The weight-loss drug race has entered a new phase. Novo Nordisk ($NVO) and Eli Lilly ($LLY) now have competing obesity pills on US pharmacy shelves, giving investors their first meaningful comparison of the two launches. Third-quarter results suggest Novo has the early advantage in pills, even as Lilly continues to dominate the broader weight-loss market.
Novo's pill delivers a much-needed win
After a difficult stretch for its stock, Novo's oral Wegovy launch is starting to pay off. The pill generated roughly $810M in third-quarter sales, comfortably ahead of the $745M analysts expected. Stronger treatment volumes also helped lift obesity care revenue 22% at constant exchange rates to $3.93B.
The performance prompted Novo to raise its 2026 guidance. Adjusted sales and operating profit are now expected to range from a 2% decline to 2% growth, an improvement of four percentage points at both ends.
Free cash flow guidance rose to $9.02B to $10.5B from $6.76B to $8.27B. Jefferies flagged that roughly $300M of the sales beat came from favorable pricing adjustments, mostly on injectable Wegovy.
There were some caveats, however. Jefferies noted that roughly $300M of the sales beat came from favorable pricing adjustments, primarily involving injectable Wegovy. Meanwhile, reported operating profit fell 9% as impairment charges and restructuring costs weighed on earnings.
Still, the stronger outlook gives investors some encouragement that Novo's efforts to regain momentum are beginning to work.
Lilly's pill misses, but demand is growing
Eli Lilly's oral treatment, Foundayo, had a less convincing quarter. Sales reached $184M, missing analysts' $216.86M forecast.
Management attributed the shortfall partly to inventory timing rather than weakening demand. Around $30M of second-quarter sales came from stocking wholesalers and pharmacies ahead of the launch. Excluding that initial inventory buildup, US demand more than tripled to over $120M in the third quarter.
Lilly's Obesity Pill Came In Under Wall Street's Number
Foundayo Q3 2026 sales, $M, reported Oct. 29, 2026
Bar chart. Actual: Sales ($M) $184. Estimate: Sales ($M) $217.
The prescription numbers tell a similar story. Foundayo's weekly prescriptions have climbed roughly ninefold since its fourth week on the market, suggesting the launch is gaining traction despite falling short of Wall Street's initial expectations.
Injectable drugs remain Lilly's biggest advantage
While Novo pulled ahead in pills, Lilly's established injectable treatments continued delivering impressive growth.
Mounjaro generated $10.72B in quarterly revenue, up 65%, while Zepbound contributed another $5.35B, a 49% increase. Together, they helped push total revenue up 39% to $24.4B, comfortably above Wall Street's $22.61B forecast.
Lilly subsequently raised its full-year revenue guidance to $91B to $92B, reflecting continued demand for its blockbuster treatments.
The company's wider market position remains formidable. Lilly controls roughly 63% of the US obesity and diabetes drug market, compared with Novo's 36.6%. About seven in 10 US injectable prescriptions also go to a Lilly medicine.
RBC Capital Markets analyst Trung Huynh noted that strong execution across Lilly's GLP-1 business continues to outweigh pricing pressure.
"Foundayo continues to lag, though the strength of Lilly's broader commercial business makes this less of a concern in our view."
Evan Seigerman, BMO Capital Markets
What decides the oral market next
Jefferies estimates oral GLP-1 prescription share as of mid-October ran about 75% Novo and 25% Lilly. IQVIA counted roughly 183K oral Wegovy prescriptions in the week of Oct. 26 to 30, about three times Foundayo's 63.1K.
Foundayo's own trajectory is steep. Weekly scripts are roughly nine times the level of the fourth week after launch, when they had just passed 7K, and they peaked near 64.3K in early October before easing.
Foundayo Weekly Scripts Climbed Ninefold Since Launch
US weekly Foundayo prescriptions, IQVIA data, through Oct. 30, 2026
Line chart. Prescriptions. Week 4 after launch: Prescriptions 7,000. Early October 2026: Prescriptions 64K. Oct. 26-30, 2026: Prescriptions 63K.
Source: Chosun Biz
About four in 10 patients starting an oral obesity medicine now pick Foundayo, double last quarter's share of new-to-brand prescriptions. Lilly expects a US approval for Type 2 diabetes in the fourth quarter, which would widen the prescribing pool.
Geography is the other lever. Foundayo is selling in four countries including the UK, with reviews underway in more than 40, and the European Medicines Agency recommended EU authorization in early October.
Novo's Wegovy and Ozempic price cuts take effect Jan. 1, 2027, with list prices down about 50% and 35% to a $675 wholesale acquisition cost. Lilly chief executive David Ricks estimates only 3% to 10% of eligible US patients access obesity care.
Behind both pills sits Lilly's retatrutide, slated for regulatory submission next year after midstage trials showed average weight loss of 24%.
