The global pharmaceutical industry is entering a pivotal phase in obesity therapeutics as companies accelerate the transition from injectable GLP-1 drugs to oral weight-loss treatments, a shift expected to significantly expand patient access, alter reimbursement dynamics, and intensify competitive pressures in one of the fastest-growing drug categories.
The commercial success of GLP-1 receptor agonists such as Ozempic and Wegovy has already reshaped market hierarchies. Novo Nordisk, the manufacturer of Ozempic and Wegovy, became Europe’s most valuable company amid soaring demand for its injectable diabetes and weight-loss treatments. However, supply shortages persist across much of the category, underscoring both the scale of demand and manufacturing constraints. The weight-loss drug market could reach an estimated $150 billion by 2033, while JPMorgan Chase analysts project the broader GLP-1 market to grow from $75bn currently to $200bn by the early 2030s.
The sector’s competitive landscape, long characterized as a “duopoly” dominated by Novo Nordisk and Eli Lilly, is now widening. Multiple pharmaceutical companies are developing oral alternatives to injectable GLP-1 therapies, aiming to capture incremental demand from patients who are unwilling or unable to use injections. Novo, Eli Lilly, and Pfizer are all advancing weight-loss pills, positioning oral delivery as a strategic lever to improve convenience, reduce storage complexity, and potentially lower cost barriers.
Novo Nordisk’s Wegovy pill represents the first major commercial move in this direction. The tablet is a reformulation of semaglutide, the same active ingredient used in the injectable Wegovy, but at a significantly higher concentration. It must be taken on an empty stomach “with a small sip of water,” reflecting pharmacokinetic requirements associated with oral peptide delivery. Following FDA approval in the United States, the Wegovy pill recorded 50,000 prescriptions per week by late January, indicating strong early uptake. Cash pricing ranges from $149 to $299 per month depending on dose, below the recently lowered cash prices for injectable GLP-1 products.
Despite strong initial demand, analysts caution that oral formulations currently demonstrate lower efficacy compared with injections. UBS forecasts peak annual sales of $3.25bn for the Wegovy pill, compared with $16bn for the injectable version in the coming years. Clinical studies indicate that one in 10 patients discontinued the pill due to side-effects including nausea and vomiting, suggesting higher drop-out rates. Analysts expect patients requiring more substantial weight reduction to continue favoring injectable therapies, while pills may attract overweight or mildly obese individuals who previously avoided treatment.
Eli Lilly is preparing the US launch of its oral candidate orforglipron, expected as soon as April. Unlike Wegovy, which is a peptide-based formulation, orforglipron is a small molecule, allowing easier absorption and eliminating the need for fasting prior to dosing. Lilly’s injectable portfolio, including Mounjaro and Zepbound, has already demonstrated superior weight-loss outcomes in clinical studies relative to Wegovy injections, contributing to competitive pressure on Novo’s franchise.
Pfizer’s development of a weight-loss pill carries heightened strategic significance. The company reported a 20% decline in sales in the first quarter of 2024, with its stock reaching the lowest point in a decade amid falling COVID-19 vaccine demand and underperformance of its RSV vaccine. Earlier this month, Pfizer released results from a 20-person trial of its weight-loss pill but refrained from making expansive claims, reflecting investor scrutiny over pipeline execution. Entry into the obesity segment is widely viewed as a potential catalyst for revenue stabilization.
Beyond the leading three manufacturers, additional development activity is underway. Structure Therapeutics and Viking Therapeutics are advancing oral candidates. AstraZeneca’s obesity and diabetes pill, acquired from the Chinese developer Eccogene, is currently in mid-stage clinical trials. AstraZeneca and others are also exploring next-generation injectable therapies targeting the hormone amylin, as well as combination regimens designed to preserve muscle mass while enhancing weight reduction.
Regulatory and reimbursement developments are reinforcing market expansion. UK regulators approved Novo Nordisk’s weight-loss drug Wegovy to reduce cardiovascular risk in overweight and obese individuals, broadening its labeled indications beyond weight management. The Wegovy pill is under review by the UK medical regulator and is expected to reach the market later this year, although inclusion in NHS coverage remains uncertain. In the United States, Medicare will begin covering GLP-1 medications for the first time from April, a policy shift that could materially increase eligible patient volumes.
Scientific research continues to expand the therapeutic narrative around GLP-1 drugs. Studies published in Nature suggest potential benefits beyond weight loss and diabetes, including reduced risk of kidney failure and death among patients with diabetes and chronic kidney disease, improved metabolic complications in people with HIV, and reduced inflammation in organs such as the brain. However, cost-effectiveness remains under scrutiny. Research conducted by the University of Chicago Medicine, led by Dr Jennifer Hwang, found that GLP-1 injections fell short of standard cost-effectiveness benchmarks for governments due to high pricing, though oral alternatives could improve value metrics. Separate studies indicate that patients who discontinue GLP-1 injections regain lost weight within two years, raising questions about long-term treatment adherence. Experts have also called for further investigation into a potential link between GLP-1 injections and increased gallbladder removals by NHS England.
Demand indicators remain robust. UCL researchers reported 1.6 million users in England, Scotland and Wales between early 2024 and early 2025, with usage concentrated among women aged 45 to 55. Nearly two-thirds (64%) of adults in England were overweight or obese in 2022. An additional 3.3 million individuals expressed interest in near-term use of weight-loss drugs. In the United States, one in eight adults reports having used such medications, although affordability remains a constraint, with some patients facing costs of up to $1,350 per month prior to price adjustments.
Analysts at Goldman Sachs describe 2026 as a “pivotal year for the development of the obesity market,” driven by the anticipated launches of oral products from Novo and Lilly that could “potentially significantly increase the addressable population for obesity medications.” Nevertheless, risks remain. Manufacturing scale-up for high-dose oral semaglutide has faced skepticism. Counterfeit risks are elevated for pills relative to injections. Novo’s shares fell 17% in a single day in early February after the company forecast a steeper-than-expected decline in sales and profits, following earlier profit warnings and 9,000 job cuts.
Taken together, the shift toward oral GLP-1 therapies signals a structural evolution in obesity pharmacotherapy. As pricing moderates, reimbursement expands, and additional competitors enter the field, the segment is positioned to become one of the most consequential long-term growth drivers in global pharmaceuticals, with implications spanning manufacturing strategy, health economics, and chronic disease management.
