Novo takes first round of oral obesity duel. Can it stay ahead of Lilly?
August 19, 2026 |
7 min read |
Tristan Manalac
Despite coming away with an early victory over Eli Lilly in the oral obesity face-off, analysts don’t expect Novo Nordisk’s lead to last for very long
It’s already been a full commercial quarter since the April approval of Eli Lilly’s weight loss pill Foundayo—which means analysts now have around three months’ worth of sales data to see how the oral obesity battle is shaping up
The results so far are “striking,” Sadaf Javed, manager of forecasting at DelveInsight, told BioSpace competitor Novo Nordisk in the injectable market, the Indianapolis pharma seems to be lagging behind in the pill contest. In the second quarter of 2026, oral Wegovy revenue hit DKK 3.22 billion ($496 million), while Foundayo made $98 million in Q2
“The gap reflects more than first-mover timing,” Javed said. “Novo extended the established Wegovy brand into an oral formulation, allowing it to leverage existing physician familiarity, patient awareness, and semaglutide experience rather than building a new obesity brand from scratch,” as Lilly is having to do
Sara Reci, managing pharma analyst at GlobalData, seconded the importance of name recall and attributed Novo’s first-round win to its “structural first-mover benefit and the exceptional brand equity of the semaglutide franchise.”
The name “Wegovy pill,” Reci told BioSpace in an email interview, is “immediately legible to patients and prescribers already familiar with the injectable, requiring far less commercial education than a new brand name.”
Then there is the question of efficacy. Oral Wegovy elicits around 16.6% weight loss at 72 weeks versus Foundayo’s 11.2% at the same time point. While there has been no direct head-to-head comparison of the two drugs, Reci gave the efficacy edge to Novo’s product
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“The efficacy dynamic has reversed,” she explained. Lilly had the more effective product in the injectable tirzepatide—sold as Mounjaro for type 2 diabetes and Zepbound for chronic weight management—allowing the company to dislodge Novo’s GLP-1 lead. But the Danish pharma now holds the efficacy upper hand in the oral arena, “removing the key lever that allowed Lilly to dislodge Novo in injectables so quickly.”
“The oral market, at least in its early phase, favors Novo Nordisk,” Reci said
Lilly takes fight overseas as Novo plays defense
Lilly, of course, isn’t taking Novo’s early win lying down
The most immediate “lever” that Lilly can pull on concerns the comparative simplicity of Foundayo’s schedule versus oral Wegovy, Javed said. Unlike Novo’s pill, which needs to be taken with water and can’t be followed by any additional food or drink intake for at least 30 minutes, Foundayo has no such restrictions—a clear acceptability advantage that “could further differentiate it as the oral market matures, particularly if convenience drives treatment initiation and switching,” she added.
Lilly should then “reinforce this advantage through its established Zepbound/Mounjaro commercial ecosystem,” Javed continued, pointing to the pharma’s extensive direct-to-consumer network, substantial physician reach, existing patient awareness and seasoned sales and marketing teams
For Srikripa Devarakonda, vice president of Biotechnology Equity Research at Truist Securities, Lilly would also do well to press its commercial advantage on a global scale. “Our view is that Foundayo is a bigger [ex-U.S.] play,” she told BioSpace in an email interview
The overseas market is more price-sensitive, Devarakonda explained, contending that “Lilly will be able to better compete with oral Wegovy on price points given the high margins of a small-molecule therapy in order to secure favorable volume growth.” Unlike oral Wegovy, which is a peptide, Foundayo is a small-molecule drug, making it easier and less costly to manufacture
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Of course, Lilly shouldn’t concede the U.S. oral market, where Devarakonda thinks the pharma’s best course of action is aggressive marketing and promoting access, rather than lowering prices
Facing down Lilly’s proven commercial track-record, Novo has its work cut out. The challenge for the Danish pharma is “no longer simply to capture the oral GLP-1 market,” Javed said. Instead, Novo needs to make the most out of the early Wegovy pill momentum and turn it into a sustainable, long-term advantage
This will hinge on a couple of key priorities, she continued. First, Novo will need to sustain access at scale, establishing reliable supply of the drug as well as competitive pricing and payer coverage. Then, the Danish drugmaker should consider “sharpening the value proposition of the pill,” including figuring out a way around Lilly’s “simpler administration profile,” which Javed reiterated “could become a meaningful differentiator as patients gain more choice.”
“Ultimately, Novo’s leadership will depend less on being first and more on continuously strengthening the franchise across efficacy, convenience, access, and value,” she added. Indeed, the most crucial thing for Novo is to “stay ahead of the efficacy curve” with its next-generation products as the obesity race moves beyond the conventional GLP-1 approach
“Maintaining leadership will require Novo to make Wegovy the platform from which it evolves—not simply the product that won the initial race,” Javed said
The long game
When Lilly first entered the GLP-1 arena with Mounjaro in 2022, it was almost 5 years behind Novo Nordisk, which secured a nod for Ozempic in late 2017. Within 3three short years, however, Lilly had overtaken Novo as the market frontrunner, an upset that was driven in no small part by tirzepatide’s potentially greater weight reduction and sugar control effects
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Something similar could potentially play out in the coming years as the broader obesity sector races past the oral stage and into the next generation of therapies
“Novo’s early lead in oral GLP-1s is meaningful, but it is unlikely to be permanent,” Javed told BioSpace, noting that even now, as oral Wegovy and Foundayo battle it out on the market, the industry is already exploring new pathways and modalities to address obesity
On this front, Novo appears to be on the back foot. The next phase of the Danish pharma’s pipeline is centered on CagriSema, a fixed-dose combination of semaglutide and a long-acting amylin analog called cagrilintide. The drug has so far failed to decisively wow analysts and investors
In December 2024, Phase 3 data showed that CagriSema elicited greater weight loss than semaglutide or cagrilintide alone but nevertheless fell below the bar that Novo itself had previously set. That miss erased some $72 billion off the pharma’s market cap at the time
Then, in February, CagriSema bowed to Lilly’s Zepbound in a Phase 3 head-to-head trial, which failed to show that CagriSema was statistically non-inferior to the tirzepatide brand. Novo filed for CagriSema’s approval in December last year, though no specific decision date has yet been revealed
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GlobalData’s Reci also pointed to zenagamtide as a potential standard-bearer for the next generation of Novo’s cardiometabolic pipeline. The molecule, previously called amycretin, elicited both blood glucose and body weight reductions in patients with type 2 diabetes, according to a mid-stage readout in June. Phase 3 development for this indication is slated to start this year
Lilly’s path to long-term leadership, meanwhile, “runs through retatrutide,” Reci told BioSpace, referring to the pharma’s oral triple-G therapy that targets the GLP-1, GIP and glucagon receptors to promote insulin secretion and boost the body’s energy expenditure
Late-stage data in June showed that in patients with obesity or overweight who also have type 2 diabetes, retatrutide elicited a 20.8% weight reduction at the highest dose, as compared with a 4% decrease in placebo controls. In May, results from a separate Phase 3 study showed 26.1% placebo-adjusted weight loss over 80 weeks at the highest dose
The expectations for retatrutide are so high that the molecule generated “the strongest KOL [key opinion leader] anticipation of any pipeline asset across all markets,” Reci said, citing data from GlobalData. An FDA submission for retatrutide is planned for 2027
Given how the commercial markets and pipelines are shaping up, she anticipates another upset in 2028: Novo will maintain its lead until then, after which Lilly will once again catch up and “progressively widen the gap through 2032.”
Several up-and-coming oral weight loss drugs that are “expected to increase competition” could potentially complicate the picture a bit, Reci cautioned. These include Structure Therapeutics’ aleniglipron, likely to hit the market in 2028, she noted, as well as Roche, AstraZeneca and Biomea Fusion
“However, none are currently forecast to challenge Lilly or Novo for market leadership by 2032,” Reci said
ObesityWeight lossGLP-1
Novo NordiskEli Lilly and Company
Tristan Manalac
