“2026 Marks the First Year of Mass Adoption for Obesity Drugs”: The Obesity Drug Market Shifts to Pills as Big Pharma Competition Intensifies

Round Two of the Global Obesity Drug Boom
Convenience-Driven Shift Toward Oral Therapies
Competition to Capture the $150 Billion Market Intensifies

The paradigm of the obesity treatment market is rapidly shifting from injections to pills. Novo Nordisk’s oral version of Wegovy has demonstrated weight-loss efficacy comparable to injectable treatments and is rapidly expanding prescriptions, while global pharmaceutical giants including Eli Lilly, AstraZeneca, and Pfizer are accelerating development of their own oral therapies. As pill-based obesity treatments gain traction thanks to greater convenience and manufacturing cost advantages, competition for dominance in the obesity drug market is intensifying.

‘Oral Wegovy’ Surpasses 300,000 Prescriptions Within Two Months of Launch

According to IQVIA, a pharmaceutical market research firm, Wegovy Pill recorded more than 300,000 prescriptions in the United States between its approval by U.S. regulators last December and the end of February this year. The oral formulation of Wegovy has so far been launched only in the U.S. market and demonstrated an average weight reduction of about 17% in clinical trials. Brian Lian, chief executive officer of U.S. biotech company Viking Therapeutics, described the launch as “one of the fastest new drug rollouts in pharmaceutical history.”

Novo Nordisk, which pioneered the obesity drug market with injectable Wegovy, turned its focus to oral treatments because pill-based therapies offer advantages over injections in cost, storage, and administration. Patients currently pay about $1,000 per month for injectable Wegovy, while the pill version is expected to cost about $149 per month—roughly one-seventh the price. Novo Nordisk aims to leverage the oral formulation’s advantages to regain market share lost to its largest rival Eli Lilly, whose injectable drug Mounjaro has gained ground in the obesity treatment market.

The strong early reception of oral Wegovy is providing Novo Nordisk with a crucial turnaround opportunity after intensifying competition weakened its market position. The company once achieved the highest market capitalization in the global pharmaceutical sector after pioneering the obesity drug market based on the diabetes treatment Ozempic. However, it has recently faced setbacks including intensifying competition, a series of clinical trial failures, and pipeline restructuring. Over the past year, the company’s share price has fallen more than 50%, relinquishing its position as Europe’s most valuable listed company and trailing competitors such as AstraZeneca, Roche, and Novartis.

By contrast, Eli Lilly has gained strong momentum in the obesity drug segment and recently joined the ranks of companies with a market capitalization exceeding $1 trillion. Its proprietary compound tirzepatide—marketed as the obesity drug Zepbound and the diabetes treatment Mounjaro—has become the second-best-selling pharmaceutical product globally. As of last month, Eli Lilly recorded roughly 1.4 million prescriptions for its obesity drugs, about 1.5 times the roughly 924,000 prescriptions for Novo Nordisk’s treatments.

Eli Lilly’s Oral Obesity Drug ‘Orforglipron’ Nears Approval, $3 Billion Investment for China Production

The global pharmaceutical industry widely views this year as the “first year of mass adoption for obesity drugs.” In particular, the upcoming patent expiration of Wegovy and the emergence of oral obesity therapies are seen as signals of a major market reshuffle. The spread of lower-cost generics and the convenience of weight-loss treatment through a simple pill could significantly expand public access to obesity drugs. Until now, most obesity treatments required injectable administration, but the development of oral formulations is expected to accelerate market expansion by improving ease of use. Individuals who have a strong aversion to injections or experience discomfort with refrigerated injectable medications are particularly likely to prefer oral treatments.

Eli Lilly is developing a next-generation oral small-molecule GLP-1 (glucagon-like peptide-1) candidate known as Orforglipron. In a multinational Phase 3 clinical trial involving 3,100 adults with obesity but without diabetes, the drug demonstrated significant weight-loss effects. Participants in the high-dose group recorded an average weight reduction of 11%, while the low-dose group showed a 7.5% reduction. The Phase 3 study compared once-daily doses of 6 mg, 12 mg, and 36 mg administered over 72 weeks with a placebo group.

Eli Lilly has indicated that Orforglipron could eventually cost about the same as a cup of coffee per day, emphasizing its potential affordability. The U.S. Food and Drug Administration (FDA) is expected to decide on approval in April. Eli Lilly has also filed regulatory applications in more than 40 countries outside the United States and has begun building local production capacity in China to capture the country’s roughly 500 million obese population. The company plans to invest a total of $3 billion in China over the next decade, with a focus on expanding production capacity for Orforglipron. Eli Lilly has steadily expanded its presence in China in recent years, investing $200 million to expand its Suzhou manufacturing facility between 2024 and 2025, establishing a China Healthcare Innovation Center, and launching “Lilly Gateway Labs (LGL)” in Beijing and Shanghai to support the clinical transition of biotech startups. The company’s cumulative investment in China is approaching $6 billion.

AstraZeneca and Pfizer Also Join the Race

Following the strong growth potential demonstrated by oral Wegovy, Novo Nordisk is accelerating development of next-generation peptide-based oral obesity drugs. On the 25th of last month, the company announced a partnership with Vibtex valued at up to $2.1 billion to develop next-generation oral biologics. The deal exceeds the $1.35 billion Novo Nordisk paid to acquire Emisphere, the developer of the SNAC drug delivery system used in oral semaglutide—the active ingredient in Wegovy and Rybelsus.

Novo Nordisk is also advancing the development of a single-molecule therapy. Another candidate drug, Amycretin, simultaneously stimulates both GLP-1 and amylin receptors with a single molecule. While CagriSema combines two separate drugs, Amycretin integrates the hormonal mechanisms within a single molecular compound.

Beyond these companies, established pharmaceutical players AstraZeneca and Pfizer are also preparing to launch oral obesity drugs. AstraZeneca recently announced successful Phase 2 clinical trial results for its oral GLP-1 receptor agonist Elecoglipron (AZD5004) and declared plans to enter global Phase 3 trials in the second half of this year. Through the VISTA (obesity) and SOLSTICE (diabetes) studies, AstraZeneca confirmed strong safety and tolerability compared with competing drugs while demonstrating the potential of small-molecule compounds designed to maximize patient convenience.

Pfizer, after encountering safety issues with internally developed candidates, has taken a decisive strategic step by rebuilding its obesity drug pipeline through the acquisition of Metsera completed last November and a licensing agreement with Yao Pharma. The company previously outlined an aggressive plan to advance at least 15 drug candidates and push most of them into Phase 3 clinical trials this year. The pipeline includes ultra-long-acting injectable treatments administered once monthly as well as next-generation small-molecule oral compounds targeting Eli Lilly’s dominance. Pfizer’s strategy reflects a strong determination to reclaim leadership in the obesity treatment market, which is projected to grow to $150 billion by 2030.

An industry expert explained that the pharmaceutical giants’ intense focus on pill-based competition stems from more than patient convenience alone. “Pills provide a solution to the two biggest bottlenecks in the obesity drug market—supply chains and profitability,” the expert said. In particular, chemically synthesized small-molecule pills have significantly lower manufacturing costs than peptide-based injectable drugs, giving them a decisive advantage as pharmaceutical companies face pressure to reduce drug prices and compete for insurance reimbursement.