Eli Lilly and Novo Nordisk are racing to broaden their reach in the multibillion-dollar weight loss market. They’ve got competing GLP-1 pills, next-generation pipeline candidates and recently ramped up efforts to rein in compounders and black-market sellers. Lilly is holding onto its lead in the overall GLP-1 market as Novo Nordisk looks to regain lost ground.
Their latest earnings reports offered a snapshot of their strengths and challenges in an evolving market. Lilly posted strong Q2 results with revenue nearing $23 billion, a 48% year-over-year increase that the company attributed to the success of its drugs Mounjaro and Zepbound. These tirzepatide treatments alone are estimated to be worth $70 billion by 2032, according to a recent Evaluate report. But its weight loss pill, Foundayo, which logged $98 million in Q2 sales, fell short of analyst expectations as sales have grown more slowly since its April launch than those of Novo’s Wegovy pill.
Novo Nordisk’s earnings report was a mixed bag. Its Wegovy pill, which nearly doubled analyst expectations with $354 million in first quarter sales, also fell short of projections in Q2. However, sales of the pill remain strong, surpassing 5 million prescriptions since its January launch and prompting Novo to adjust its earnings expectations upwards.
But while supply-side strategy will heavily influence the GLP-1 market, recent surveys point to other factors these companies should pay attention to, including drug affordability, physician preferences and patient perceptions of these drugs.
Prescriber preferences could give Lilly an edge
One poll by Spherix Global Insights shows that some prescribers may be playing favorites with GLP-1s — and that Eli Lilly could stand to benefit. Among 185 surveyed respondents including doctors, nurse practitioners and physician assistants, 80% said they were highly satisfied with Zepbound, compared to 59% for Wegovy, 48% for the Wegovy pill and 47% for Foundayo.
Zepbound also ranked highest when respondents were asked which drug produced the most weight loss, the fastest weight loss and the most sustainable weight loss. It also took the top spot as the most tolerable option for patients, but lost points for its out-of-pocket cost.
Competitors ranked higher than Zepbound in some areas. For example, Wegovy was ranked highest for cardiovascular outcomes evidence and access, and the Wegovy pill took the top spot for affordability.
The high cost of weight loss
Cost presents another potential barrier as companies look to broaden their audience for weight loss drugs. A KFF survey found that 55% of current or former GLP-1 users with health insurance said it was difficult to afford their GLP-1 prescriptions.
Injectable GLP-1s typically cost between $25 to $150 with insurance, depending on coverage. But many health plans don’t cover them when they’re used exclusively for weight loss, according to Forbes. Without insurance, prices average $900 to $1,400 a month for these medications, which are typically taken long term. The newer GLP-1 pills are less expensive — or at least come with a lower advertised cash price. The starting cost for both the Wegovy pill and Foundayo is around $149 per month for patients without insurance paying cash, and co-pays as low as $25 with insurance.
The price of these drugs has led many patients to seek out compounded versions, which often cost less, but can raise safety risks. Often, patients just stop taking them. Spherix poll respondents estimated that 74% of patients who discontinued GLP-1 treatment did so due to cost.
There is a push at the federal level to make these drugs more affordable. The government website TrumpRx links patients with discounted GLP-1 drugs. In addition, research into the drugs’ long-term health benefits is ongoing, which could pave the way for broader coverage, according to IQVIA.
Overcoming social stigma
Even when patients can afford these drugs, some might balk at taking them due to the stigma that surrounds them. A HarrisX–Allison Worldwide study of more than 6,000 adults in the U.S. and U.K. found that while some people embrace the drugs as a medical advance, others judge their use.
The study found that while nearly a quarter of U.S. adults reported using a GLP-1 and another 23% said they would consider it, half of respondents saw the drugs as a weight loss shortcut. In addition, nearly three-quarters of U.S. respondents polled said too many people are using these drugs for weight loss to improve their appearance.
Even so, the study showed that GLP-1s have relatively broad support. Some 66% of those polled said that it is socially acceptable to use a GLP-1, and 64% would be open about using the medication.
People using a GLP-1 had more favorable views than those who didn’t, with 68% of users saying they worked “better than expected.” The study also found social media could change public perception. Some 58% of Americans polled said that seeing online creators talk about using GLP-1s improved their view of the drugs.
For Novo and Lilly, winning market share may depend on more than drug performance. Success may also depend on how patients and doctors view these drugs and their affordability
