With the U.S. approval of a second oral GLP-1 drug to treat obesity, analysts are starting to analyze the potential for Eli Lilly’s Foundayo to become a blockbuster hit in 2026, as well as Novo Nordisk’s similarly hot pill Wigovy, which was launched three months ahead of Lilly’s drug in January.
Meanwhile, Novo, which appears intent on maintaining its first-mover advantage in the obesity drug space, has launched an aggressive defense, focusing on the company’s claims that the weight loss of oral Wigovy vs. Foundayo is “substantially greater.”
With the FDA’s approval of Foundayo (orforglipron) on Wednesday, Lilly announced that it is now accepting prescriptions for the oral drug through its LillyDirect cash payment channel, with shipments expected to begin next week. This will give Foundayo about nine months to establish commercial roots by 2026.
Analysts at Jefferies believe that Foundayo’s sales could reach up to $1.6 billion this year, and in a note to clients on Wednesday they warned that Lilly’s new oral option is unlikely to fully replace the company’s flagship obesity injectable product, Zepbound (tirzepatide), and urged investors to “focus more on the total size of the obesity market.”
Looking at it another way, for Foundayo to reach this year’s consensus sales estimate of $1.7 billion, Lilly would need to fill about 5.4 million prescriptions between April and December, according to a UBS memo dated April 1. To achieve sales of about $2 billion in its launch year, Foundayo will need to generate about 6 million prescriptions, the UBS team said, adding that it believes 5 million to 6 million patient numbers in 2026 is “feasible,” especially given the sustained “strong demand” for Novo’s Wegovy tablets.
To put this goal in context, Lilly’s injectable GIP/GLP-1 dual obesity drug Zepbound (tirzepatide) recorded approximately 6.4 million prescriptions in 2024, its first year on the market, with 4 million of those patient referrals coming in the first nine months of the drug’s launch, UBS analysts noted.
Lilly also believes access, awareness and direct-to-patient channels are in a much better position to support Foundayo’s launch now than when Zepbound debuted, according to the UBS report.
catch up with novo
Approved late last year and launched on January 5, Novo’s Wigovy tablets have a head start in the newly developed oral segment of the obesity market. With approximately 20,000 prescriptions issued in the first two weeks of its U.S. launch, Novo’s pill managed to outstrip both injectables Wegoby (approximately 1,600 prescriptions) and Zepbound (approximately 7,300 prescriptions) over the same period of their respective rollout periods, Jefferies noted at the time.
Meanwhile, industry watchers say Foundayo may offer certain perks that could give it an edge over Wegovy pills, despite its slightly delayed arrival to the market.
First, according to William Blair’s Wednesday memo, Foundayo, unlike oral Wigoby, has no dietary restrictions. Wigobee must be taken on an empty stomach with up to 4 ounces of water and then fasted for 30 minutes.
With this in mind, William Blair analysts say they “expect Foundayo to see a slowdown in the adoption of oral Wegovy once it becomes available.”
Nevertheless, Novo’s pills are likely to maintain a price advantage, William Blair’s team and other analysts noted.
The starting prices for both drugs are about the same, but Foundayo’s top dose will cost $349 per month for cash-paying patients, compared to $299 per month for Wigovy tablets through the same distribution channels, UBS said.
Still, Jeffries said Lilly will offer cash-paying patients the highest doses of Foundayo, 14.5 mg and 17.2 mg, for $299 a month if they refill their prescriptions within 45 days.
Meanwhile, the UBS team added that it expects cash payment platforms like Lilly Direct to be the “largest initial launch channel” before Medicare and commercial insurance coverage for Foundayo begins this summer.
Foundayo’s wholesale acquisition cost (WAC), which corresponds to the drug’s list price before insurance and other discounts, is expected to reach $649 per month, Lilly told Jefferies this week.
Novo, on the other hand, appears to be hoping to generate early enthusiasm for Lilly and its new obesity drug.
On Thursday, the Danish drugmaker teased an upcoming data presentation scheduled for the Obesity Medicine Society’s annual meeting in San Diego, showing that 25 mg Wigovy tablets were “associated with significantly greater mean weight loss than Orforglipron 36 mg in a population-adjusted indirect treatment comparison.”
Patients also showed a “higher preference” for an “oral semaglutide-like profile over an orforglyprone-like profile” in a separate patient preference survey, Novo said.
“These studies add to the body of evidence supporting semaglutide’s clinical efficacy and highlight the characteristics patients value when choosing an obesity treatment that fits their lifestyle,” Jamie Miller, vice president of Novo’s U.S. operations, said in a statement Thursday.
“We are often asked how one drug compares to another when making obesity treatment management decisions,” Robert F. Kushner, MD, of Northwestern Feinberg School of Medicine, continued in the Novo release. “There are no head-to-head trials comparing oral semaglutide and orforglipron for obesity, so this indirect treatment comparison from the Orion study provides important information that can be used in a common decision-making process.”
As competitive dynamics begin to unfold between Foundayo and Wegovy pills, analysts remain largely agreed on the fact that Lilly’s and Novo’s new oral options are unlikely to replace the companies’ obesity injectables, Zepbound and Wegovy.
Overall, these injectable drugs are likely to maintain around an 80% share of the U.S. branded obesity market, according to William Blair analysts, which the research team attributes to the “high efficacy of injectable drugs” and the “increasing U.S. population (body mass index).”
Nevertheless, the rapid launch of Wegovy tablets indicates that many patients new to GLP-1 are trying oral options, and William Blair’s team suggests that Novo and Lilly’s launches could help expand the overall addressable market for obesity treatment more broadly.
Additionally, the high single-digit, placebo-adjusted weight loss reported for Foundayo may be particularly appealing to the approximately 32% of the U.S. adult population who are classified as overweight but not obese, the researchers added.
