Zepbound passes Wegovy in US prescriptions as Lilly takes 58% of GLP-1 market

Eli Lilly's Zepbound has passed Novo Nordisk's Wegovy in U.S. prescription volume and in dollar sales, with Lilly now holding about 58% of total U.S. GLP-1 prescriptions to Novo's 42% ^[1][2]. Zepbound is Eli Lilly's tirzepatide product; Wegovy and Ozempic are Novo Nordisk's semaglutide products ^[2].

The ranking change comes as Novo's growth has slowed sharply. Wegovy sales rose 18% year over year in the third quarter, down from 67% growth in the second quarter, while Ozempic growth fell to 3% from 15% ^[1]. Novo cut its full-year forecast three times in 2025 ^[1] and has warned that overall sales will decline as pricing pressure builds ^[2]. In a head-to-head trial, Zepbound showed superior weight-loss results compared with Wegovy ^[2], and Zepbound's dollar sales passed Wegovy's in 2025, with analyst consensus compiled by Bloomberg suggesting that lead could extend into 2026 ^[2].

Novo cuts prices

Ozempic carried a list price of about $1,000 for a four-week supply and Wegovy listed at $1,349.02 per month ^[1]. Under a new direct-to-consumer program called TrumpRx, both drugs would launch at $350 per month, and Novo is separately offering many cash-pay patients Ozempic and Wegovy at $349 per month, down from $499, a 30% cut, with new patients paying $199 for their first two months at low doses ^[1]. For Medicare and Medicaid, the government-negotiated price for a month's supply of Ozempic, Wegovy and other GLP-1 drugs drops to $245 for eligible patients ^[1].

Novo has said the combined effect of U.S. price negotiations and the discount programs should have only a 'low single digit' negative impact on its global sales growth in 2026 ^[1]. One estimate puts the semaglutide franchise at roughly $36 billion in 2026, up from about $33 billion in 2025, with a range of about $36.5 billion to as high as $38 billion depending on how quickly volume responds to lower prices ^[1].

Competition is also arriving from outside the brand-name market. Novo has estimated that as many as 1.5 million patients in the U.S. are using compounded versions of GLP-1 drugs ^[2]. The FDA has declared the shortage over, which in principle ends the pathway for such copies, but compounders have continued selling customized versions by adjusting doses or adding ingredients such as vitamin B12 ^[2]. Semaglutide patents are also beginning to expire in several countries, which could open the door to broader generic competition ^[2].

Novo received FDA approval for an oral version of Wegovy ahead of Lilly and began selling it in the U.S. in January ^[2]. A cheaper copycat pill from Hims & Hers Health briefly entered the market less than a month later but was withdrawn after the FDA pledged to crack down on copycat weight-loss drugs ^[2].

Why it matters for patients

The two most-used GLP-1 brands are now being sold under programs that set different prices for different buyers. The $245 Medicare and Medicaid figure and the $350 TrumpRx figure apply to those specific channels, while the $349 cash-pay price applies to patients buying directly from Novo, so the amount any one patient pays depends on coverage and on where the prescription is filled ^[1]. Eligibility rules for the TrumpRx price and for the government-negotiated price have not been disclosed.

Before the recent cuts, net prices for GLP-1 obesity drugs were estimated at about $7,000 to $9,000 per year, or roughly $600 to $750 per month ^[1]. One analysis estimates that about 36 million non-elderly Americans with employer coverage alone meet BMI criteria for a GLP-1, while only a small fraction take one today ^[1]. That gap suggests the market has been limited by cost rather than by the number of people who might qualify ^[1].

Competition between the two manufacturers is also playing out in clinical results, not only in price. Novo is developing a higher-dose Wegovy that it says offers the same weight-loss potential as Zepbound, and in February the company reported that its next-generation candidate CagriSema delivered less weight loss than Lilly's tirzepatide in a head-to-head study ^[2].

What happens next

Under a November agreement with the administration, Novo and Lilly agreed to lower prices for Medicaid and Medicare, and direct-to-consumer prices for Ozempic and Wegovy are set to fall under the arrangement ^[2]. In exchange, Novo received a fast-tracked FDA review of a higher-dose Wegovy and a three-year exemption from U.S. tariffs on pharmaceutical imports ^[2].

Analysts have not yet fully modeled the pricing changes. The agreement was announced in early November, and most notes so far focus on pricing, eligibility and timelines rather than revised revenue forecasts ^[1]. Novo chief executive Mike Doustdar, who took over in August, has reduced jobs and cut prices while expanding NovoCare, the company's direct-to-patient U.S. platform ^[2].