NEW YORK – Weight-loss drugs known as GLP-1s are transforming healthcare. Some people who struggled for years to shed pounds experience dramatic weight loss on the medications, and there are indications that the drugs have potential to treat diseases beyond obesity.
The drugs also have minted billions of dollars for Eli Lilly and Denmark’s Novo Nordisk, the two pharmaceutical powerhouses that developed the injected medications.
Their rivalry is evolving: A head-to-head study showing Lilly’s Zepbound to be more effective than Novo’s Wegovy gave the Indianapolis-based company an edge in 2025.
But Novo appeared poised to recover some ground after
regulators approved a pill version of Wegovy
, the first oral GLP-1 for weight loss.
While the drugs have become spectacularly popular, their high prices, along with spotty insurance coverage, have left them out of reach for many Americans. Pill versions, which will be cheaper, might change that.
Here’s what to know about the newest developments in weight-loss medication and how access to drug treatments is changing.
Zepbound and Wegovy cause weight loss by mimicking an appetite-controlling gut hormone called GLP-1, which is released after eating and makes people feel full.
Zepbound also targets a second related gut hormone called GIP, which helps lower blood sugar and may boost metabolism.
New drugs in development, such as Lilly’s retatrutide and Novo’s CagriSema, target GLP-1 in combination with different hormones.
Gastrointestinal problems including nausea, vomiting and diarrhoea are common side effects of weight-loss medications.
A recent poll by health research organisation The Kaiser Family Foundation (KFF) found that about 13 per cent of adults who have taken a GLP-1 cited side effects as the reason for stopping the medication.
In a study funded by Lilly, Zepbound helped people trim about 5cm more off their waists than Novo’s Wegovy, with the Lilly drug spurring an average of 47 per cent more weight loss over 72 weeks.
Patients in the study who took Zepbound were twice as likely as the Wegovy group to lose at least 25 per cent of their body weight.
The impact on waistlines is crucial because they are a surrogate measure for dangerous fat around organs in the abdomen.
In the study, patients lost an average of 18.4cm around their waists on Zepbound and 13cm on Wegovy.
Belly fat is linked to diseases such as heart attacks, strokes and diabetes, so doctors recommend that a person’s waistline be no more than half their height.
Both drugs have benefits beyond weight loss.
Wegovy is the only GLP-1 drug proven to prevent heart attacks and other cardiovascular events in people with heart disease and obesity. Zepbound is the first drug approved to treat sleep apnoea.
A next-generation weight-loss drug that Lilly is developing shows even more promise.
Retatrutide, which combines GLP-1, GIP and another gut hormone called glucagon, delivered 23 per cent weight loss in a recent late-stage study. Those results put it on track to become the most potent obesity medicine yet.
Patients in the study, who also had knee osteoarthritis, experienced a more than 62 per cent reduction in knee pain.
The trial was the first of many Lilly is running to test retatrutide in obesity and other related conditions like heart disease and chronic kidney disease.
The company expects to share results from its other studies beginning in 2026.
Both Lilly and Novo have started offering lower cash prices for their drugs to people lacking insurance coverage.
In November, Lilly and Novo said they would cut their US prices in a deal with the Trump administration that applies to both Medicare and cash-paying customers.
The medications still cost hundreds of dollars a month for people paying out of pocket, making them unaffordable for many.
Under the deal with the Trump administration, Lilly and Novo also agreed to charge just US$149 (S$190) a month for the lowest doses of their forthcoming pills.
Many patients cannot get or have lost coverage by insurers who refuse to cover the expensive drugs, leaving consumers to pay out of pocket or, until recently, to seek out compounded versions.
About 44 per cent of large employers cover the drugs for weight loss, but nearly all restrict coverage to those who meet certain narrow criteria, according to Mercer’s 2024 National Survey of Employer-Sponsored Health Plans.
Medicare, the government health plan for Americans aged 65 and over, historically has not covered drugs for weight loss.
In recent years, it started covering Zepbound for sleep apnoea and Wegovy for heart disease after regulators approved the drugs for those indications.
In exchange for Lilly and Novo cutting their prices, the Trump administration is widening access to the drugs for some Medicare patients.
Under the Trump administration deal, those with a body mass index, or BMI, between 27 and 29 will be eligible for the drugs if they have another health condition such as prediabetes or cardiovascular disease.
People whose BMI is in the low 30s will be eligible if they have uncontrolled hypertension, kidney disease or heart failure; those with a BMI over 35 will also be able to get the medications for weight alone.
The changes are expected to kick in around the middle of 2026, with patients paying just US$50 a month out of pocket.
The changes to Medicare coverage are expected to expand access to roughly 10 million additional patients, analysts say. Lilly estimates as many as 8.5 million people are taking the drugs currently.
For patients with Medicaid, which is managed by states, it is unclear what impact the deal will have.
Several state Medicaid plans pay for weight-loss drugs, but the cost of covering so many users has strained government budgets. That has led some states, including North Carolina and California, to drop Wegovy and Zepbound coverage for weight loss.
The lower prices negotiated by the Trump administration, however, may entice states to reconsider.
Both Lilly and Novo struggled to meet demand for several years after introducing the drugs.
By early 2025, the supply shortages had largely resolved, according to the US Food and Drug Administration.
Pill versions of popular shots are likely to be available for patients beginning in 2026.
Novo received FDA approval for its weight-loss pill in December, which it plans to start selling in the US in January.
The approval was based on the results of the Oasis 4 trial, which found people taking a 25-milligram pill once daily lost about 13.6 per cent of their body weight over 64 weeks.
The company said it filed for approval in Europe and other parts of the world in the second half of 2025.
Novo’s pill uses a significant amount of the active ingredient semaglutide that also powers Wegovy and Ozempic, its best-selling shot to treat diabetes.
Making enough semaglutide could prove to be a challenge, despite Novo pouring billions of dollars into ramping up production.
In trials, Novo’s pill appeared to be slightly more effective than a similar medication in development from Lilly, which
led to about 11 per cent weight loss
.
However, the Novo version has more restrictions. Patients must take it in the morning with a sip of water on an empty stomach and then wait 30 minutes before eating or drinking.
Lilly’s pill, called orforglipron, does not have those restrictions.
The FDA gave Lilly’s pill an expedited review under a new voucher program launched in 2025.
Lilly chief executive officer Dave Ricks has said he expects the pill to be approved as soon as March.
Other companies, including Pfizer and Structure Therapeutics, have also been developing their own weight-loss pills. BLOOMBERG
Source link
