Eli Lilly’s stock is still rebounding after disappointing trial results for its closely watched obesity pill, orforglipron. Earlier this month, data showed the drug caused less weight loss and more side effects than Wall Street expected, trailing slightly behind Novo Nordisk’s oral semaglutide in efficacy. Shares of Eli Lilly plunged 13% on release day but have since recovered about 12%.
Despite setbacks, analysts say Lilly’s once-daily pill could still compete strongly in the booming weight-loss market. If approved, orforglipron would likely follow Novo’s pill to market but may offer advantages: it absorbs more easily, avoids dietary restrictions, and is easier to manufacture at scale. That could help meet soaring demand while easing supply shortages tied to injectable treatments like Wegovy and Mounjaro.
Pricing may also tilt the competition. While neither company has disclosed costs, experts believe Lilly could undercut Novo Nordisk’s oral semaglutide, which faces complex and expensive manufacturing. Lower prices could be a key edge as many U.S. insurers still exclude obesity coverage.
Analysts at Goldman Sachs project daily oral pills will make up 24% of the global $95 billion weight-loss market by 2030, generating around $22 billion in sales. They forecast Eli Lilly will capture 60% of that segment, roughly $13.6 billion, compared to Novo’s estimated $4 billion.
Both companies are racing to expand pipelines, alongside rivals like Pfizer, Viking Therapeutics, AstraZeneca, and Roche. For now, experts say cost and insurance coverage may ultimately decide the winner. As Dr. Mihail Zilbermint of Johns Hopkins noted: “Both drugs are gamechangers. But cost is the biggest issue.”
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Weight Loss and Side Effect Comparisons
Direct comparisons between Eli Lilly’s orforglipron and Novo Nordisk’s oral semaglutide remain difficult since no head-to-head trials exist. Lilly’s ATTAIN-1 enrolled 3,000 patients, while Novo’s OASIS 4 studied about 300. Full phase-three results from both are still pending.
Based on available data, Novo’s pill appears more effective. Lilly’s highest dose led to 12.4% average weight loss at 72 weeks (11.2% including all patients), while Wall Street had hoped for 15%, matching Wegovy injections. Novo’s 25mg semaglutide showed up to 16.6% loss at 64 weeks (13.6% including all patients), with nearly one-third of patients losing 20% of their weight.
Still, analysts say Lilly’s results are strong enough to support demand. “For many patients, 12% is a really great number,” said BMO’s Evan Seigerman. Bank of America echoed this view, noting most prescribers are unlikely to change their approach.
Side effect profiles also look similar. In Lilly’s trial, 10.3% of patients on the highest dose discontinued due to gastrointestinal issues, compared with 2.6% on placebo. Nausea affected 33.7% of patients, and 24% experienced vomiting. Novo’s pill showed slightly higher rates: 46.6% nausea and 30.9% vomiting. Most cases were mild to moderate.
Experts caution it’s too early to declare a winner. Johns Hopkins’ Dr. Mihail Zilbermint said tolerability comparisons remain unclear until more data is available. Seigerman added that dietary restrictions — required for Novo’s pill but not Lilly’s — could play an important role in patient preference.
Food Requirements, Manufacturing, and Pricing
Novo Nordisk’s oral semaglutide comes with strict dosing rules: patients must take it in the morning with no more than four ounces of plain water, then wait 30 minutes before eating, drinking, or taking other medications. Analysts say this could deter some patients in real-world use. “If you’re a parent waiting for coffee every morning, that half-hour gap will matter,” noted BMO’s Evan Seigerman.
Manufacturing is another hurdle. As a peptide drug, semaglutide is complex and costly to produce, which may push its price above Eli Lilly’s small-molecule orforglipron. Small molecules are easier and cheaper to scale. Novo Nordisk has invested $24 billion in U.S. manufacturing capacity over the past decade, but Leerink’s David Risinger expects higher production costs to translate into higher pricing.
Eli Lilly has not revealed pricing for orforglipron. CEO David Ricks said it will reflect the drug’s value, factoring in health savings and related conditions it addresses. Goldman Sachs analysts expect pricing to align with Lilly’s injectable Zepbound, which costs just over $1,000 per month.
Experts caution lower production costs won’t guarantee lower prices. “They should be cheaper, but that doesn’t mean they will be,” said Johns Hopkins’ Dr. Mihail Zilbermint.
Commercial strategy may also shape competition. Novo’s recent deal with CVS Caremark made its Wegovy injection the preferred obesity drug on standard formularies, a move analysts say could influence adoption of its oral version. Meanwhile, Lilly may leverage its direct-to-consumer platform, LillyDirect, which bypasses insurers and pharmacy benefit managers by selling drugs like Zepbound directly to patients. Seigerman expects “a lot of nuances in the go-to-market campaign,” emphasizing that distribution choices could be as decisive as clinical results.
Other Competitors Trail Behind
Most rival obesity pills remain in early development, making comparisons with Eli Lilly and Novo Nordisk difficult until larger, long-term trials are complete. So far, experts say the gap is wide.
Viking Therapeutics recently released mid-stage trial results that disappointed investors, sending its stock down nearly 40%. The company’s once-daily pill showed up to 12.2% weight loss at three months with no plateau, suggesting potential for continued reduction over time.
Still, analysts say Viking lags behind. “The results look inferior to Eli Lilly’s pill on almost all metrics,” said Mizuho strategist Jared Holz. He noted that 28% of patients discontinued Viking’s treatment within 13 weeks, compared with about 25% of patients who stopped Eli Lilly’s orforglipron but over a much longer 72-week trial.
That contrast, Holz said, makes Lilly’s data appear far stronger in a head-to-head view.
Frequently Asked Questions
How does Eli Lilly’s obesity pill compare to Novo Nordisk’s oral semaglutide?
Eli Lilly’s orforglipron showed an average weight loss of 12.4% at 72 weeks, while Novo Nordisk’s oral semaglutide achieved up to 16.6% at 64 weeks. Both drugs had similar side effect profiles, mainly gastrointestinal issues like nausea and vomiting.
Why is Novo Nordisk’s pill considered harder to take?
Patients must take oral semaglutide on an empty stomach with only four ounces of water and wait 30 minutes before eating, drinking, or taking other medications. Eli Lilly’s pill does not have these restrictions, which may make it more convenient for daily use.
Which pill is easier to manufacture?
Orforglipron is a small-molecule drug, making it simpler and cheaper to produce at scale. Novo Nordisk’s oral semaglutide is a peptide drug, which is more complex and costly to manufacture.
How much will these obesity pills cost?
Neither company has released official prices. Analysts expect Eli Lilly’s pill to be priced similarly to its injectable Zepbound (around $1,000 per month). Novo Nordisk’s pill may cost more due to higher manufacturing expenses.
When will these obesity pills be available?
Novo Nordisk’s oral semaglutide could be the first to receive U.S. approval, potentially later this year. Eli Lilly aims to launch orforglipron globally in 2026.
Are there other competitors in the obesity pill market?
Yes, companies like Viking Therapeutics, Pfizer, AstraZeneca, and Roche are developing oral obesity drugs. However, most are still in early stages and currently trail behind Eli Lilly and Novo Nordisk.
Will insurance cover obesity pills?
Coverage remains uncertain. Many U.S. health plans do not cover obesity treatments, meaning pricing and reimbursement strategies will play a key role in adoption.
Conclusion
The race to dominate the obesity pill market is heating up, with Eli Lilly and Novo Nordisk leading the way. Novo’s oral semaglutide shows slightly higher efficacy, while Lilly’s orforglipron may win on convenience, manufacturing efficiency, and potentially pricing. Side effects remain comparable, and both pills could significantly expand access beyond costly injections like Wegovy and Zepbound.
