefit from solutions that help them not only access GLP-1s, but also help them achieve health outcomes with GLP-1s.
  • Value will accrue to companies that solve for these results and build the infrastructure to do so.
  • AI will be essential to delivering these outcomes at scale.

The four keys to success

To deliver durable outcomes with GLP-1s, healthcare companies need to get four things right:

Identify which patients are eligible for GLP-1s: The FDA-approved indications for GLP-1–based therapies are widening quickly, with cardiovascular risk reduction, sleep apnea, and MASH now approved. With the expanded benefits of GLP-1s, there is a commercial and clinical opportunity to better identify which patients are strong candidates for the treatment. AI tools that are EHR-integrated could, for example, help physicians identify eligible patients rather than leaving it to the patient’s ability to self-advocate.

Make GLP-1s affordable for patients and payers: The promise of GLP-1s will remain constrained if patients cannot afford therapy and employers cannot sustain its cost. RxSaveCard, a Rock Health Capital portfolio company, enables employers to subsidize GLP-1s at lower direct-cash prices without changing PBMs or adding the drugs to their formularies. Innovations like these can replace the binary choice between broad coverage and exclusion with more affordable and financially predictable benefit design.

Keep patients on therapy: Studies have consistently shown that adherence improves with increased frequency and quality of patient touchpoints. Comprehensive engagement models, which turn signals like weight, blood glucose (for diabetics), symptom reports, injection timing, and lifestyle data into proactive outreach, will be a defining feature of the companies that win here. For example, Omada and Virta, both Rock Health Capital Portfolio companies, pair GLP-1 prescriptions with wrap-around coaching, side-effect support, and nutrition guidance.

Predict and manage response and side effects of GLP-1 prescriptions: Nearly 15% of patients discontinue treatment due to side effects. Among tolerability-driven discontinuations, nausea dominates, and it is also one of the easier to predict. A study from Phenomix Sciences and Mayo Clinic showed that a genetic risk score could separate high-risk from low-risk patients with a roughly 2x difference in nausea incidence on liraglutide. This research highlights the value of multimodal classifiers that use genetics, prior medication history, GI comorbidities, and BMI trajectory over time to produce a risk score before or during the first dose escalation. AI tools like these can reduce side effects, subsequently boosting the effectiveness of the treatment and lowering the cost of lapses.

The opportunity ahead

The first phase of the GLP-1 market was a distribution race. The second will be won by companies that can prove a patient is still on therapy at month twelve, still getting clinical benefit from it, and still worth covering. That model is harder to build and harder to copy, and we at Rock Health Capital think it is where the durable value sits. If you’re building the infrastructure that turns a prescription into an outcome, we’d like to hear from you.