Eli Lilly’s Obesity Pill Could Be a Game-Changer — But Here’s Why Zepbound Already Has a Giant Lead

Eli Lilly (NYSE:LLY) has taken a commanding position in the obesity drug market with its GLP-1 agonist Zepbound, and now the pharmaceutical giant is preparing for its next leap: a daily oral pill named orforglipron. Despite recent formulary setbacks—like CVS Health’s pharmacy benefit manager Caremark dropping Zepbound in favor of Novo Nordisk’s Wegovy—Lilly’s momentum has barely slowed. The company continues to onboard nearly 500,000 new Zepbound patients each month and maintains a 60% share of the market, with 75% of treatment starts. What distinguishes Lilly from its peers is not just the efficacy of its drugs but also its aggressive development pipeline, evolving distribution models like LillyDirect, and solid execution on global launches. With clinical readouts for orforglipron (a small-molecule pill) expected soon and expansion plans underway in countries like India, China, and Mexico, Lilly is betting big on transforming GLP-1 therapies from specialty injectables to mainstream daily oral treatments. Here's what’s driving its lead.

Superior Clinical Efficacy & Market Capture With Zepbound

Zepbound, Eli Lilly’s injectable GLP-1/GIP dual agonist based on tirzepatide, has emerged as the dominant force in the fast-growing obesity drug market. Although Novo Nordisk’s Wegovy had an earlier launch, Zepbound has decisively overtaken it in efficacy and uptake. Head-to-head studies revealed that Zepbound users lost an average of 20.2% of body weight compared to 13.7% for Wegovy, cementing its therapeutic edge. This efficacy has translated into dominant market penetration: Zepbound now controls about 60% of the U.S. GLP-1 obesity market, with 75% of all new treatment starts. Even though CVS Health’s Caremark recently dropped Zepbound from its preferred formulary, impacting roughly 200,000 prescriptions, the company continues to onboard 500,000 new users monthly. Importantly, many patients pay cash or use Lilly’s own LillyDirect platform to bypass PBM restrictions. The company's consistent commercial strategy, extensive direct-to-consumer marketing, and seamless payer engagement have allowed it to maintain market leadership despite competitive headwinds and formulary shifts. Additionally, Zepbound’s superior efficacy and growing awareness are helping to expand the overall obesity drug market rather than just taking share from competitors, an indicator of broader secular demand. International launches under the Mounjaro brand have also begun in nearly 40 countries, including high-demand regions like India and China. Despite early concerns around pricing erosion and compounded alternatives, Lilly has aggressively pursued legal action to curtail unauthorized versions and remains firmly positioned to extract value globally. Overall, Zepbound’s early and sustained success has created a formidable platform from which Lilly can launch its next wave of GLP-1-based products.

Orforglipron: The Oral GLP-1 Pill That Could Broaden The Market

Lilly’s upcoming oral GLP-1 receptor agonist, orforglipron, represents a potentially transformative opportunity to expand the reach of GLP-1 therapies to a broader patient population. Unlike existing injectable GLP-1s like Zepbound and Wegovy, orforglipron is a small-molecule drug that can be taken as a daily pill. This removes key barriers like needle aversion, refrigeration needs, and complex administration, making it more accessible and scalable for global markets. Results from late-stage trials such as ACHIEVE-1 and ATTAIN-1 are expected soon, with early data already showing weight-loss efficacy comparable to injectable semaglutide and good tolerability. Eli Lilly is strategically positioning orforglipron as a GLP-1 option for the masses, ideal for patients who require modest weight loss (e.g., in the low double-digit percentage range) and seek convenience in dosing. While not expected to replace Zepbound, orforglipron could complement it by extending the duration of therapy and creating a lower-cost, maintenance-oriented alternative. Furthermore, the pill’s chemical stability allows for easier distribution and storage in emerging markets, enhancing Lilly’s global reach. Analysts expect the pill to be priced based on value, and its oral nature could unlock large swaths of the international market currently inaccessible to injectables. Regulatory approvals are being pursued aggressively, and Lilly anticipates a global launch in 2026. Importantly, Lilly sees the oral GLP-1 as part of a portfolio strategy rather than a single blockbuster, and is building infrastructure, marketing, and payer engagement accordingly. With ongoing headwinds in PBM contracting and generic competition looming, orforglipron may prove critical in maintaining volume growth and defending Lilly’s GLP-1 franchise over the next decade.

Integrated Direct-to-Consumer Distribution Through LillyDirect

One of Lilly’s most significant strategic differentiators in the GLP-1 race is the deployment of LillyDirect, a vertically integrated direct-to-consumer pharmacy and service platform. Originally launched for insulin and migraine drugs, LillyDirect now includes Zepbound and serves as a vital hedge against restrictive payer decisions. Through this platform, patients can bypass pharmacy benefit managers and obtain medications directly, often at discounted prices. For instance, Zepbound’s starting dose costs $349/month and higher doses $499/month via vials—significantly undercutting traditional distribution channels. LillyDirect also offers telehealth services, in-person appointments, and recently expanded to include services related to Alzheimer’s treatments. As CVS Caremark and other PBMs adjust formulary positions, LillyDirect gives the company a mechanism to retain patient volume and brand loyalty without relying solely on intermediaries. While still a small part of total distribution, the platform has shown notable momentum, especially among self-paying or underinsured patients. The broader strategic implication is that Lilly is building an infrastructure to gradually reduce reliance on third-party payers while directly shaping patient experiences and adherence. Moreover, LillyDirect offers a launchpad for future therapies like orforglipron, which could benefit even more from digital-first distribution models. The company has been transparent that LillyDirect is not meant to replace traditional access but to act as a bridge while payer coverage scales up. In the long run, however, such a model may help Lilly better manage pricing, improve access, and potentially influence prescription decisions in a heavily intermediated healthcare system.

Global Launch Momentum & Controlled Cost Structure Support Future Expansion

Eli Lilly’s lead in the GLP-1 space is reinforced by its global execution strategy and financial discipline, both of which support its ability to scale access rapidly while maintaining margin growth. Over the past year, the company has launched its tirzepatide-based products (Mounjaro/Zepbound) in over 40 countries, up from just a dozen in late 2024. Key markets like China, India, and Mexico are already showing strong early uptake, with Zepbound often becoming the market leader within two quarters. Lilly has tailored its pricing and reimbursement strategies to local healthcare structures—for instance, navigating separate channels for branded vs. generic drugs in China’s NRDL and BBP systems. On the cost side, Lilly has maintained SG&A discipline, choosing to scale with variable costs and avoid unnecessary salesforce expansion. Operating margins expanded by 11 percentage points in Q1 2025 alone, and gross margins now stand at 82–83%, driven by high manufacturing efficiency. The company continues to invest heavily in R&D and early-stage tuck-in acquisitions (e.g., Camurus, SiteOne, Scorpion) to support long-term innovation while avoiding large, dilutive M&A. Furthermore, the recent partnership with Camurus could enable monthly dosing regimens, adding another layer of optionality to its obesity platform. Taken together, Lilly’s global strategy combines commercial agility with operational excellence, allowing it to defend and extend its GLP-1 franchise as competitors and generics enter the field. International launches and efficient cost control are not only fueling current growth but also creating a foundation for sustained advantage in the decade-long expansion of the global obesity market.

Final Thoughts

Source: Yahoo Finance

Eli Lilly’s stock trajectory has been volatile for the past 6 months but its LTM EV/ Revenue has already escalated to a staggering 15.24x given its commanding position in the GLP-1 obesity drug space. The market has factored in its strong market position resulting from its product efficacy through Zepbound, promising follow-up candidates like orforglipron, an innovative direct-to-consumer distribution model, and careful global expansion with tight operational control. While there are headwinds such as formulary exclusions, legal battles over compounded alternatives, and eventual generic competition, Lilly appears structurally prepared to navigate them. The company is also investing in long-term diversification, with pipeline developments in Alzheimer’s, immunology, and pain management. In the long term, we believe that the success of orforglipron will depend not only on clinical results but also on pricing, tolerability, and international adoption. As a result, while Lilly's lead in the GLP-1 space is clear, the path forward will require continued execution across science, commercial strategy, and policy engagement.