For nearly three years—from March 2022 to February 2025—patients couldn't reliably get GLP-1 medications even with valid prescriptions and insurance coverage. Shortages affected semaglutide (Ozempic/Wegovy) and tirzepatide (Mounjaro/Zepbound) at various points, leaving millions of patients scrambling and driving over a million Americans to seek compounded alternatives from non-FDA-approved sources.
The response from pharmaceutical manufacturers was unprecedented: more than $70 billion in combined manufacturing investment, construction projects spanning three continents, acquisitions of entire companies for their production capacity, and a race against time to build the infrastructure needed to meet global demand.
The Three-Year Shortage
The GLP-1 shortage story begins with success. As prescriptions surged—growing 442% between 2021 and 2023—manufacturing capacity designed for diabetes treatment volumes couldn't keep pace with weight loss demand. The FDA added semaglutide to its shortage list in March 2022, where it remained until February 2025.
Shortage Timeline
The shortage had real consequences. Diabetic patients—the original intended users—sometimes couldn't access medications they'd relied on for years. Weight loss patients faced interrupted treatment, which research shows significantly increases likelihood of weight regain. An estimated 1 million Americans turned to compounded versions, which are not FDA-approved and vary in quality.
Eli Lilly's $27+ Billion Bet
Eli Lilly responded to demand with the largest manufacturing investment in its 150-year history. The company committed over $27 billion to U.S. manufacturing expansion, with the flagship project in Lebanon, Indiana.
đź”´ Eli Lilly Manufacturing Investments
The Lebanon facility deserves special attention. At $9 billion, it represents the largest single investment in synthetic medicine active pharmaceutical ingredient (API) manufacturing in U.S. history. The facility will produce the raw tirzepatide that gets processed into finished Mounjaro and Zepbound products.
Eli Lilly CEO David Ricks captured the intensity of the manufacturing push in a telling quote: "There's not a single hour of any day that every machine isn't working at Lilly right now." The company operates existing facilities at maximum capacity while building new ones as fast as construction allows.
Novo Nordisk's $40+ Billion Response
Novo Nordisk, which manufactures semaglutide (Ozempic, Wegovy, Rybelsus), has invested even more heavily—though with different strategies.
🔵 Novo Nordisk Manufacturing Investments
Novo Nordisk's Kalundborg campus in Denmark is the primary manufacturing site for semaglutide. The facility has expanded to 1.6 million square meters—approximately 280 football fields. A 42 billion Danish kroner ($6.1 billion) expansion announced in 2023 represents roughly 1.5% of Denmark's entire GDP spent on a single factory project.
The scale of construction at Kalundborg requires around-the-clock operations. Construction crews work under floodlights through the night, with up to 3,000 workers on-site during peak building phases. The company essentially runs a small city dedicated to pharmaceutical manufacturing.
The Catalent Acquisition
Perhaps the most dramatic move in the GLP-1 manufacturing race was Novo Holdings' $16.5 billion acquisition of Catalent, a major contract drug manufacturing organization. The deal, completed in late 2024, gave Novo Nordisk's parent company access to Catalent's fill-finish capacity—the bottleneck step where drug substances are packaged into final injectable form.
Fill-finish bottleneck: Even with enough raw drug substance, packaging into pens/vials limited output
Catalent's capacity: One of the world's largest contract fill-finish operations
Strategic value: Secured capacity that competitors couldn't access
Deal size: $16.5 billion—largest pharmaceutical manufacturing acquisition in years
The acquisition was notable for its scale and strategic implications. By acquiring an entire contract manufacturing organization, Novo Nordisk effectively removed capacity from the market that competitors might have used. It signaled how seriously the company views manufacturing as a competitive advantage.
What $70 Billion Buys
The combined $70+ billion investment represents an industrial mobilization rarely seen outside wartime. To understand the scale:
Comparison to other industries: Intel's entire U.S. semiconductor manufacturing initiative—considered a national priority for technology independence—is roughly comparable at $100 billion over several years. The GLP-1 manufacturing build-out is pharmaceutical industry's equivalent, driven by commercial demand rather than government subsidy.
Employment impact: The new facilities will employ tens of thousands of workers across manufacturing, quality control, logistics, and support functions. Lilly's Lebanon facility alone will create thousands of jobs in central Indiana.
Production capacity: When fully operational, the new facilities will multiply current production capacity several times over—potentially enough to serve 50+ million patients globally, compared to roughly 20 million current users.
Why Shortages Happened in the First Place
The shortage reveals fundamental challenges in pharmaceutical manufacturing:
Long lead times: Building pharmaceutical manufacturing facilities takes 3-5 years minimum. When demand surged in 2022, capacity couldn't be added quickly regardless of financial resources. The investments being made now will show results in 2026-2028.
Demand forecasting failures: Manufacturers planned based on diabetes treatment patterns. No model predicted the viral social media adoption that drove off-label weight loss use to explode. By the time demand was obvious, the supply gap was already locked in for years.
Complex manufacturing: GLP-1 peptides aren't simple molecules. They require specialized production processes, extensive quality control, and sophisticated cold-chain distribution. You can't just "make more" without purpose-built facilities.
Regulatory constraints: Manufacturing changes require FDA approval. Even expanding existing facilities involves regulatory processes that add months to timelines. Quality can't be sacrificed for speed.
The Compounded Market Consequence
The shortage created an opening for compounded GLP-1 medications—products made by compounding pharmacies rather than the original manufacturers. When FDA lists a drug as in shortage, compounding pharmacies can legally produce versions even for patented medications.
The compounding market has faced controversy. FDA does not approve compounded medications for safety and efficacy, and quality varies by pharmacy. Counterfeit products entered the market. Novo Nordisk and Eli Lilly have both taken legal action against compounders and petitioned FDA to limit compounding even during shortages.
For patients, the compounding market represented a double-edged sword: access when brand-name products weren't available, but uncertainty about quality and efficacy. As brand supply stabilizes, questions about compounding's future role remain unsettled.
What Supply Stabilization Means
The February 2025 removal of semaglutide from FDA's shortage list marked a turning point—though not an ending. Supply and demand are approaching balance, but several factors will shape the market going forward:
New patient starts: As supply improves, more patients will begin treatment. Demand could increase alongside supply, potentially maintaining tight conditions even with expanded manufacturing.
International expansion: Currently, 77% of GLP-1 revenue comes from North America. As Novo Nordisk and Lilly expand global availability, manufacturing must serve larger populations.
New formulations: Oral Wegovy (approved December 2025) requires different manufacturing processes than injectables. New products add complexity to supply planning.
Competition: As other companies bring GLP-1 alternatives to market, manufacturing capacity across the industry will matter. First-movers' production advantages provide competitive moats.
The Manufacturing Advantage
The $70 billion manufacturing investment creates more than production capacity—it establishes competitive barriers that will shape the GLP-1 market for decades.
New entrants face massive capital requirements to compete at scale. The 3-5 year construction timeline means competitors starting today won't have comparable capacity until 2028 at earliest. Quality systems, supply chains, and manufacturing expertise take years to develop. And with Novo Nordisk acquiring major contract manufacturing capacity, options for outsourced production have narrowed.
Supply Is Improving
As manufacturing capacity expands, GLP-1 medications are becoming more accessible. Compare providers and find your path to treatment.
Compare ProvidersThe Bottom Line
The GLP-1 manufacturing story is one of unprecedented scale: a three-year shortage affecting millions of patients, followed by a $70+ billion industrial response that represents the largest pharmaceutical manufacturing expansion in history.
It's also a cautionary tale about demand forecasting, supply chain vulnerabilities, and the time required to scale complex pharmaceutical production. Social media can create overnight demand; factories cannot be built overnight.
For patients, the practical implication is improving access. The investments being made now will yield expanded supply through 2026 and beyond. The era of rationing and shortages appears to be ending—replaced by an era where manufacturing capacity may finally match the scale of patient need.
Whether $70 billion proves sufficient depends on how demand evolves. With only 2.3% of eligible patients currently treated and global expansion just beginning, the manufacturing race may be entering a new phase rather than concluding. The factories under construction today may be just the beginning.
Last updated: January 2026. Manufacturing data from company announcements, SEC filings, and industry reports.