Zepbound overtakes Wegovy in US prescriptions

Eli Lilly's tirzepatide shot Zepbound has passed Novo Nordisk's semaglutide shot Wegovy in US sales, and Lilly now accounts for about 58% of total US GLP-1 prescriptions compared with Novo's 42% ^[1]. Zepbound's sales surpassed Wegovy's in dollar terms in 2025, and analyst consensus compiled by Bloomberg suggests that lead could widen in 2026 ^[2].

The numbers behind the shift are stark. Wegovy sales grew 18% year over year in the third quarter of 2025, down sharply from 67% growth in the prior quarter ^[1]. Ozempic, the diabetes version of semaglutide, slowed to 3% growth from 15% the quarter before ^[1]. Novo Nordisk cut its full-year forecast three times during 2025 as GLP-1 growth decelerated ^[1], and has warned that overall sales will decline as pricing pressure builds ^[2].

Competition is only part of the story. Lilly's Zepbound, launched in 2023, produced better weight-loss results than Wegovy in a head-to-head trial ^[2]. But the slowdown also suggests Novo may be running out of buyers at list prices of roughly $1,000 to $1,350 per month — in other words, nearing saturation among patients who can afford the drugs or whose insurers cover them ^[1].

Prices are falling fast

That pressure has triggered a broad price reset. Ozempic previously listed at about $1,000 for a four-week supply and Wegovy at $1,349.02 per month ^[1]. Under the new TrumpRx direct-to-consumer program, both are set to launch at $350 per month ^[1]. Separately, Novo is offering many cash-pay patients Ozempic and Wegovy at $349 per month, down from $499, with new patients getting the first two months at low doses for $199 ^[1]. For eligible Medicare and Medicaid patients, the government-negotiated price for a month's supply drops to $245 ^[1]. Novo and Lilly reached the pricing agreement with the Trump administration in November ^[2].

Novo is betting that lower prices will pull in far more patients. The company told investors the combined effect of US price negotiations and discount programs should have only a "low single digit" negative impact on 2026 global sales growth ^[1]. One KFF analysis estimates roughly 36 million non-elderly Americans with employer coverage alone meet the BMI criteria for a GLP-1, while only a small fraction take one today ^[1]. Novo has also estimated that as many as 1.5 million US patients use lower-cost compounded versions of GLP-1 treatments ^[2].

Why it matters for patients

For people paying cash, the practical effect of the competition is a much lower sticker price than a year ago — from roughly $1,000 or more per month at list to the $245 to $350 range for Medicare, Medicaid and TrumpRx buyers ^[1]. Health economists at the Institute for Clinical and Economic Review estimate net prices of about $7,000 to $9,000 per year, or roughly $600 to $750 per month, already sat within the usual US cost-effectiveness range for obesity treatment ^[1].

Market share shifts can also affect which drug your insurer or pharmacy benefit manager prefers, though the sources do not break down how coverage decisions are changing plan by plan. Lilly's growing share does not mean tirzepatide is right for every person; the head-to-head trial showed greater average weight loss with Zepbound ^[2], but individual results, side effects and coverage vary and are not addressed in these sources.

One caution: compounders have continued selling customized semaglutide by adjusting doses or adding ingredients such as vitamin B12, even though the FDA declared the shortage over ^[2]. A copycat pill from Hims & Hers Health briefly entered the market and was withdrawn after the FDA pledged to crack down on copycat weight-loss drugs ^[2].

What happens next

Novo began selling an oral version of Wegovy in the US in January after winning FDA approval ahead of Lilly ^[2]. The company is developing a higher-dose Wegovy it says matches Zepbound's weight-loss potential, and the pricing deal secured a fast-tracked FDA review of that higher dose plus a three-year exemption from US pharmaceutical tariffs ^[2]. Novo's other candidate, CagriSema, delivered less weight loss than tirzepatide in a head-to-head study reported in February ^[2].

Analysts had modeled about $37.5 billion in 2026 semaglutide sales before the pricing deal; the post-cut central estimate is about $36.5 billion, off a roughly $33 billion 2025 base ^[1]. How quickly lower prices translate into more filled prescriptions is not yet known ^[1].