Novo Nordisk’s oral Wegovy has a few months’ head start on Eli Lilly’s newly approved pill. While the Indianapolis pharma has come from behind the Danish rival in the weight loss space before, last time it clearly had the better drug.
Eli Lilly announced Thursday the formal launch of obesity pill Foundayo eight days after its FDA approval. The pharma was well prepared, having stocked $1.5 billion worth of the drug back in February, and is hot to trot, already trailing rival Novo Nordisk’s oral Wegovy, which hit the market in early January after receiving approval just before Christmas.
The oral Wegovy launch was, by all accounts, a smashing success. The drug reached more than 3,000 patients in its first week, shooting up another 500% the following week, according to a Jan. 23 note from BMO Capital Markets. This greatly outpaced even the launch of Lilly’s ever-popular injectable Zepbound, which hit some 1,300 new prescriptions during its launch week in December 2023.
But Lilly isn’t one to let a competitor get in the way. Despite a two-year delay in launching Zepbound as compared with Novo’s injectable Wegovy, Lilly has emerged as the clear victor in that race, overtaking Novo in total GLP-1 sales last year and hitting a historic $1 trillion valuation along the way. The American pharma might have overtaken its Danish peer even sooner had both companies notfaced extended shortages and the GLP-1 compounding industry that grew up during that time.
But this head-to-head battle in the oral obesity space has a key difference from the rivals’ injectable contest—comparable efficacy. When it comes to Zepbound and injectable Wegovy, Lilly has a clear edge, with its drug helping patients lose 47% more weight in a head-to-head trial. For the companies’ oral options, on the other hand, Novo appears to have a leg up, achieving 16.6% weight loss at 72 weeks in a Phase 3 trial, as compared with Foundayo’s 11.2%, though no studies have directly pitted the two pills against each other.
Novo is fighting back against the market share lost on the injectable front with a new high-dose Wegovy, approved last month and launched on Tuesday. BMO analysts were not sold, however. The firm called the 7.2 mg approval “a step in the right direction” as Novo tries to “reinvigorate its commercial business,” according to a March 19 note. “Still, even with the new higher weight loss efficacy on label we see an uphill battle for the company as it fights to regain share from Lilly and grow the broader incretin market.”
But maybe Novo will be able to maintain its early lead in the oral race, given the apparent efficacy edge. Though growth has slowed, prescriptions for oral Wegovy continue to climb, jumping 3.9% this week, according to a BMO note on Friday.
Needless to say, all eyes are closely watching this duopoly in the obesity market. When it comes to price, the pills are largely the same, with both starting at $149 through self-pay options, and as low as $25 through insurance. But there are a few other differentiators beyond efficacy that might influence the race.
For one, Lilly’s Foundayo can be taken with or without food, whereas oral Wegovy must be taken on an empty stomach. And Foundayo is a small molecule while Wegovy is a peptide, which is typically harder to manufacture.
And because both companies offer injectable options, uptake of the pills could steal market share, effectively shuffling revenue around. Indeed, while oral Wegovy scripts continue to climb, injectable Wegovy continues to trend downward, with scripts falling 6.5% this week, according to BMO.
Novo will soon report initial revenue for the pill during the first quarter earnings period—the first and last quarter the company will enjoy a competitor-free market in the oral class.
But both Novo and Lilly are hopeful to reach new patients with the oral options, and that does seem to be happening. A February report from health analytics firm Truveta found that 36.1% of the 8,762 patients who had filled a prescription for oral Wegovy in its first six weeks on the market had never taken a GLP-1 medication before. Still, however, 21.1% had transitioned to the Wegovy pill from an injectable version, while 15.8% had switched from Eli Lilly’s injectable Zepbound.
For now, the stocks tell the same story. Novo’s valuation is holding steady at pre-Wegovy levels, less than one-third of its peak of $650 billion in mid-2024. Lilly, meanwhile, has climbed close to the $1 trillion mark again, after dipping below $900 billion last month for the first time since the early fall. But at this point in the oral obesity race, it’s anyone’s game.
