Affordability and prescriber preference, not efficacy, may decide the GLP-1 race

Eli Lilly and Novo Nordisk are locked in a fierce race for share of the weight loss drug market, but a new analysis suggests the outcome may hinge less on how much weight a drug helps someone lose and more on what it costs and how doctors feel about prescribing it ^[1].

BioPharma Dive's review of recent survey data found that affordability is a major barrier. A KFF survey cited in the report found that 55% of current or former GLP-1 users with health insurance said it was difficult to afford their prescription ^[1]. Injectable GLP-1s such as Wegovy, Zepbound, Ozempic and Mounjaro typically cost $25 to $150 a month with insurance, but many health plans don't cover them when used only for weight loss. Without insurance, prices average $900 to $1,400 a month, according to Forbes data cited in the analysis ^[1]. Newer GLP-1 pills carry lower advertised cash prices, with the Wegovy pill (oral semaglutide) and Foundayo (orforglipron) both starting around $149 a month for cash-paying patients without insurance, and co-pays as low as $25 for those with coverage ^[1].

The cost pressure has consequences. A Spherix Global Insights poll of 185 prescribers, cited in the report, found respondents estimated that 74% of patients who stopped GLP-1 treatment did so because of cost ^[1]. Some patients have turned to compounded versions of these drugs, which often cost less but carry safety risks, or have simply stopped treatment altogether ^[1].

The same Spherix survey pointed to a second factor: prescriber preference. Among the doctors, nurse practitioners and physician assistants surveyed, 80% said they were highly satisfied with Zepbound (tirzepatide), compared with 59% for Wegovy (semaglutide), 48% for the Wegovy pill and 47% for Foundayo ^[1]. Zepbound also ranked highest for producing the most weight loss, the fastest weight loss, the most sustainable weight loss, and the best tolerability, according to the poll — though it scored lower on out-of-pocket cost ^[1]. Wegovy ranked highest for cardiovascular outcomes evidence and access, and the Wegovy pill ranked highest for affordability ^[1].

A separate factor is social stigma. A HarrisX-Allison Worldwide study of more than 6,000 adults in the U.S. and U.K., cited in the report, found that nearly a quarter of U.S. adults said they had used a GLP-1 and another 23% said they would consider it ^[1]. But half of respondents saw the drugs as a weight loss shortcut, and nearly three-quarters of U.S. respondents said too many people are using them for appearance rather than health reasons ^[1]. Even so, 66% said it is socially acceptable to use a GLP-1, and 64% said they would be open about using one ^[1].

Why it matters for patients

For people weighing whether to start or continue a GLP-1 medication, this analysis suggests the choice between drugs may increasingly come down to what a patient's insurance covers and what price they can pay out of pocket, not just which drug produced the best results in a trial ^[1]. The finding that most people who stopped treatment cited cost, according to prescriber estimates, points to affordability as a practical hurdle that can interrupt long-term use of medications meant to be taken continuously ^[1]. The gap between doctor satisfaction ratings and drug cost rankings also means a patient's own doctor may lean toward a particular drug for reasons that don't always match the price tag that patient will actually face ^[1]. And the stigma findings suggest that even when cost and access aren't obstacles, some patients may weigh social judgment as part of their decision ^[1].

What happens next

The report notes an ongoing federal effort, through the government website TrumpRx, to link patients with discounted GLP-1 drugs ^[1]. It also points to continuing research into these drugs' long-term health benefits, which the analytics firm IQVIA suggests could eventually support broader insurance coverage ^[1]. No specific timeline for expanded coverage decisions was given in the sources.