Novo and Lilly are competing to win the GLP-1 pill market as they prepare for Medicare coverage

Novo Nordisk and Eli Lilly took their GLP-1 pill battle to the preeminent obesity meeting this weekend as they prepare for the next sea change in how patients receive their drugs.

Novo Nordisk on Sunday announced that prescriptions of the Wegovy pill have topped 3 million since it entered the U.S. market about five months ago. The Danish drugmaker's CEO Mike Doustdar celebrated the milestone, saying in an interview with CNBC that Novo was able to accelerate prescriptions even as Lilly introduced its own GLP-1 pill in April.

"If that's not acceleration, then I don't know what is," Doustdar told CNBC this weekend at the American Diabetes Association's Scientific Sessions.

Meanwhile, Lilly CEO Dave Ricks told CNBC that prescriptions of its pill Foundayo are "markedly higher" than the 20,000 that Lilly reported about six weeks ago around its first-quarter earnings release, without giving a specific number. He said the number builds week over week and that Lilly is pleased with the progress.

The competition for the weight loss pill market is only the latest for the longtime rivals. Signs of that tension were evident throughout the industry event this weekend. Cars drove around advertising Novo's Wegovy pill, while pictures of Lilly's Foundayo pill covered some of the floors of the convention center in New Orleans.

And the two companies will soon make their case for their daily pills and their weekly shots to seniors. Starting in July, millions of people with Medicare will be able to access GLP-1 drugs for weight loss for $50 a month. Until now, Medicare beneficiaries have had to pay out of pocket for the obesity drugs, costing them potentially hundreds of dollars a month. Both companies say they're focused on raising awareness of the program, though they have different pitches.

Weight loss pills available: A heap of GLP-1 pills

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Doustdar thinks the program could be an opportunity to regain some of the ground Novo's Wegovy shot has lost to Lilly's Zepbound. The drugmaker plans to advertise Wegovy's other health benefits on its label, he said, like the fact that it can decrease the risk of cardiovascular problems like heart attacks and strokes. He said Novo should win with seniors "if common sense is to prevail, and I put myself in their shoes."

"With the Wegovy high dose, why would you not take a product that has the same efficacy, percentage wise, than my competitor?" he said. "On top of it, you get kidney, liver, heart, stroke protection, let's say free of charge. I would take it if I was 10 years older."

Lilly's pitch to seniors is convenience. The company's pill Foundayo can be taken at any time of day with food, water and other medicines, whereas Novo's pill needs to be taken on an empty stomach with little water and requires fasting for 30 minutes afterward.

"The main thing is, it's easy," Ricks said. "This is something that can just go in your daily routine. Most seniors are on many other medications, and they've got their pill case, and they use that every day, and this will just fit right into that without any extra thought."

Ricks said Lilly is working closely with the government to prepare, and he's confident that Humana, which will process prescription requests, will do a good job. He thinks the program will be popular with seniors and that longer term, the initiative could help prove that obesity care should be "regular health care."

"We have to prove that in this pilot and prove cost effectiveness and then kind of reset what we expect from our health insurance, which is obesity care should be health care," Ricks said.

Lilly and Novo are trying to increase insurance coverage of GLP-1 drugs for obesity. At least one analysis found the drugs to be cost effective, but employers have balked at paying for them because so many people could be eligible for the treatments and many patients stop them after achieving a weight loss goal. Health insurance company Cigna last week said it would stop covering the medicines for its own employees.

At Lilly, less than 20% of the company's beneficiaries are using the drugs for weight loss, and people are staying on them, Ricks said. Lilly is conducting an internal study to measure its health costs and outcomes like hospitalization rate, progression to diabetes and cardiovascular events. Lilly plans to publish those results later this year, he said.

The next stage in the GLP-1 race

While they prepare for Medicare coverage, both companies are trying to introduce more drugs to treat obesity. At the conference this weekend, Lilly presented Phase 3 data for retatrutide, an experimental triple agonist that helped people lose an average of 28% of their body weight when they stayed on the drug. Nearly half of people lost more than 30% of their body weight, an amount that's similar to bariatric surgery. The drug also helped improve related conditions like knee osteoarthritis and sleep apnea.

Initially, Ricks expects retatrutide to primarily be used to treat people with higher body mass indexes, or BMI. He also sees promise for the second-lowest strength of the drug. It helped people lose an average of 19% of their body weight with fewer side effects than the higher strengths.

One question was whether Lilly would make retatrutide available on its direct-to-consumer sales platform LillyDirect once it's approved by the Food and Drug Administration because it's so powerful. Lilly "absolutely" plans to make the drug available there, Ricks said.

For Novo, the next drug on the horizon is called CagriSema. It combines the main ingredient of Wegovy with another molecule called cagrilintide, which mimics another hormone called amylin. The drug's efficacy has underwhelmed investors since it has showed weight loss that is similar to Lilly's Zepbound and less than Lilly's retatrutide. Doustdar thinks the drug's edge in effectiveness over Wegovy, even if only a few percentage points, is meaningful, and said he's committed to launching CagriSema. Novo expects an approval decision from the U.S. Food and Drug Administration on the drug in the fourth quarter of this year.

"If I have to forget about CagriSema, a lot of other products have to be forgotten about as well," Doustdar said. "I don't think it should work that way."

Doustdar took over as chief executive almost one year ago after a major shakeup that led to the departure of the company's former leader and thousands of employees being laid off. He's tasked with reinvigorating sales of Wegovy, the company's pipeline and its stock price. Eventually, he said Novo will be more diversified within the area of cardiometabolic health — like diabetes and obesity — and some of the "adjacencies."

In the meantime, Doustdar said the early success of the Wegovy pill has helped Novo regain some momentum.

"The pill was a great example of people getting confident that we can do this, that at Novo Nordisk, better days are ahead of them and not just behind," he said. "So we also have to really make sure that we turn these positive moments that right now we're in into a longer term trend, so we gain the trust day by day and improve that both internally as well as, of course, externally, and I will work hard to make sure that this continues."