Eli Lilly Pledges to Bring GLP-1s to Lower-Income Countries
The new Lilly Change the Course Commitment aims to treat as many people with diabetes and obesity in low- and middle-income countries as in wealthy ones by 2040.
The newest diabetes and obesity drugs have changed medicine in wealthy countries. In much of the world, most people who could benefit still can't get them. On September 28, 2026, Eli Lilly announced a plan to change that. The company calls it the Lilly Change the Course Commitment, and its goal is simple to state and hard to reach: by 2040, treat as many people with Lilly's diabetes and obesity medicines in resource-limited settings as it does in high-income countries.
That includes GLP-1 medicines, the class behind the recent wave of weight-loss and blood-sugar treatments. Lilly says it will register these medicines in more low- and middle-income countries (LMICs), with a focus on Africa, Latin America and Asia.
The access gap today: For every four people in high-income countries who can get Lilly's diabetes and obesity medicines, only one person in a low- or middle-income country can — a ratio of 4 : 1.
Why this matters
Diabetes and obesity are often thought of as problems of rich countries. The numbers say otherwise. According to figures Lilly cited from the International Diabetes Federation and published research, most people living with these conditions are in lower-income nations, and prevalence there is still rising.
- 4 in 5 adults with diabetes live in low- and middle-income countries
- 7 in 10 adults with obesity live in low- and middle-income countries
- ~3× longer for newer drugs to launch in lower-income nations
The delay is the core problem. New medicines usually reach high-income markets first, and patients elsewhere can wait years, sometimes a decade or more, for the same treatment. Fierce Pharma, reporting on Lilly's figures, notes that newer drugs take nearly three times as long to launch in lower-income countries. During that wait, preventable complications like kidney disease, heart disease, vision loss and amputations continue to build up.
"Innovation only matters when it reaches the people who need it." — David A. Ricks, Lilly chair and CEO
How Lilly plans to close the gap
Lilly acknowledges that shipping more medicine is not enough on its own. Fragmented health systems, limited clinic infrastructure and gaps in diagnosis all stand between a patient and treatment. The commitment is built around three focus areas:
Design medicines for low-resource settings. Lilly says it will consider the needs of resource-limited settings from the earliest stages of clinical development, including where trials are run, how medicines are packaged and whether they need cold-chain storage.
Register medicines in more countries, sooner. Lilly intends to register its diabetes and obesity medicines, including GLP-1s, in more LMICs, working with regulators and local health systems. Africa, Latin America and Asia are the priority regions.
Strengthen primary care. Working with global health organizations and NGOs, Lilly plans to support training for community health workers, expand digital tools, and improve awareness, prevention, diagnosis and care.
The role of a GLP-1 pill
A big practical barrier for injectable GLP-1s is refrigeration. Many clinics and homes in lower-income regions don't have reliable cold storage. Lilly points to Foundayo (orforglipron) as a medicine that fits this challenge. Foundayo is a once-daily oral GLP-1 pill that can be stored at room temperature and taken at any time of day, with no planning around food or drink.
Ricks said medicines like Foundayo "will help us distribute and scale access across more LMICs." In the U.S., Foundayo is FDA-approved for chronic weight management in adults with obesity, or adults with overweight who also have weight-related health problems, alongside diet and physical activity. Lilly is also studying orforglipron for type 2 diabetes, sleep apnea, hypertension and other conditions.
Good to know: Like other GLP-1 medicines, Foundayo carries a boxed warning about possible thyroid tumors and can cause stomach side effects such as nausea, diarrhea and vomiting. It should not be combined with other GLP-1 drugs. Talk with your healthcare provider about whether a GLP-1 medicine is right for you.
Building on 30x30
This is not Lilly's first global access program. Its earlier Lilly 30x30 initiative set out to improve access to quality healthcare for 30 million people in resource-limited settings every year by 2030. Lilly says it reached 40 million people in 2025, five years ahead of schedule. Change the Course is the follow-up, with a narrower focus on diabetes and obesity and a goal defined by patients treated rather than people reached.
Lilly says it will report progress in its annual Sustainability Report and at major global health forums.
What to watch
The commitment sets a clear target, but several questions remain. Lilly has not published country-by-country launch timelines or pricing for these markets. The 2040 goal is also a parity goal, which means progress depends on how fast access grows in high-income countries too. Supply is another factor, since global demand for GLP-1 medicines has strained manufacturing in recent years. Independent watchdogs such as the Access to Medicine Foundation, which ranks drugmakers on access in LMICs, will be one way to track whether the pledge turns into patients treated.
For patients and clinicians in the countries that have waited longest, the announcement is a signal that the newest treatments may arrive years sooner than they would have otherwise.
This article is for general information and is not medical advice. Speak with a qualified healthcare provider before starting or changing any medication.