Next steps for Eli Lilly, Novo Nordisk and Pfizer

The future of the booming obesity drug market won’t rest on drugs that deliver greater weight loss alone.

Senior executives from large and small pharmaceutical companies told CNBC that the next phase of the space will be defined by a broader range of treatment options and improved access for patients. Those were among the topics that came up at JPMorgan’s annual healthcare conference in San Francisco during interviews with senior officials from the sector Eli Lilly, Novo Nordisk, Pfizer And other pharmaceutical makers.

“We’re really seeing the obesity market move, this year, from a one-size-fits-all idea to different drugs for different patients,” Dan Skovronsky, chief scientific officer at Eli Lilly, told CNBC in an interview during the conference. “We don’t have a crystal ball to know how it’s all going to be resolved.”

“But I think by offering people choices, they’ll make choices for themselves with their doctors, and I think we want to have something for everyone,” he continued. “And we’re not finished yet.”

Over the coming years, executives anticipate an expanding menu of obesity treatments that can be tailored to fit an individual patient’s needs — from less frequent pills and injections to combination regimens and medications designed to preserve muscle mass while promoting weight loss. Some also expect the direct-to-consumer market to become a larger segment of the market, while hoping that barriers preventing patients from accessing treatment will continue to decline.

Novo Nordisk and Eli Lilly are widely credited with establishing the market with their weekly GLP-1 injections to treat obesity and diabetes, which have risen in popularity in recent years. The next chapter is already taking shape, with Novo launching its first GLP-1 obesity pill earlier this month, and Lilly preparing to bring its own oral option to market later this year.

While these companies will play a crucial role in how the field evolves, other players from pharmaceutical giant Pfizer to little-known startups could enter the market as well — both threatening competitors’ sales dominance and offering consumers more therapeutic alternatives.

While access remains a challenge for many patients, the ability to obtain GLP-1 has improved significantly over the past year. Both Novo and Lilly lowered cash prices for their shots and struck deals with President Donald Trump in November that will, for the first time, offer Medicare coverage for obesity drugs later this year.

More treatment options and expanded access could boost analyst projections that the weight-loss and diabetes drug market could be worth nearly $100 billion annually by the end of the decade.

In an interview at the conference, Novo Nordisk CEO Mike Doostdar said the company and Lilly currently have about 15 million people with obesity taking GLP-1s. He added that there is still a “long tail” to reach the 110 million with the condition, along with those who are overweight.

In a report released in May, McKinsey said it expects 25 to 50 million US patients to use GLP-1s by 2030.

Here’s what executives are saying about the future of space.

Pills have not yet been proven to be more effective than injections.

However, the consensus among executives is that oral options can expand the market, reaching entirely new patients. This may include people who are afraid of needles, as well as people who could benefit from existing injections but do not consider their condition serious enough to warrant a weekly injection.

In an interview during the conference, Doostdar said the number may also include people who travel a lot and cannot easily refrigerate injections.

“There’s a lot that fits right into this market expansion story…because there’s a significant number of patients who simply aren’t interested in losing weight at the expense of injecting themselves,” Doostdar said.

Ray Stevens, CEO of Hope in the Obesity Market, said the “real growth” and uptake of pills will come from primary care doctors, who write the majority of prescriptions for Americans and typically prefer pills over injections. Structural treatments.

He said he believes his company’s GLP-1 pill, aleniglipron, will be the third to hit the market after Eli Lilly and Novo Nordisk. The combination’s oral medication will enter phase III trials this year.

Daily pills can provide greater flexibility for patients. For example, Stevens said, a patient could cut a pill in half to mitigate side effects on a day he has to attend an important meeting.

The pills will also serve as a way for patients to “de-escalate their treatment” after taking the shots, Lilly’s Skovronsky said. In December, the company released data showing that patients who initially took Wegovy or Zepbound doses maintained the majority of their weight loss after switching to Lilly pills.

“They say, ‘I lost weight, I got this, so I can maintain this on myself with something less powerful,'” Skovronsky said.

Structure is also developing oral medications targeting amylin, an emerging form of weight loss treatment that mimics a hormone secreted with insulin in the pancreas to suppress appetite and reduce food intake. Novo is developing a drug called amicretin, which targets both GLP-1 and amylin to provide better weight loss potential.

Combined systems “will be the next phase of this field,” Stevens said.

For example, Structure hopes to combine GLP-1 drugs with oral amylin drugs to achieve greater weight loss than with a single drug, which he said is likely to be “one of the best combinations in the future.” It is too early to say which patients would be best suited to this regimen, but Stevens said it could achieve “good tolerability, good patient experience and good efficacy.”

He said the company is already working on manufacturing the two ingredients together in one pill, which is similar to what Novo’s Amicretin achieves.

But he said combination regimens can also help treat some obesity-related conditions better than one product alone. This would look like combining GLP-1 with one of the existing treatments for fatty liver disease.

“I feel like winners are now starting to emerge for monotherapy,” he said. But Stevens said the treatment patients take will be divided according to other health conditions a person has in addition to obesity, such as fatty liver disease, chronic kidney disease and cardiovascular disease.

Lilly’s next birth control pill is an oral GLP-1 pill, but Skovronsky said the company could see the potential for a pill that targets that hormone along with another pill called GIP, since it’s a “preferred combination.”

That’s how tirzepatide, the active ingredient in Lilly’s popular obesity and diabetes injections, works. This drug has proven to be more effective than semaglutide, the active ingredient in Novo Nordisk’s competing injections, which targets only GLP-1.

“We are working hard on manufacturing these drugs” in oral form, but we are not ready to reveal any details, Skovronsky said.

Pfizer inherited several experimental injections and tablets with combination potential from its nearly $10 billion acquisition of obesity biotech company Metsera last year.

But Pfizer CEO Albert Bourla said the company is also developing an oral drug internally that blocks the GIP receptor, which could significantly reduce side effects when combined with GLP-1.

“I have very high hopes that he will make the difference as well,” Bourla said.

One biotechnology Wave life sciencesIt sees the groups as part of its broader strategy, its CEO Paul Polnow said in an interview at the conference.

Wave takes a different approach to weight loss, targeting how the body burns fat rather than suppressing appetite. The goal is to achieve weight loss similar to GLP-1, without the associated muscle loss, and with less frequent dosing of once or twice a year rather than weekly.

The push comes amid a growing focus on quality weight loss with next-generation obesity drugs, as GLP-1 treatments have raised concerns about muscle loss, side effects and patient absenteeism.

Wave has an experimental injection that uses RNA technology to lower levels of a protein called activin E – a protein produced by the liver that slows fat burning. By reducing this protein, Wave believes the drug can increase fat loss, especially harmful visceral fat, while maintaining lean muscle mass.

The company is developing the injection, called WVE-007, as a monotherapy or potential maintenance treatment that patients could switch to and take much less often after using GLP-1s, Polnow said.

But he also sees an opportunity to combine the company’s injections with GLP-1 injections to “continue to deliver benefits.”

“We can double weight loss with combined GLP-1,” Polnow said, referring to what the company is seeing in preclinical research.

Adding Wave injections on top of GLP-1 won’t make it harder for patients to tolerate the treatment regimen, so it makes the company’s drug options “very combinable,” he said.

As for who could use the Wave injection, Polnow said it would work in any patient because “that’s the goal that’s already there in human genetics.”

The future of the industry will also likely include medications that can achieve greater weight loss than current treatments on the market.

Lilly in December released the first late-stage data on an injectable drug called retatrotide, the highest dose of which achieved more than 28% weight loss over 68 weeks among patients who continued treatment. Lilly will read data from seven more Phase 3 trials of the drug this year.

Retatrotide, called the drug Triple G, works by mimicking three hormones that regulate hunger — GLP-1, GIP, and glucagon — instead of just one or two. This appears to have stronger effects on a person’s appetite and food satisfaction than other treatments.

Skovronsky said the drug could serve patients who need to lose more weight or who have other serious health conditions in addition to obesity, such as knee pain and arthritis.

Novo Nordisk is racing to catch up: In March, it agreed to pay up to $2 billion for the rights to an early experimental drug from Chinese drugmaker United Laboratories International. The newly acquired treatment is an obvious potential competitor to retatrutide because it similarly uses a three-pronged approach to promote weight loss and blood sugar regulation.

The industry has made strides toward improving drug access for patients, and executives expect that to continue. The cash price for Novo Pills is already the lowest on the market, at $149 for the initial dose and up to $299 for higher doses.

GLP-1 injections cost about $1,000 per month before insurance and without recent cash deductibles.

Both Pfizer’s Bourla and Lilly’s Skovronsky said Medicare’s upcoming coverage of obesity drugs should also move the needle with coverage.

“Once the government starts covering them in Medicare, it will probably become more and more uncomfortable for employers not to — it’s that societal pressure,” Skovronsky said.

He also cited “consumer activation,” as patients began calling their employers and asking why their benefits didn’t cover obesity medications.

Drugmakers, researchers and scientists are also compiling more data on the benefits of obesity drugs for health care spending, which could help spur more employer coverage, Skovronsky said.

“So for employers, is there less absenteeism? Is there better productivity? Are there better medical costs?” He said. “The data is coming in, and we’re seeing more and more of it.”

Regarding the direct-to-consumer channel, Skovronsky said it could become the “fastest growing segment” in the space given the recent push by drugmakers to launch cash offerings.

Lilly was among the first companies to launch a direct-to-consumer platform in 2024, offering obesity drug Zepbound at a discount, with Novo following more than a year later.

Bourla estimated that the direct-to-consumer channel already makes up 30% of the obesity and diabetes drug market in the United States, and could become closer to 90% or more of that market abroad.

When asked what the broader market will look like by 2030, Structure’s Stevens said he hopes access and affordability will no longer be an issue.

“I’m OK with the cost being lower, because for me, it’s always been about scale and really trying to meet a very large need that’s not being met globally,” he said.