This article first appeared on GuruFocus.
Weight-loss drugs known as GLP-1s are increasingly reshaping healthcare and the pharmaceutical landscape, with Eli Lilly (NYSE:LLY) and Novo Nordisk (NYSE:NVO) emerging as the two dominant forces in the category. A Lilly-funded head-to-head study published in 2025 showed Zepbound delivering stronger weight-loss outcomes than Novo’s Wegovy, including greater waist reduction and a higher likelihood of patients losing at least 25% of their body weight over 72 weeks. That data has helped tilt near-term momentum toward Lilly, even as Novo appeared positioned to regain ground following regulatory approval of the first oral GLP-1 pill for weight loss, a development that could meaningfully broaden access as pills are expected to be cheaper than injections.
Both companies are also expanding beyond obesity into adjacent conditions, which could reinforce the long-term investment case. Wegovy remains the only GLP-1 drug proven to reduce heart attacks and other cardiovascular events in people with heart disease and obesity, while Zepbound became the first approved treatment for sleep apnea. Lilly is also advancing a next-generation therapy, retatrutide, which combines GLP-1, GIP and glucagon and delivered 23% weight loss in a late-stage trial involving patients with knee osteoarthritis, alongside a more than 62% reduction in knee pain. The company has indicated it is running additional trials in obesity-related conditions such as heart disease and chronic kidney disease, with further results expected to begin emerging next year.
Pricing and access are now becoming central to the competitive narrative. In November, Lilly and Novo agreed with the Trump administration to cut US prices for Medicare and cash-paying customers, including a $149 monthly price for the lowest doses of their forthcoming pills, while Medicare coverage is set to expand around the middle of next year with patient out-of-pocket costs of about $50 a month. Novo plans to begin selling its FDA-approved weight-loss pill in the US in January following Oasis 4 trial results showing 13.6% average weight loss over 64 weeks, while Lilly’s oral alternative, orforglipron, received expedited FDA review under a new 2025 voucher program and could be approved as soon as March, according to CEO Dave Ricks. With companies such as Pfizer (NYSE:PFE) and Structure Therapeutics also developing oral weight-loss drugs, competition in the GLP-1 market could intensify as supply constraints ease and access gradually expands.