Lilly Claims 61% of US GLP-1 Market as Novo Bets $23B Pipeline

Lilly held roughly 61% of the U.S. GLP-1 market in the second quarter, against Novo Nordisk's 39%, and its lead is widening in the very segments Novo is counting on for its next chapter.

Novo laid out an ambitious strategy this week to reignite growth beyond Wegovy and Ozempic, the injections that face patent expirations in key markets in the early 2030s. At its Capital Markets Day on Monday, the Danish drugmaker promised a pipeline of potential blockbusters, including drugs outside its core areas of obesity and diabetes.

Wall Street wasn't buying it. Investors pummeled the stock, underwhelmed by growth targets that matched industry averages rather than outpaced them and by the lack of clarity on a near-term turnaround plan.

Lilly gains in pills and Medicare

Novo holds an early lead in the oral weight loss market after launching the Wegovy pill months ahead of Lilly's rival pill, Foundayo. CEO Mike Doustdar told CNBC on Tuesday that early adoption suggests patients were waiting for an alternative to injections.

"If that continues to the extent that we have seen, then yes, mathematically, by the end of the decade, there is going to be a larger portion on the pill than injectable," Doustdar said.

Lilly is closing the gap fast. CEO Dave Ricks told CNBC in an exclusive interview Monday in Houston, Texas, that one-third of new GLP-1 pill patients in the U.S. are taking Foundayo, and its share of the oral market is growing "week by week."

Lilly also claims an early lead in the newly established Medicare obesity market, which began covering the treatments in July. Ricks said 700,000 seniors have started GLP-1s under Medicare since coverage began, and 70% of those patients are on Lilly's drugs. Medicare patients show a particular preference for Lilly's Zepbound injection, which has helped make Lilly the dominant player in the broader market.

Analysts see Lilly keeping the upper hand

Leerink Partners analyst David Risinger expects Lilly's advantages — commercial scale, globalization and an advanced pipeline — to keep it on top.

"Lilly is in the leadership position, and we think that they will remain in this strong leadership position, given their substantial commercial advantage, their global initiative to globalize their products further, and then their advanced pipeline of novel candidates as well," Risinger said in an interview.

He expects Foundayo to eventually dominate the global pill market, partly because the small-molecule drug should cost less to manufacture at scale than Novo's peptide-based Wegovy pill. Foundayo produces less average weight loss than the Wegovy pill but carries no food and water restrictions — a selling point for some patients.

Novo executives this week did not directly answer whether Foundayo is easier to manufacture. The company is investing billions in manufacturing capacity and says it aims to increase the number of patients on its GLP-1 drugs tenfold by 2030. Executives insist supply is not an issue and that Novo will avoid the shortages that hit injectables in the early days of Ozempic and Wegovy.

Lilly's pipeline extends beyond current products. Retatrutide, a triple-agonist targeting three gut hormones, has produced greater weight loss than existing obesity drugs in clinical trials, and Lilly plans to seek approval in the first quarter of 2027. Lilly is also developing a weekly injection targeting the amylin receptor, which Risinger said has "much greater potential than the Street currently realizes," particularly for patients who don't tolerate or respond adequately to GLP-1s.

"We're quite enthusiastic about the company's pipeline for follow-on agents beyond Zepbound and Foundayo," Risinger said.

Novo's sweeping bet

Novo targets launching more than five potential multi-blockbuster drugs by 2030 and more than 150 billion Danish kroner — about $23 billion — in pipeline sales by 2035. It plans at least five Phase 3 programs in obesity and diabetes and another five across other therapeutic areas.

The scale of that plan underscores the problem. Novo holds patent protection on semaglutide, the active ingredient in Wegovy and Ozempic, until 2032. Those two drugs account for roughly two-thirds of company sales and generated a combined $31 billion in 2025.

The new lineup includes CagriSema, a combination of semaglutide and the amylin-targeting drug cagrilintide, expected to launch early next year. Standalone cagrilintide and a higher-dose CagriSema follow in 2028. Wall Street remains lukewarm on CagriSema after late-stage trials showed weight loss below expectations.

Novo maintains the drug is viable. Chief Scientific Officer Martin Holst Lange pointed to new late-stage data released this week showing CagriSema produced greater weight loss than tirzepatide — the active ingredient in Zepbound and Mounjaro — in a head-to-head trial among people with Type 2 diabetes. Caveats apply: that study used lower doses, and tirzepatide outperformed CagriSema in a separate head-to-head Phase 3 trial at higher doses.

Lange argues the breadth of Novo's pipeline matters more than any single drug, citing effects on tolerability, muscle preservation and obesity-linked conditions.

"We can't do that with one single drug," Lange told CNBC.

Volume versus share

Novo argues market share isn't the only measure of success. Doustdar stressed that the obesity market itself can still grow significantly. Novo plans manufacturing capacity to serve 15 million people on oral obesity treatments by 2030 and says pills could ultimately account for as much as half of the global obesity drug market. The Wegovy pill has already reached 7 million U.S. prescriptions, with 90% of sales through cash-pay channels.

Investors want more than a promising pipeline. Analysts on Monday pressed executives on pricing assumptions, questioning whether new drugs can sustain premium prices once Wegovy and Ozempic lose exclusivity. Novo's 2026–2030 revenue outlook targets growth in line with pharmaceutical peers — not the outsized growth of the Wegovy boom years.

That leaves Novo defending its existing franchise against Lilly while simultaneously funding the drugs meant to replace it.