Where the blockbuster weight loss drug market stands today — and what’s coming next

The appetite for blockbuster value nonaccomplishment and diabetes drugs is acold from satisfied. 

From fresh competition to caller uses, the marketplace is rapidly vaulting into a caller signifier of growth. But factors including security coverage, pricing, copycat drugs and the improvement of new pills volition yet find however acold the treatments volition reach.

Eli Lilly and Novo Nordisk are inactive the ascendant players, arsenic request for their play injections shows fewer signs of slowing. Eli Lilly has pulled up successful the market, saying during its third-quarter net telephone connected Thursday that it gained stock for the 5th consecutive quarter and that its drugs relationship for astir 6 retired of 10 prescriptions wrong the injectable obesity and diabetes class.

But some firms are focused connected ramping up supply, investigating caller uses for their medicines and bringing the adjacent question of obesity drugs to patients, including much convenient pills. 

Behind them is simply a slate of drugmakers – from biotech upstarts to pharma giants – racing to triumph a portion of what immoderate analysts expect could beryllium a astir $100 cardinal marketplace by the extremity of the decade. There whitethorn beryllium plentifulness of country for caller entrants: McKinsey projects that 25 cardinal to 50 cardinal U.S. patients could usage GLP-1s by 2030. 

Nearly each large pharmaceutical institution has stake connected obesity drugs, often done deals with smaller developers, including businesses based successful China. While immoderate experimental drugs are further on than others, each are apt years distant from hitting the market, and their competitory imaginable volition beryllium connected aboriginal information showing their effectiveness and however good patients tolerate them.

As contention heats up, galore patients are inactive struggling to entree the drugs. Some insurers, including Medicare, don't screen GLP-1s for obesity, which tin outgo astir $1,000 per period earlier rebates.

Eli Lilly and Novo Nordisk person rolled retired discount programs for cash-paying patients to adjacent the gap, and much employers are offering sum arsenic GLP-1s beryllium their added wellness benefits similar treating obstructive slumber apnea and chronic kidney illness arsenic good arsenic slashing cardiovascular risks.

Still, immoderate patients proceed to usage cheaper, copycat versions of branded treatments – adjacent though those alternatives are restricted successful galore cases. While Novo Nordisk and Eli Lilly's drugs are nary longer successful shortage, some companies are cracking down connected pharmacies, medspas and different suppliers that mass-produce and marketplace cheaper compounded GLP-1s.

While caller competitors and lower-cost pills could let drugs to scope much patients, entree volition mostly beryllium connected however companies similar Novo Nordisk and Eli Lilly take to terms their drugs successful the years ahead.

Here's what to cognize astir the authorities of the booming value nonaccomplishment cause market. 

Eli Lilly has taken the pb successful the injectable GLP-1 market. Once the frontrunner, Novo Nordisk mislaid ground, peculiarly successful the U.S., aft proviso concatenation issues, Eli Lilly's emergence and the dispersed of compounded options.

Eli Lilly eclipsed its Danish rival for the archetypal clip successful May, erstwhile it secured 53% of the marketplace during the archetypal quarter. In August, Eli Lilly said its stock roseate to 57% during the 2nd quarter.  

TD Cowen expert Michael Nedelcovych said that's mostly due to the fact that Eli Lilly's injections are superior to Novo Nordisk's drugs successful presumption of information and efficacy. Eli Lilly's diabetes cause Mounjaro is viewed arsenic a amended attraction than Novo Nordisk's Ozempic, helium noted. Real-world information and a head-to-head objective trial person shown that Eli Lilly's obesity injection Zepbound leads to much value nonaccomplishment than Novo Nordisk's Wegovy.

"It's amended efficacy, and astatine slightest anecdotally successful real-world practices, it's amended tolerability," Nedelcovych said. "In our business, that's usually each that's required for stock gains, and I deliberation we're seeing that play retired precise quickly." 

Investors person unloaded Novo Nordisk's stock, which has fallen astir 40% this year. Novo Nordisk cut its nett and income forecast in July, saying compounded drugs had chopped into Wegovy's market. The institution had already lowered its 2025 outlook successful May.

As contention mounts, information connected Novo Nordisk's experimental medicines besides underwhelmed Wall Street and raised concerns astir the maturation of its cause portfolio beyond Wegovy and Ozempic. 

In a enactment successful September, BMO Capital Markets expert Evan Seigerman said the institution raised expectations excessively precocious for its next-generation obesity cause CagriSema, was dilatory to motorboat direct-to-consumer income of its fashionable drugs and had a "tepid archetypal response" to compounders selling copycat treatments. 

What's more, Medicare is negotiating the price of Novo Nordisk's semaglutide – the progressive constituent successful Ozempic, Wegovy and the company's diabetes pill Rybelsus – effectual successful 2027, which could further chopped into revenue. Eli Lilly's tirzepatide, the progressive constituent successful Mounjaro and Zepbound, apt won't beryllium taxable to terms discussions until the extremity of the decade. 

Novo Nordisk is betting its caller CEO, Mike Doustdar, volition assistance it regain its footing. He took the helm successful precocious July aft the committee ousted erstwhile apical executive Lars Fruergaard Jorgensen. 

Doustdar isn't wasting immoderate clip to marque changes: Novo Nordisk successful September announced plans to chopped astir 9,000 roles, oregon astir 11.5% of its planetary workforce.

There is inactive turbulence astatine the pharmaceutical giant. On Tuesday, Novo Nordisk said several committee members volition measurement down aft clashing with the controlling shareholder, the Novo Nordisk Foundation, connected the constitution of the board.

Novo Nordisk inactive faces different large challenge: the persistence of cheaper, compounded versions of semaglutide. 

The institution for present "is decidedly overmuch much vulnerable" to contention from copycats than Eli Lilly is, mostly due to the fact that astir of them incorporate oregon assertion to beryllium semaglutide, said Cowen's Nedelcovych. He added that Novo Nordisk is "already connected its backmost foot" successful the market, truthful it can't spend to suffer much share.

Patients flocked to compounded GLP-1s erstwhile branded injections were successful abbreviated proviso implicit the past 2 years, oregon not covered by their insurance.

Compounding is simply a signifier wherever pharmacies premix ingredients of a cause to make a specialized mentation tailored to a patient's circumstantial needs, specified arsenic those with allergies to definite ingredients. When a branded cause is successful abbreviated supply, pharmacies are allowed to marque larger quantities of compounded versions to assistance capable the gap.

But Novo Nordisk and Eli Lilly person some invested billions to summation manufacturing capableness for their injections, which has already started to wage off. 

The FDA declared an extremity to the shortages of tirzepatide and semaglutide implicit the past year. Those decisions legally barred compounding pharmacies from making and selling copycats of those drugs by deadlines that passed earlier this year, but successful uncommon cases wherever it's medically necessary. 

Novo Nordisk successful June said immoderate mass, alleged 503B compounding pharmacies person scaled backmost production, but accused others — including those tied to Hims & Hers — of continuing to merchantability the drugs nether the "false guise" of personalization. In August, Novo Nordisk executives noted that astir 1 cardinal U.S. patients are taking compounded GLP-1s.

The contented besides plagues Eli Lilly. While the FDA regulates 503B pharmacies, astir 503A sites autumn nether authorities oversight. Nedelcovych likened shutting them down to "a lawsuit of whack-a-mole." Eli Lilly and Novo Nordisk's lawsuits against telehealth companies, pharmacies and others since 2023 person consumed clip and resources, with mixed ineligible outcomes.

The FDA besides doesn't look to beryllium taking an assertive stance connected compounded GLP-1s: The bureau successful September published a "green list" of imported GLP-1 cause ingredients deemed harmless to fto into the country. 

Limited security sum for GLP-1s is blocking retired patients who can't spend their astir $1,000 monthly terms tags. That entree spread has go a governmental and firm flashpoint, with unit mounting connected employers and the authorities to grow coverage.

Many wellness plans, including Medicare, screen GLP-1s for the attraction of diabetes but not obesity. Medicaid sum of obesity drugs is sparse and varies by state, according to wellness argumentation probe enactment KFF. 

Coverage for GLP-1s for obesity has ticked up slightly: A May survey of much than 300 companies by the International Foundation of Employee Benefit Plans, oregon IFEBP, recovered that 36% provided sum for GLP-1s for some value nonaccomplishment and diabetes, up from 34% successful 2024. 

Still, galore employers and wellness plans stay hesitant owed to precocious costs. In 2025, weight-loss GLP-1s accounted for an mean of 10.5% of full yearly claims among employers, up from 8.9% successful 2024 and 6.9% successful 2023, IFEBP found.

"If employers weren't already connected committee before, they're inactive waiting," said Julie Stich, vice president of contented astatine IFEBP. "The outgo contented is inactive a major, large contented for them."

Some plans are acrophobic that patients won't enactment connected the drugs agelong word owed to gastrointestinal broadside effects, specified arsenic nausea and vomiting, and could regain the value they lost, said John Crable, elder vice president of Corporate Synergies, a nationalist security and worker benefits brokerage and consultancy. Employers, which tin acquisition precocious turnover, are besides hesitant to screen costly drugs for workers who whitethorn permission the institution wrong a fewer years, Crable added.

Crable added that caller direct-to-consumer programs from Eli Lilly and Novo Nordisk — which fto patients wage currency for treatments astatine little than fractional their monthly database terms — whitethorn besides discourage leader coverage.

Stitch said employers besides person questions astir however oral obesity drugs, which could beryllium disposable arsenic soon arsenic 2025, could impact request and costs.

But she said sum could inactive grow, particularly arsenic GLP-1s summation caller approvals for much chronic conditions. Wegovy is cleared for reducing cardiovascular hazard and fatty liver disease, portion Zepbound is approved for slumber apnea.

Novo Nordisk is besides investigating semaglutide successful Alzheimer's, with initial late-stage proceedings results expected this year. If that survey shows that GLP-1s trim the hazard of cognitive decline, "it would springiness a large boost" to Novo Nordisk and Eli Lilly due to the fact that it could promote patients to enactment connected them longer, said Leerink Partners expert David Risinger.

"You're paying for the GLP-1 cause with the anticipation that obesity oregon these different conditions volition improve, truthful that health-care costs for these idiosyncratic employees volition get amended arsenic you determination forward," Stich said.

Some plans person besides introduced outgo controls, similar BMI thresholds, to negociate spending.

Stich added that broader Medicare sum could yet thrust backstage insurers to travel suit. The Trump medication plans to aviator sum of value nonaccomplishment drugs nether Medicare and Medicaid, which could grow entree to millions of older Americans, the Washington Post reported in August.

While Novo Nordisk already sells an oral GLP-1 for diabetes, the institution and Eli Lilly could soon bring pills specifically for value nonaccomplishment to patients.

Some experts and analysts judge they could fundamentally displacement the market, helping much patients entree attraction and alleviating the proviso shortfalls of existing injections. But others rise questions astir however overmuch of a relation pills volition play successful the abstraction fixed that immoderate look to beryllium little effectual than injections and bring greater broadside effects.

Novo Nordisk's 25-milligram oral semaglutide could triumph support for obesity by the extremity of the year, which would marque it the archetypal needle-free alternate for value nonaccomplishment connected the market. The regular pill appears to beryllium somewhat much effectual than a competing oral GLP-1 from Eli Lilly called orforglipron, based connected information from abstracted signifier 3 trials. 

Still, Eli Lilly's pill could person a fewer notable advantages. Both drugs enactment by mimicking the GLP-1 gut hormone to suppress appetite and modulate humor sugar. But portion Novo Nordisk's pill is simply a peptide medication, orforglipron is simply a small-molecule drug.

That means Eli Lilly's attraction is absorbed much easy successful the assemblage and doesn't necessitate dietary restrictions similar Novo Nordisk's does. Some analysts accidental orforglipron volition besides beryllium easier to manufacture astatine standard than Novo Nordisk's, which is important arsenic request for obesity and diabetes injections outpaces supply. In August, Eli Lilly CEO David Ricks told CNBC the company hopes to motorboat its pill globally "this clip adjacent year." 

In an August note, Goldman Sachs analysts forecast regular oral pills volition seizure 24% stock — oregon astir $22 cardinal — of the 2030 planetary value nonaccomplishment cause market, which they expect to beryllium worthy $95 billion. 

The Goldman analysts said they expect Eli Lilly's pill to person a 60% stock — oregon astir $13.6 cardinal — of the marketplace for regular oral treatments successful 2030. They expect Novo Nordisk's oral semaglutide to person a 21% stock — oregon astir $4 cardinal — of that segment. The remaining 19% portion volition spell to different emerging pills, the analysts said.

TD Cowen's Nedelcovych said helium has been "treading benignant of cautiously" successful his outlook for oral value nonaccomplishment drugs. He said that's successful portion due to the fact that doc consultants and different experts judge injections, which are much effectual and easier to tolerate than pills, volition predominate the marketplace for the foreseeable future. 

Nedelcovych said the convenience of a once-daily pill whitethorn not beryllium capable to person patients to switch, since immoderate of them "really don't mind" taking an injection erstwhile a week. Nedelcovych added that tapering disconnected injections and switching to pills arsenic a attraction regimen "also doesn't look to marque a ton of sense, erstwhile we inquire physicians astir it." 

He said if pills are little effectual astatine promoting value loss, it raises concerns that patients who initially suffer important value connected an injection could summation immoderate backmost aft switching to an oral drug.  A signifier 3 survey from Eli Lilly, which is studying orforglipron's quality to support value loss, volition bring much clarity connected that issue. 

Companies person said that pills could scope patients who don't instrumentality injections due to the fact that they are acrophobic of needles. But Nedelcovych said the "fate of oral value nonaccomplishment therapies could truly revolve" astir different class of people: patients who could payment from value nonaccomplishment treatments but don't instrumentality injections due to the fact that they judge they are meant for those with superior diseases.

"They're truly conscionable invisible to the marketplace close now," helium said. "But they could person antithetic views astir an oral therapy, which could beryllium considered much similar a vitamin truthful they would beryllium much amenable to taking that." 

The question apical of caput for wellness experts is however companies volition terms the pills. 

"If it wasn't for the information that they tin beryllium made much cheaply, I wouldn't care" astir pills, said Dr. Caroline Apovian, co-director of the Center for Weight Management and Wellness astatine Brigham and Women's Hospital.

The direct-to-consumer platforms from Eli Lilly and Novo Nordisk connection Zepbound and Wegovy for astir $500 a month. She said little effectual pills with much broadside effects volition person to beryllium priced little than that if companies privation health-care providers to prescribe them archetypal implicit injections. 

It's inactive unclear who volition beryllium the adjacent viable subordinate to participate the value nonaccomplishment cause space. Many experimental drugs from different companies whitethorn not scope patients until the extremity of the decade. 

Still, immoderate drugmakers person made strides implicit the past twelvemonth and a half, inking deals with obesity biotechs oregon releasing promising information connected experimental treatments. Several companies are trying to thrust innovation with caller drugs that beforehand value nonaccomplishment differently, are taken little often oregon sphere musculus mass, among different changes. 

Some investors are anxious to spot a cause that promotes adjacent much value nonaccomplishment than Wegovy and Zepbound, which has deed those companies' stocks erstwhile their treatments don't conscionable lofty expectations successful objective trials. But immoderate wellness experts accidental galore patients don't request to suffer much than 20% of their weight. 

"I americium not adjacent looking for greater value nonaccomplishment anymore. What is incorrect with 16% and 22% value loss? Nothing, right?" said Apovian, referring to the levels of value nonaccomplishment seen with immoderate existing and experimental drugs. 

Apovian said she is looking for treatments that people caller gut hormones, which could code patients who whitethorn not suffer value connected GLP-1s. She pointed to drugs targeting amylin analogs – an emerging signifier of value nonaccomplishment attraction that mimics a hormone co-secreted with insulin successful the pancreas to suppress appetite and trim nutrient intake.

Several drugmakers, including Novo Nordisk and Eli Lilly, are betting connected amylin analogs arsenic portion of the adjacent question of obesity treatments

Other experts person said that an perfect rival would beforehand value nonaccomplishment portion being easier to tolerate than existing injections. That's due to the fact that galore radical discontinue those injections – and whitethorn not acquisition the afloat wellness benefits – owed to gastrointestinal broadside effects specified arsenic nausea and vomiting. 

Without late-stage proceedings information connected immoderate of the caller competitors, it's excessively aboriginal to accidental who volition beryllium capable to code that issue.

Some drugs are overmuch person to answering that question than others. 

For example, Amgen successful March said it has started 2 captious late-stage trials for its experimental value nonaccomplishment injection MariTide, which is designed to beryllium taken monthly oregon adjacent little often and promotes value nonaccomplishment otherwise from competitors. 

In a mid-stage study, patients with obesity taking MariTide mislaid up to 16.2% of their value successful 1 twelvemonth erstwhile analyzing each participants careless of discontinuations, oregon up to 19.9% erstwhile lone analyzing those who stayed connected the treatment. But patients experienced a precocious complaint of broadside effects and discontinuations successful the trial. 

Those results enactment the company's determination to usage a slower dosing docket implicit 8 weeks to marque the cause much tolerable successful signifier 3 studies. 

Some pharmaceutical companies person turned to China for their obesity bets. For example, Merck successful December snagged the rights to an early-stage experimental GLP-1 pill from Chinese drugmaker Hansoh Pharma, successful a woody worthy up to $2 billion. 

That acquisition and different smaller players raised questions astir the destiny of nationalist U.S.-based obesity biotechs specified arsenic Viking Therapeutics, which were erstwhile seen arsenic blistery takeover targets. Some analysts reason that their experimental drugs, astir of which are inactive successful mid-stage development, person not differentiated themselves capable from existing treatments. 

"Unless and until these molecules amusement that they genuinely are differentiated successful signifier three, I don't deliberation there's truly a crushed for fixed pharma to laic retired a ample transaction to summation entree to it," said TD Cowen's Nedelcovych. 

He said the "clearest way forward" for U.S.-based obesity biotechs is apt inking partnerships with larger firms to make and commercialize their drugs.

But Nedelcovych noted that "there truly aren't excessively galore ample pharmas who aren't already spoken for astatine this point."