Eli Lilly’s obesity pill will rival Novo Nordisk’s oral Wegovy drug

Eli Lilly‘s stock is still recovering after the drugmaker released trial data earlier this month on its closely watched obesity pill that underwhelmed Wall Street.

In a key late-stage trial, Eli Lilly’s pill, orforglipron, caused less weight loss and had higher side effects than what analysts were expecting. The pill’s efficacy also appeared to come in slightly below that of Novo Nordisk‘s oral semaglutide for obesity, which showed strong data in a separate study.

Shares of Eli Lilly fell about 13% on the day the trial results were released, although they’re up about 12% since then.

But some analysts say Eli Lilly’s daily pill, if approved, could still be a viable competitor in the weight loss drug space — even if it will likely be second to enter the market. It’s a highly lucrative area that is eager for more convenient options that could ease the supply shortfalls and access hurdles created by the pricey weekly injections currently dominating it.

Analysts note that Eli Lilly’s pill could have a few advantages over the daily oral version of Novo Nordisk’s weight loss drug semaglutide, which is on track to become the first needle-free alternative for obesity to win approval in the U.S. later this year. Eli Lilly hopes to launch its pill globally “this time next year,” CEO David Ricks told CNBC in early August.

Both drugs work by mimicking a gut hormone called GLP-1 to suppress appetite and regulate blood sugar. But while Novo Nordisk’s pill is a peptide medication, orforglipron is a small-molecule drug.

That means Eli Lilly’s pill is absorbed more easily in the body and doesn’t require dietary restrictions like Novo Nordisk’s does. Orforglipron will also be easier to manufacture at scale, which is crucial as demand for obesity and diabetes injections outpaces supply.

Neither company has released prices for its respective pill, but some analysts said Eli Lilly’s drug could potentially have a lower price than Novo Nordisk’s pill. That would be a notable edge, as many health plans in the U.S. still don’t cover obesity treatments.

“It’s a little bit of an apples and oranges comparison because Novo Nordisk could have difficulty manufacturing enough of the product, given the high cost and requirements to manufacture oral semaglutide,” Leerink Partners analyst David Risinger said in an interview. 

“Whereas Lilly plans to blanket the world with orforglipron, and very quickly it will generate dramatically more sales,” he continued. “It can launch globally in an extraordinary manner with lower prices and with no food intake consideration.”

Goldman Sachs analysts seem to agree, based on a note in August. They forecast daily oral pills will capture 24% share — or around $22 billion — of the 2030 global weight loss drug market, which they expect to be worth $95 billion. 

The Goldman analysts said they expect Eli Lilly’s pill to have a 60% share — or roughly $13.6 billion — of the daily oral segment of the market in 2030. They expect Novo Nordisk’s oral semaglutide to have a 21% share — or around $4 billion — of that segment. The remaining 19% slice will go to other emerging pills, the analysts said.

The race to develop a more convenient obesity pill has been fraught, as companies such as Pfizer have had to scrap previous contenders and bring forward new ones. Novo Nordisk and Eli Lilly are also exploring other experimental oral drugs, along with a slate of other companies such as Viking Therapeutics, Structure Therapeutics, AstraZeneca and Roche. 

In a statement, Novo Nordisk CEO Mike Doustar said “we strongly believe in the efficacy” of the oral drug. The Danish company added it will be “laser-focused on getting this product to patients without supply constraints” in the U.S. 

Dr. Mihail “Misha” Zilbermint, director of endocrine hospitalists at Johns Hopkins Community Physicians, said it’s hard to crown a winner between Eli Lilly and Novo Nordisk without knowing how their respective pills will be priced and whether insurance will cover them. 

“I think both of the drugs are going to be gamechangers,” he said. “When it comes to which company is going to win the game — cost is the biggest issue.”

It’s difficult to directly compare the results of separate clinical trials, especially as investors wait for Eli Lilly and Novo Nordisk to release the full data from their phase three studies.

Eli Lilly’s ATTAIN-1 trial also followed 3,000 patients, while Novo Nordisk’s OASIS 4 study evaluated a much smaller group of roughly 300. There are currently no studies directly comparing the two drugs, a Novo Nordisk spokesperson said.

But Novo Nordisk’s oral semaglutide appears to cause a greater level of weight loss than Eli Lilly’s pill based on the available data, said BMO Capital Markets analyst Evan Seigerman. 

In the trial, the highest dose of Eli Lilly’s pill helped patients lose 12.4% of their body weight on average at 72 weeks. The pill’s weight loss was 11.2% when analyzing all patients regardless of discontinuations.

Wall Street had hoped Eli Lilly’s pill would generate weight loss of around 15%, the same level as Novo Nordisk’s blockbuster weight loss injection Wegovy. Semaglutide is the active ingredient in Wegovy and its diabetes counterpart Ozempic. 

Meanwhile, the 25-milligram dose of Novo Nordisk’s oral semaglutide helped patients lose up to 16.6% of their weight on average at 64 weeks, according to results from the trial presented at a medical conference in 2024. That weight loss was 13.6% when the company analyzed all patients regardless of whether they stopped the drug. 

A Novo Nordisk spokesperson added that 20% of weight loss was observed in nearly one-third of patients in the trial.

Still, the slightly lower efficacy of Eli Lilly’s pill may not be significant enough to deter patients from taking it. 

“For many patients, 12% is a really great number,” said Seigerman. “There’s definitely a market there” for orforglipron.

In a note earlier this month, Bank of America analysts shared a similar sentiment. 

“Yes, weight loss fell a bit short, but ask 100 prescribers whether this new data will really make a difference in who they’d put on orforglipron, and our belief is the vast majority would say, ‘not really,'” they wrote, referring to Eli Lilly’s trial data. 

Some investors raised concerns about the side effects and discontinuation rates in the trial of Eli Lilly’s pill. But Seigerman said the drug’s tolerability data — how well patients tolerate it — appears to be relatively in line with that of Novo Nordisk’s oral semaglutide. 

About 10.3% of patients who took the highest dose of Eli Lilly’s pill — 36 milligrams — discontinued treatment due to side effects, compared with around 2.6% of those who took a placebo.

Those side effects were mainly gastrointestinal, such as nausea and vomiting, and mild to moderate in severity. An estimated 24% of those who took the highest dose of Eli Lilly’s pill reported vomiting, while 33.7% had nausea. 

Leerink’s Risinger said he is watching to see how persistent those gastrointestinal issues are once Eli Lilly presents the full data. 

The side effects in the trial on Novo Nordisk’s pill were mostly gastrointestinal-related: 30.9% of those who took oral semaglutide reported vomiting and 46.6% reported nausea, according to the trial results. 

Johns Hopkins’ Zilbermint said it’s difficult for him to decide which one has a better safety and tolerability profile based on the available data. 

Meanwhile, Seigerman pointed to a different factor “that will also matter a lot”: dietary requirements. 

Unlike Eli Lilly’s pill, patients need to take Novo Nordisk’s oral semaglutide in the morning on an empty stomach with no more than four ounces of plain water. They’re instructed to wait 30 minutes before eating, drinking or taking other oral medicines.

Seigerman said that could be a hurdle for some patients. 

For example, “if you’re a parent with kids and you have to take this drug and wait half an hour before you can drink your coffee, you’re going to drive yourself crazy, especially if you have to take this every day,” he said. “I try to think about the real-world use of these drugs in a market like this. It’s going to matter.” 

Leerink’s Risinger said oral semaglutide will also be “extremely expensive to manufacture” since it is a peptide medication, and “is likely going to have to be priced higher than orforlipgron.”

A Novo Nordisk spokesperson said the pill will be made mostly in the U.S., and the company is excited about the potential the pill “provides millions of Americans living with obesity.”

“Currently, all typical launch readiness activities [for the pill] are fully underway and building momentum,” the spokesperson said. They added that over the past decade, the company has invested $24 billion in the U.S. to expand manufacturing capacity and fuel research and development. That includes investments aimed at increasing manufacturing of active pharmaceutical ingredients and capacity for the final stages of production for both current and future injectable and oral products. 

Small molecules are chemically simpler and easier to produce at scale, making them generally cheaper for companies to formulate. But it is still unclear how Eli Lilly will price orforglipron. 

During an earnings call in August, Eli Lilly’s Ricks said the pricing will be based on the value orforglipron brings, considering health-care savings and the comorbidities it can address.

In the note earlier this month, Goldman Sachs analysts said they expect the pill to be “priced at parity” to Eli Lilly’s tirzepatide, the active ingredient in the company’s obesity injection Zepbound and diabetes counterpart Mounjaro, which list for just over $1,000 for a month’s supply. 

“They should be cheaper than injections because they are easier to produce. But it does not mean they will be cheaper,” Johns Hopkins’ Zilbermint said. “We just don’t know — for example, we don’t know how much went into research and development.”

Seigerman said commercialization strategies will also be key when the pills compete on the market. 

He questioned whether Novo Nordisk will lean into the deal it recently struck with CVS‘s pharmacy benefit manager, Caremark. Under the deal, Caremark started to prioritize Novo Nordisk’s Wegovy on its standard formularies on July 1, making that weekly injection the preferred GLP-1 drug for obesity over Zepbound. 

But it is unclear whether oral semaglutide could receive a similar preferential status.

Seigerman also questioned whether Eli Lilly will offer orforglipron through its direct-to-consumer pharmacy, LillyDirect. That offering bypasses insurers and pharmacy benefit managers, allowing patients to directly purchase Zepbound and some of Eli Lilly’s other drugs from the company. 

Seigerman said he expects “a lot of nuances in the go-to-market campaign for these drugs,” adding “that’s going to matter.”

Other obesity pills are in earlier stages of development, making it difficult to directly compare them to the drugs from Eli Lilly and Novo Nordisk without longer and larger trials. 

But so far, some experts think they pale in comparison.

For example, Viking Therapeutics on Tuesday released mid-stage trial data that disappointed investors, sending its stock down as much as 40%. 

Jared Holz, Mizuho health care equity strategist, said in an email Tuesday that the results on Viking’s drug “look inferior” to those of Eli Lilly’s pill “on almost all metrics.” 

Viking’s once-daily pill helped patients lose up to 12.2% of their weight at around three months, with no plateau, which means patients could lose even more in a longer-term study.

Holz pointed to the high rate of patients who discontinued Viking’s drug for any reason over 13 weeks, which was around 28%. Meanwhile, around a quarter of people discontinued Eli Lilly’s pill, orforglipron, for any reason over 72 weeks.

That’s “a much longer trial and therefore [Lilly] looks far better head-to-head,” Holz said.