The blockbuster era of obesity drugs has shifted from scarcity to scale, but the market’s trajectory remains uncertain. Eli Lilly and Novo Nordisk continue to dominate a class that could be worth roughly $95–100 billion by 2030, yet the fight for share is increasingly a story of supply, pricing strategy, regulatory pressure and new product formats. As weekly injectable GLP-1s move from niche specialty scripts to mainstream use, the industry is confronting whether insurers, regulators and patients will let growth continue unimpeded.

Market leaders and shifting share

Eli Lilly has clearly taken the lead in the injectable segment, claiming about six out of ten prescriptions and reporting roughly 57% market share in recent quarters. That momentum follows data showing tirzepatide-based therapies deliver larger mean weight losses and — by several accounts — better tolerability versus older semaglutide injections. Novo Nordisk, long the class incumbent, has seen its stock and outlook pressured by compounded rivals and earlier supply issues; its shares have dropped steeply this year amid downgrades and forecast cuts. The Near-term winners are those that pair demonstrable clinical efficacy with consistent manufacturing output.

Access, cost and the compounding challenge

Price and coverage remain the primary brakes on adoption. List prices for branded injections approach $1,000 a month, though manufacturer direct-to-consumer programs have offered roughly $500 monthly options for cash payers. Many insurers still limit coverage to diabetes indications, leaving obesity patients exposed. Medicare’s looming negotiation of semaglutide pricing in 2027 adds upside risk for payers and downside risk for manufacturers’ future revenues. Compounding pharmacies and telehealth channels that offered cheaper, unapproved GLP-1 alternatives during shortages created an extra headache: regulators have curtailed large-scale compounding but enforcement is uneven, and an estimated one million U.S. patients reportedly used compounded GLP-1s at one point.

Pills, pipelines and competition dynamics

The next inflection could come from oral therapies. Analysts at Goldman expect daily oral pills to capture roughly 24% of the 2030 market (about $22 billion), with Eli Lilly potentially taking 60% of that slice and Novo Nordisk a smaller share. Oral agents promise broader uptake—lower manufacturing complexity and easier patient acceptance—but questions remain about relative efficacy and side-effect profiles. If pills prove materially less effective than injections, they may be relegated to a maintenance or lower-severity cohort rather than displacing weekly injectables.

Strategic implications for investors and payers

Longer term, winners will be companies that manage manufacturing scale, fend off unauthorized competitors, and navigate payer politics. Biotech challengers that fail to show clear superiority in phase-three trials will struggle to break entrenched market leaders; partnerships and M&A are likely as large pharmas seek differentiated pipelines. For payers and employers, the calculus is whether short-term drug costs are offset by downstream savings in cardiovascular, metabolic and renal complications.

Looking ahead, the industry faces a two-pronged test: translate clinical gains into sustainable commercial models, and demonstrate durable health economics to unlock broader insurance coverage. Monitor quarterly share shifts, Medicare pricing developments and the first real-world data on oral GLP-1s — they will determine whether the market’s current boom becomes long-term structural growth or a high-volatility episode driven by pricing and policy shocks.