This year’s catalysts in the space include a near-term FDA decision on Eli Lilly’s oral challenger to the new Wegovy pill. Looking further ahead, Novo Nordisk is expecting more clinical data for next-gen weight loss asset CagriSema, which recently lost a head-to-head battle with Lilly’s Zepbound.
Novo Nordisk’s Wegovy injection reeled in $12.5 billion in 2025, while Eli Lilly’s Zepbound took home $13.5 billion. However, according to BMO Capital Markets, they’re leaving money on the table.
“Obesity med net pricing has declined significantly, but access remains difficult for some patients, preventing full uptake and usage among eligible patients,” BMO wrote in a Wednesday note following its third annual Metabolic Health Summit.
The event, held Tuesday in New York, brought together pharma representatives from Novo and Lilly, along with Structure Therapeutics, Amgen, Pfizer and Corbus Pharmaceuticals. Healthcare was also well-represented, with ProCare RX, Ro Health and several physicians in attendance.
Certainly, prices for the drugs have fallen over the past year. In November, Novo and Lilly struck a deal with the White House to offer their respective GLP-1s—Novo’s semaglutide, marketed as Wegovy for weight loss and Ozempic for type 2 diabetes, and Lilly’s tirzepatide, marketed as Zepbound and Mounjaro for the same indications, respectively—through President Donald Trump’s direct-to-consumer marketplace for about $350 per month. Under the deal, weight loss pills would be offered at $150 for the initial doses. Novo’s oral Wegovy launched in January, while Lilly’s orforglipron is currently under review at the FDA.
Despite these price drops, however, BMO said access improvements have been limited over the past year.
Oral options could start to improve access. BMO called the launch of the Wegovy pill “impressive,” adding that it is activating new patient segments. The product, approved just before Christmas 2025, got off to a strong start in January, reaching more than 3,000 patients in its first week. BMO in its Wednesday note attributed some of the pill’s early success to “an attractive entry cash price of $149,” combined with branding connection to the Wegovy injectable. Sales of the Wegovy portfolio are expected to increase from $13.5 billion in 2026 to $18.9 billion in 2031, with the pill contributing $2.76 billion, according to a recent GlobalData report.
Meanwhile, “Don’t rule out CagriSema just yet,” the analysts cautioned. Novo’s next-gen candidate, which combines semagutide with amylin agent cagrilintide, fell to Zepbound last month in a head-to-head trial, generating 23% weight loss compared to Zepbound’s 25.5%.
“We view this as the worst case scenario for Novo Nordisk, though we do not believe there is material read-through to the amylin class more broadly,” William Blair analysts wrote in their own Wednesday morning note rounding up fourth quarter earnings updates from obesity companies they cover.
But the BMO group said that Novo’s REDEFINE-11 Phase 3 study, which is expected to read out in the first half of 2027, could offer a better opportunity for investors to assess the efficacy of the next-gen combo weight loss treatment. BMO added that its key opinion leader “likes [CagriSema] too!”
The FDA is expected to make a decision on CagriSema by the end of the year, according to William Blair.
On the Lilly front, near-term catalysts include a decision on orforglipron by April 10 plus a regulatory submission for retatrutide in overweight/obesity, the analysts said.
BMO also noted that the Indianapolis-based pharma is studying its incretin therapies in the neuropsychiatric space for addiction and depression. This effort, the analysts wrote, “appears a moral imperative, but may be more challenging for clinical success.”
Specifically, Lilly is evaluating brenipatide, which targets both the GLP-1 and GIP receptors, in two Phase 3 trials for alcohol use disorder and a Phase 2 study for relapse in tobacco use disorder. Another Phase 2 trial will test the drug in combination with other medicines in people with opioid use disorder. Lilly expects the trials to wrap in 2027 and 2028, a spokesperson told BioSpace earlier this month.
BMO also gave a shoutout to Structure Therapeutics’ ACCG-2671, a dual amylin and calcitonin receptor agonist currently in Phase 1 studies, writing that data expected during the second half of 2026 “could be a key development point for the company, demonstrating pipeline expansion beyond [lead candidate] aleniglipron.”
BMO offered other key takeaways from the summit, including that care delivery models are starting to emphasize durability of treatment over headline weight loss, and that Medicaid access “remains tougher with recent cuts to the program.”
