Novo Nordisk, Eli Lilly roll out obesity pills, prepare to cover Medicare

Novo Nordisk and Eli Lilly They took their GLP-1 pill battle to a prominent obesity meeting this weekend as they prepare for the next big change in how patients receive their medications.

Novo Nordisk announced Sunday that prescriptions for the Wegovy pill have exceeded 3 million since it entered the U.S. market about five months ago. Mike Doostdar, CEO of the Danish pharmaceutical company, celebrated the milestone, saying in an interview with CNBC that Novo was able to speed up prescriptions even when Lilly introduced its own GLP-1 pill in April.

“If that’s not acceleration, I don’t know what is,” Doostdar told CNBC this weekend at the Scientific Sessions of the American Diabetes Association.

Meanwhile, Lilly CEO Dave Ricks told CNBC that prescriptions for its Foundayo pill are “significantly higher” than the 20,000 Lilly reported about six weeks ago around its first-quarter earnings release, without giving a specific number. He said the number is increasing week by week and Lilly is happy with the progress.

The competition for the weight loss pill market is just the latest for long-time competitors. Signs of this tension were evident throughout this weekend’s industry event. Cars drove around advertising Novo’s Wegovy birth control pill, while images of Lilly’s Foundayo birth control pill covered some floors of the New Orleans Convention Center.

The two companies will soon make their case for their daily pills and weekly doses for seniors. Starting in July, millions of people on Medicare will have access to GLP-1 weight-loss drugs for $50 a month. Until now, Medicare beneficiaries have had to pay out of pocket for obesity medications, which can cost them hundreds of dollars a month. Both companies say they are focused on raising awareness of the program, although their views differ.

Doustdar believes the program could be an opportunity to regain some of the ground that Novo’s Wegovy shot lost to Lilly’s Zepbound. He said the pharmaceutical company plans to advertise Wegovy’s other health benefits on its brand, such as the fact that it can reduce the risk of cardiovascular problems such as heart attacks and strokes. He said Novo should win with the seniors “if we want common sense to prevail, and I put myself in their shoes.”

“With Wegovy’s high dose, why not take a product that is just as effective, in percentage terms, as my competitor?” He said. “On top of that, you get kidney, liver, heart and stroke protection, let’s say for free. I would take it if I were 10 years old.”

Night show for seniors is comfort. The company’s Fundayo pills can be taken at any time of the day with food, water, and other medications, while Novo pills must be taken on an empty stomach with a little water and require fasting for 30 minutes afterward.

“The main thing is that it’s easy,” Rex said. “This is something that can fit into your daily routine. Most seniors take several other medications, have their own pill box, and use it every day, and this will fit perfectly into that without any extra thought.”

Rex said Lilly is working closely with the government to prepare, and he is confident of that Humanawhich will process prescription orders, will do a good job. He believes the program will be popular with older people, and that in the long term, the initiative could help demonstrate that obesity care should be “regular health care.”

“We have to prove that in this pilot program and prove the cost-effectiveness and then reset what we expect from our health insurance, which is that obesity care should be health care,” Rex said.

Lilly and Novo are trying to increase insurance coverage for GLP-1 drugs to treat obesity. At least one analysis found that the drugs are cost-effective, but employers are reluctant to pay for them because too many people may qualify for the treatment and too many patients stop them after achieving a weight loss goal. Health insurer Cigna said last week it would stop covering drugs for its employees.

Less than 20% of Lilly’s beneficiaries use medications to lose weight, and people continue to take them, Ricks said. Lilly is conducting an internal study to measure its health costs and outcomes such as the rate of hospitalizations, progression to diabetes, and cardiovascular events. Lilly plans to publish these results later this year, he said.

As they prepare to cover Medicare, the two companies are trying to offer more drugs to treat obesity. At the conference this weekend, Lilly presented phase 3 data for retatrotide, an experimental triple agonist that helped people lose an average of 28% of body weight when they continued taking the drug. Nearly half of the people lost more than 30% of their body weight, an amount similar to bariatric surgery. The medication has also helped improve related conditions such as knee osteoarthritis and sleep apnea.

Initially, Rex expects retaretide to be used primarily to treat people with higher body mass indexes, or BMIs. He also finds the drug’s second-lowest strength promising. It has helped people lose an average of 19% body weight with fewer side effects than those with higher strengths.

One question was whether Lilly would make retaretide available on its direct-to-consumer sales platform LillyDirect was once approved by the FDA because it is so powerful. Lilly “absolutely” plans to make the drug available there, Ricks said.

For Novo, the next drug on the horizon is called CagriSema. It combines the main component of ligand with another molecule called cagrelintide, which mimics another hormone called amylin. The drug’s effectiveness disappointed investors because it showed weight loss similar to Lilly’s Zepbound and less than Lilly’s Retatrutide. Doostdar believes the drug’s efficacy advantage over Wegovy, even if only by a few percentage points, is meaningful, and said he is committed to launching CagriSema. Novo expects to issue an approval decision from the US Food and Drug Administration for the drug in the last quarter of this year.

“If I have to forget CagriSema, I have to forget a lot of other products as well,” Dostdar said. “I don’t think it has to work this way.”

Dostdar took over the position of CEO about a year ago after a major change that led to the departure of the previous president of the company and the dismissal of thousands of employees. He was tasked with revitalizing Wegovy’s sales, the company’s pipeline and its stock price. Ultimately, he said Novo will have more diversity in the areas of heart and metabolic health — such as diabetes and obesity — and some “similarities.”

Meanwhile, Doostdar said the early success of the Wegovy pill helped Novo regain some momentum.

“The pill was a great example of people’s confidence in our ability to do this, and that better days at Novo Nordisk are ahead, not just behind them,” he said. “So we also have to really make sure that we turn these positive moments that we are experiencing now into a long-term trend, so we gain confidence day by day and improve that internally as well as, of course, externally, and I will work hard to make sure that continues.”