The appetite for blockbuster weight loss and diabetes drugs is far from satisfied. 

From fresh competition to new uses, the market is quickly vaulting into a new stage of growth. But factors including insurance coverage, pricing, copycat drugs and the development of new pills will ultimately determine how far the treatments will reach.

Eli Lilly and Novo Nordisk are still the dominant players, as demand for their weekly injections shows few signs of slowing. Eli Lilly has pulled ahead in the market, saying during its third-quarter earnings call on Thursday that it gained share for the fifth consecutive quarter and that its drugs account for nearly 6 out of 10 prescriptions within the injectable obesity and diabetes class.

But both firms are focused on ramping up supply, testing new uses for their medicines and bringing the next wave of obesity drugs to patients, including more convenient pills. 

Behind them is a slate of drugmakers – from biotech upstarts to pharma giants – racing to win a slice of what some analysts expect could be a roughly $100 billion market by the end of the decade. There may be plenty of room for new entrants: McKinsey projects that 25 million to 50 million U.S. patients could use GLP-1s by 2030. 

Nearly every major pharmaceutical company has bet on obesity drugs, often through deals with smaller developers, including businesses based in China. While some experimental drugs are further along than others, all are likely years away from hitting the market, and their competitive potential will depend on future data showing their effectiveness and how well patients tolerate them.

As competition heats up, many patients are still struggling to access the drugs. Some insurers, including Medicare, don’t cover GLP-1s for obesity, which can cost roughly $1,000 per month before rebates.

Eli Lilly and Novo Nordisk have rolled out discount programs for cash-paying patients to close the gap, and more employers are offering coverage as GLP-1s prove their added health benefits like treating obstructive sleep apnea and chronic kidney disease as well as slashing cardiovascular risks.

Still, some patients continue to use cheaper, copycat versions of branded treatments – even though those alternatives are restricted in many cases. While Novo Nordisk and Eli Lilly’s drugs are no longer in shortage, both companies are cracking down on pharmacies, medspas and other suppliers that mass-produce and market cheaper compounded GLP-1s.

While new competitors and lower-cost pills could allow drugs to reach more patients, access will largely depend on how companies like Novo Nordisk and Eli Lilly choose to price their drugs in the years ahead.

Here’s what to know about the state of the booming weight loss drug market. 

TD Cowen analyst Michael Nedelcovych said that’s largely because Eli Lilly’s injections are superior to Novo Nordisk’s drugs in terms of safety and efficacy. Eli Lilly’s diabetes drug Mounjaro is viewed as a better treatment than Novo Nordisk’s Ozempic, he noted. Real-world data and a head-to-head clinical trial have shown that Eli Lilly’s obesity injection Zepbound leads to more weight loss than Novo Nordisk’s Wegovy.

“It’s better efficacy, and at least anecdotally in real-world practices, it’s better tolerability,” Nedelcovych said. “In our business, that’s usually all that’s required for share gains, and I think we’re seeing that play out very quickly.” 

Investors have unloaded Novo Nordisk’s stock, which has fallen almost 40% this year. Novo Nordisk cut its profit and sales forecast in July, saying compounded drugs had cut into Wegovy’s market. The company had already lowered its 2025 outlook in May.

As competition mounts, data on Novo Nordisk’s experimental medicines also underwhelmed Wall Street and raised concerns about the growth of its drug portfolio beyond Wegovy and Ozempic. 

In a note in September, BMO Capital Markets analyst Evan Seigerman said the company raised expectations too high for its next-generation obesity drug CagriSema, was slow to launch direct-to-consumer sales of its popular drugs and had a “tepid initial response” to compounders selling copycat treatments. 

What’s more, Medicare is negotiating the price of Novo Nordisk’s semaglutide – the active ingredient in Ozempic, Wegovy and the company’s diabetes pill Rybelsus – effective in 2027, which could further cut into revenue. Eli Lilly’s tirzepatide, the active ingredient in Mounjaro and Zepbound, likely won’t be subject to price discussions until the end of the decade. 

Novo Nordisk is betting its new CEO, Mike Doustdar, will help it regain its footing. He took the helm in late July after the board ousted former top executive Lars Fruergaard Jorgensen. 

Doustdar isn’t wasting any time to make changes: Novo Nordisk in September announced plans to cut around 9,000 roles, or roughly 11.5% of its global workforce.

There is still turbulence at the pharmaceutical giant. On Tuesday, Novo Nordisk said several board members will step down after clashing with the controlling shareholder, the Novo Nordisk Foundation, on the makeup of the board.

Novo Nordisk in June said some mass, so-called 503B compounding pharmacies have scaled back production, but accused others — including those tied to Hims & Hers — of continuing to sell the drugs under the “false guise” of personalization. In August, Novo Nordisk executives noted that around 1 million U.S. patients are taking compounded GLP-1s.

The issue also plagues Eli Lilly. While the FDA regulates 503B pharmacies, most 503A sites fall under state oversight. Nedelcovych likened shutting them down to “a case of whack-a-mole.” Eli Lilly and Novo Nordisk’s lawsuits against telehealth companies, pharmacies and others since 2023 have consumed time and resources, with mixed legal outcomes.

The FDA also doesn’t appear to be taking an aggressive stance on compounded GLP-1s: The agency in September published a “green list” of imported GLP-1 drug ingredients deemed safe to let into the country. 

Many health plans, including Medicare, cover GLP-1s for the treatment of diabetes but not obesity. Medicaid coverage of obesity drugs is sparse and varies by state, according to health policy research organization KFF. 

Coverage for GLP-1s for obesity has ticked up slightly: A May survey of more than 300 companies by the International Foundation of Employee Benefit Plans, or IFEBP, found that 36% provided coverage for GLP-1s for both weight loss and diabetes, up from 34% in 2024. 

Still, many employers and health plans remain hesitant due to high costs. In 2025, weight-loss GLP-1s accounted for an average of 10.5% of total annual claims among employers, up from 8.9% in 2024 and 6.9% in 2023, IFEBP found.

“If employers weren’t already on board before, they’re still waiting,” said Julie Stich, vice president of content at IFEBP. “The cost issue is still a major, major issue for them.”

Some plans are concerned that patients won’t stay on the drugs long term due to gastrointestinal side effects, such as nausea and vomiting, and could regain the weight they lost, said John Crable, senior vice president of Corporate Synergies, a national insurance and employee benefits brokerage and consultancy. Employers, which can experience high turnover, are also hesitant to cover costly drugs for workers who may leave the company within a few years, Crable added.

Crable added that new direct-to-consumer programs from Eli Lilly and Novo Nordisk — which let patients pay cash for treatments at less than half their monthly list price — may also discourage employer coverage.

Stitch said employers also have questions about how oral obesity drugs, which could be available as soon as 2025, could affect demand and costs.

But she said coverage could still grow, especially as GLP-1s gain new approvals for more chronic conditions. Wegovy is cleared for reducing cardiovascular risk and fatty liver disease, while Zepbound is approved for sleep apnea.

Novo Nordisk is also testing semaglutide in Alzheimer’s, with initial late-stage trial results expected this year. If that study shows that GLP-1s reduce the risk of cognitive decline, “it would give a big boost” to Novo Nordisk and Eli Lilly because it could encourage patients to stay on them longer, said Leerink Partners analyst David Risinger.

“You’re paying for the GLP-1 drug with the hope that obesity or these other conditions will improve, so that health-care costs for these individual employees will get better as you move forward,” Stich said.

Some plans have also introduced cost controls, like BMI thresholds, to manage spending.

Stich added that broader Medicare coverage could eventually drive private insurers to follow suit. The Trump administration plans to pilot coverage of weight loss drugs under Medicare and Medicaid, which could expand access to millions of older Americans, the Washington Post reported in August.

That means Eli Lilly’s treatment is absorbed more easily in the body and doesn’t require dietary restrictions like Novo Nordisk’s does. Some analysts say orforglipron will also be easier to manufacture at scale than Novo Nordisk’s, which is crucial as demand for obesity and diabetes injections outpaces supply. In August, Eli Lilly CEO David Ricks told CNBC the company hopes to launch its pill globally “this time next year.” 

In an August note, Goldman Sachs analysts 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 market for daily oral treatments 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.

TD Cowen’s Nedelcovych said he has been “treading kind of cautiously” in his outlook for oral weight loss drugs. He said that’s in part because physician consultants and other experts believe injections, which are more effective and easier to tolerate than pills, will dominate the market for the foreseeable future. 

Nedelcovych said the convenience of a once-daily pill may not be enough to convince patients to switch, since some of them “really don’t mind” taking an injection once a week. Nedelcovych added that tapering off injections and switching to pills as a maintenance regimen “also doesn’t seem to make a ton of sense, when we ask physicians about it.” 

He said if pills are less effective at promoting weight loss, it raises concerns that patients who initially lose significant weight on an injection could gain some back after switching to an oral drug.  A phase three study from Eli Lilly, which is studying orforglipron’s ability to maintain weight loss, will bring more clarity on that issue. 

Companies have said that pills could reach patients who don’t take injections because they are afraid of needles. But Nedelcovych said the “fate of oral weight loss therapies could really revolve” around another category of people: patients who could benefit from weight loss treatments but don’t take injections because they believe they are meant for those with serious diseases.

“They’re really just invisible to the marketplace right now,” he said. “But they could have different views about an oral therapy, which could be considered more like a vitamin so they would be more amenable to taking that.” 

The question top of mind for health experts is how companies will price the pills. 

“If it wasn’t for the fact that they can be made more cheaply, I wouldn’t care” about pills, said Dr. Caroline Apovian, co-director of the Center for Weight Management and Wellness at Brigham and Women’s Hospital.

The direct-to-consumer platforms from Eli Lilly and Novo Nordisk offer Zepbound and Wegovy for roughly $500 a month. She said less effective pills with more side effects will have to be priced lower than that if companies want health-care providers to prescribe them first over injections. 

For example, Amgen in March said it has started two critical late-stage trials for its experimental weight loss injection MariTide, which is designed to be taken monthly or even less frequently and promotes weight loss differently from competitors. 

In a mid-stage study, patients with obesity taking MariTide lost up to 16.2% of their weight in one year when analyzing all participants regardless of discontinuations, or up to 19.9% when only analyzing those who stayed on the treatment. But patients experienced a high rate of side effects and discontinuations in the trial. 

Those results support the company’s decision to use a slower dosing schedule over eight weeks to make the drug more tolerable in phase three studies. 

Some pharmaceutical companies have turned to China for their obesity bets. For example, Merck in December snagged the rights to an early-stage experimental GLP-1 pill from Chinese drugmaker Hansoh Pharma, in a deal worth up to $2 billion. 

That acquisition and other smaller players raised questions about the fate of public U.S.-based obesity biotechs such as Viking Therapeutics, which were once seen as hot takeover targets. Some analysts argue that their experimental drugs, most of which are still in mid-stage development, have not differentiated themselves enough from existing treatments. 

“Unless and until these molecules show that they truly are differentiated in phase three, I don’t think there’s really a reason for given pharma to lay out a large transaction to gain access to it,” said TD Cowen’s Nedelcovych. 

He said the “clearest path forward” for U.S.-based obesity biotechs is likely inking partnerships with larger firms to develop and commercialize their drugs.

But Nedelcovych noted that “there really aren’t too many large pharmas who aren’t already spoken for at this point.”