Novo Nordisk’s head start on GLP-1 pills forces investors to rethink Eli Lilly’s dominance

When the Wegovy pill launched in January, telehealth provider LifeMD said its business doubled almost overnight. 

LifeMD went from seeing between 300 and 400 new patients a day to 600 to 1,000 new patients a day, said CEO Justin Schreiber. He knew there would be demand, but that level of interest surprised him. 

“There’s no question that the launch of oral medications has improved access,” Schreiber said. 

Tens of thousands of people have started taking Novo Nordisk’s Wegovy pill in the four months since it launched in the U.S., the majority of them new to the GLP-1 category. Investors will get a fresh look at the Wegovy pill’s momentum when Novo reports first-quarter results on Wednesday.

The launch has already forced investors to rethink the opportunity in oral GLP-1s — and which company might win it. While obesity and diabetes market leader Eli Lilly launched its own pill, Foundayo, last month, early signs indicate its rollout has been more modest than the Wegovy pill’s start.

“We were all in this camp of Foundayo, Foundayo, Foundayo because Lilly was talking it up and we were also concerned about making enough peptide because Novo was still coming out of shortage,” said BMO Capital Markets analyst Evan David Seigerman. 

Now, Novo’s early success has upended the expectations of some investors and analysts who expected the Danish company would fall behind its U.S. rival in the oral category, as it did in injectables.

Novo’s Wegovy pill uses the same main ingredient as its weekly shot. The company had at times struggled to produce enough of the peptide to satisfy the soaring demand for the injection, and the oral formulation required even more of it. Meanwhile, Lilly was telling investors its GLP-1 pill was easier to make and wouldn’t face the shortages that hindered the shots. 

Doubts about Lilly’s lock on the market emerged last summer when the company said its pill helped people lose about 12% of their body weight, on average. Seigerman noticed Novo pounced on the opportunity and started to highlight the efficacy of oral semaglutide, the active ingredient in Novo’s Wegovy, which delivered almost 17% weight loss in a separate trial. 

When the Wegovy pill was approved around the New Year, Novo and its telehealth partners rolled out a high-profile promotional blitz. Ads blanketed New York subways and TV broadcasts. The Danish drugmaker even tapped celebrities like DJ Khaled for its first-ever Super Bowl ad. 

Novo pushed the pill’s lower entry price of $149 per month and injection-like efficacy. The company used its three-month head start on Lilly to shape the narrative and combat concerns that people wouldn’t want a pill that needs to be taken first thing in the morning without food and with little water, which Novo CEO Mike Doustdar said were “a bit fueled by our competitor.” 

“Well, I have news for you, this has been absolutely not the case,” Doustdar told CNBC in March. “People are really interested because it’s the most efficacious pill right now in the market.”

The Wegovy pill — and now Lilly’s own oral drug — are helping to expand the GLP-1 market, reaching patients who wouldn’t have otherwise sought treatment due to a fear of needles or difficulty accessing the injections, which used to cost much more than today’s pills for many patients.

“There’s a fair number of patients that don’t want to be stuck by the needle in the case of a vial and syringe or stung by the price,” Jamey Millar, Novo’s head of U.S. operations, said in a March interview. 

People are choosing GLP-1 pills “by a huge factor” more than shots through telehealth platform Sesame, said president and co-founder Michael Botta. He attributes the preference to the lower price of the pills versus the shots and the fact that people are more comfortable trying oral drugs than going straight to shots.

That could bring in a more diverse set of patients to the category. More men are “definitely” starting the medications than before, he said, though women still make up a majority of new patients. 

Shortly after the launch, Novo said that many of the initial users were taking the lowest starter dose of the drug. Millar told CNBC that the company is closely watching how many patients move to the highest doses over the coming months. 

Eli Lilly appears to have work to do to catch up to Novo.

While Novo was able to leverage the Wegovy brand recognition right out the gate, Lilly is trying to introduce introduce people to an entirely new brand. Its pill Foundayo has a different active ingredient than its best-selling weight loss shot Zepbound. Lilly executives last week sought to reassure investors that it’s going to take time to introduce the drug to doctors and patients. 

In the first few weeks of the launch, more than 20,000 people have started taking Foundayo, Lilly CEO Dave Ricks told CNBC following the company’s first-quarter earnings report. More than 1,000 people are starting the drug every day, and 80% of those patients are new to GLP-1 drugs, he said. Lilly still needs to build consumer awareness around the pill, Ricks said, adding the company hasn’t started widely advertising it on TV. 

“So what we’re seeing now is basically organic demand, which is really strong to us,” Ricks said.

RBC analyst Trung Huynh said investors should wait two or three months to judge the momentum of Lilly’s Foundayo launch because there’s so much early volatility. He thinks it’ll take a year or two for the story to play out. He pointed to the market for weekly shots: Prescriptions of Zepbound surpassed those for Novo’s Wegovy six months after Zepbound was introduced in the U.S., even though it launched two years later.

Because Lilly hiked its full-year sales forecast on strength across its GLP-1 business, it should take some pressure off Foundayo prescriptions in the near term, said Barclays analyst Emily Field. The company plans to start introducing Foundayo in other countries later this year and has touted the pill as the key to reaching people around the world.

Novo hasn’t disclosed any specifics around a potential launch of its Wegovy pill outside of the U.S., but in March it announced a $500 million manufacturing investment in Ireland to meet current and future demand for its oral products outside of the U.S. The European Medicines Agency is expected to approve the Wegovy pill later this year.

Investors will get a better look at the Wegovy pill’s performance this week when the company reports earnings from the first quarter it was available in the U.S. Analysts have praised the strength of the rollout, which outpaced even the launch of its shots.

Even so, Wall Street expects a significant drop in overall sales this quarter, as generic competition for the Wegovy shot threatens sales in India, China and Canada. The pill’s lower price point could also crimp U.S. sales.

Investors will be on high alert for any data related to the Wegovy pill and whether Novo stands by the gloomy forecast it issued in February, when it said sales and profits will both decline by 5% to 13% in 2026. Novo’s pipeline will also be a focus. Disappointments in the clinic have weighed on the stock, causing investors to wonder whether Novo’s pipeline is rich enough to help the company stay competitive. 

And while the pills are important to both Novo and Lilly, analysts say they won’t define either company. 

“Yes it’s shaking things up, but I still think Lilly has enough components to excel,” BMO’s Seigerman said. “And while Novo may win with this, they need more than one win to be the champion.”

Correction: This story has been updated to correct Michael Botta’s title. A previous version misstated his title.