Newsletter · 2026-09-25 · Ashutosh Agarwal

Wall Street Calls the Obesity Race for Lilly as Maintenance Dosing Becomes the Test - The Healthcare Pulse: Weekly Podcast Intelligence Brief - Week of September 25, 2026

The Healthcare Pulse weekly podcast intelligence brief for the week of September 18–25, 2026. Across the podcast tape Wall Street has mostly decided the first round of obesity drugs for Eli Lilly (winning 7 of 10 new Medicare GLP-1 patients) as Novo Nordisk's capital markets day dropped its stock 8%, while Viking's maintenance data made keeping the weight off the market's new scoreboard.

The Healthcare Pulse: Weekly Podcast Intelligence Brief

Week of September 25, 2026: Wall Street Calls the Obesity Race for Lilly as Maintenance Dosing Becomes the Test

This Week at a Glance

Last week, a cancer vaccine brought money back into biotech. This week the podcasts were mostly about obesity drugs again, and the verdict was lopsided. On Monday, Novo Nordisk laid out its plan for life after Ozempic and the stock fell 8%. On the same day, Eli Lilly broke ground on a $6.5 billion pill factory in Houston.

Here is what came up again and again across the podcasts and the news:

• Lilly vs. Novo is starting to look settled, at least to Wall Street. Lilly CEO Dave Ricks said on CNBC's Halftime Report that Lilly is winning 7 out of every 10 new Medicare patients starting a GLP-1 drug. UBS's top biotech analyst called Novo "a value trap" and predicted Lilly will hold 65% of the obesity market.
• A new obesity drug got people excited. Viking Therapeutics' shot VK2735 showed patients kept 90–97% of their lost weight after switching to less frequent doses. The stock jumped about 30%. Keeping weight off, not just losing it, is now the main question in this market.
• China's growing role in drug discovery. STAT's The Readout Loud sent a reporter to a Jefferies biotech conference in Shanghai. He called the race for Chinese drug candidates "basically a gold rush." Roughly a third of the world's experimental drugs now come from China.
• The FDA gets a new face. Heidi Overton, the nominee for FDA Commissioner, had her Senate hearing on September 24. The industry mainly wants one thing from her: stability.
• Biotech's money taps are opening again. A wave of biotech IPOs was filed, Blackstone explained how it writes $2 billion checks to drug companies, and deals kept coming.
• Policy deadlines are close. Pharma tariffs take full effect September 29. Medicare's next price-negotiation offers are due September 30. A new "most favored nation" drug-pricing pilot starts October 1. Medicare Advantage star ratings land in early October.

Below: the people, the debates, the numbers, and why each one matters.

The People Driving the Conversation

Dave Ricks, CEO of Eli Lilly, on CNBC's Halftime Report (September 21)

Ricks gave the clearest early look at how Medicare's new obesity-drug coverage is going. Medicare started paying for weight-loss drugs on July 1 Halftime Report.

"I think there's about 700,000 new seniors who've started on GLP-1 medicine just since July 1... It's very market expansionary, which is what we had hoped. Lilly's doing well in that. We're capturing about 7 out of 10 of those new patients."

He also said Foundayo, Lilly's new obesity pill, is getting "about one out of three new starts for orals," and that its share is "growing week on week." He was bullish on the diabetes market for the pill, which is waiting for an FDA decision later this year:

"Today still the oral GLP-1 medicines are the same size as the obesity market. That seems hard to believe, but it's about the same size market."

He even praised the government: "CMS probably isn't letters you think about when you think about efficiency and effectiveness. But they did a nice job rolling this out." CMS is the agency that runs Medicare.

After the interview, the show's panel split on the stock:

• Joe Terranova (bull): He owns Lilly. He pointed to a "trillion dollar basically biotech close to a 30 times valuation" that has done "$20 billion so far year to date in 2026" in acquisitions to broaden beyond obesity drugs. ("30 times" means the stock costs about 30 times the profit it is expected to earn next year.)
• Jim Lebenthal (cautious): He doesn't own Lilly and said the "real question is, can they diversify beyond GLP-1s." He prefers "more diverse pharmaceuticals like AbbVie, like AstraZeneca, like Vertex."
• A third panelist used her final trade on healthcare name Natera (NTRA), calling it "a play on women's health, organ health, and oncology."

Michael Yee, UBS Senior Biotech Analyst, on CNBC's Fast Money (September 21)

Yee gave the harshest verdict of the week on Novo CNBC's "Fast Money":

"We've been very consistent on this. We think it's a value trap... you have an incumbent GLP-1 obesity player that's facing significant headwinds and declining market share. And obviously that is because Lilly offers a significantly better drug."

(A "value trap" is a stock that looks cheap but keeps getting cheaper because the business is shrinking.)

His argument is about the next five years. Even if Novo's Wegovy pill is selling well, he expects injections to stay "65% or 75% of the overall market." And Lilly is lining up two newer drugs, the "Triple G" (retatrutide) and an amylin drug, "which has very high efficacy and not a lot of side effect." His bottom line: "Lilly will dominate with 65% of that market over the next five or seven years."

On the smaller players, Yee said Structure Therapeutics (GPCR) is "still on the radar screen of a lot of players" as a takeover target. Viking "remains a question mark for a lot of people, given that it's still just a peptide." Peptides are protein-like drugs that are harder to make at scale than pills.

Co-host Tim Seymour owns Novo and pushed back only a little: "Lilly at 32 times forward, Novo at 11 and a half times forward... I don't mind holding the stock." Another panelist pointed out that "75% of [Novo's] revenues comes from one molecule." He suggested looking elsewhere: "Merck is outperforming. AbbVie already got the patent cliff behind it... I would play small cap biotech."

Maziar Mike Doustdar, CEO of Novo Nordisk, via BioSpace and Closing Bell (September 22–23)

Doustdar's capital markets day set a goal of $23 billion in revenue by 2035, with five multi-blockbuster drugs on the market by 2030. That includes CagriSema and cagrilintide. BioSpace's Annalee Armstrong noted that Novo made about $20 billion last year, and analysts said the plan was "pretty much like in line with what investors and analysts expected" BioSpace.

Other details from the day:

• Job cuts: 4,000 more people have left Novo, bringing the total to about 13,000 fewer employees than last year.
• Pill supply: Novo will increase production of its Wegovy pill tenfold. About 1.5 million patients take it today. The pill needs "an order of magnitude more semaglutide than the injectable," so investors worried Novo couldn't make enough. Doustdar's answer, per the hosts: "you don't have to worry about this anymore."
• Deals: Novo bought three early-stage obesity molecules from Kallyope and signed a partnership with Danish company Orbis Medicines worth up to $1.4 billion.

On CNBC's Closing Bell, Doustdar signaled that his next deals will likely be outside obesity Closing Bell:

"It would be more obvious for me to imagine that we will be making more deals on areas outside of the core than in the core."

Pain treatment that doesn't rely on opioids was one area Novo named. On The Rundown, Zaid Admani of Public.com summed up the mood: Novo is down 27% over 12 months while Lilly is up more than 50%, and "Novo Nordisk fumbled the weight loss opportunity with Ozempic so bad that investors are now hesitant to give the company any benefit of the doubt" The Rundown.

Jason Mast, STAT Reporter, on The Readout Loud (September 24)

Mast reported from Jefferies' first-ever Shanghai biotech conference, where GSK, Merck, AstraZeneca and U.S. investors were shopping for drug candidates. The hosts put the scale plainly: Pfizer, Merck, AstraZeneca and Eli Lilly "have spent approximately $50 billion to acquire and license medicines developed by Chinese scientists." About one-third of the world's drug pipeline now comes from China The Readout Loud.

One Chinese biotech CEO told him bluntly: "U.S. companies cannot compete. We are too fast. We are too efficient." Mast's own summary of the conference:

"The competition for molecules here is as high as it's ever been, and people are actively bidding against each other and bidding against other investors, bidding against pharma companies. It's basically a gold rush out here."

He also described a new way deals are being structured to get around U.S.–China tension. A Chinese biotech licenses its molecule to a new company set up mostly by U.S. investors, which makes it "easier to then sell to a U.S. pharma company." One investor called the geopolitics "the 100-pound gorilla in the room." There are safety questions too. Three patient deaths in Chinese gene-therapy studies happened under a fast-track "investigator-initiated trial" system, which lets hospitals start early human studies without full central approval.

Nick Galakatos, Global Head of Life Sciences at Blackstone, on The BioCentury Show (September 18)

Galakatos runs the largest private fund dedicated to life sciences, a $6.3 billion fund closed in March. He explained why that much money is needed. Late-stage trials have become so expensive that "it's not uncommon now to see a phase three program cost in excess of a billion dollars" The BioCentury Show.

Blackstone backs individual drugs, not companies. It gets paid through royalties, meaning a share of the drug's sales. "Our success is directly linked to the success of the product." His best example was a $2 billion package for Alnylam that started "on a napkin at dinner." Only $100 million of it was new stock. The rest was royalty money and loans, so existing shareholders weren't diluted, and it helped carry Alnylam to profitability.

Dave Knapp, Host of On The Pen (September 22)

Knapp covers obesity drugs for patients, and this week he dug into the legal fight over Lilly's retatrutide. Lilly wants it classified as a "biologic." That would block pharmacies from making cheaper copies and give Lilly longer protection from competition. The FDA said no, Lilly sued, and oral arguments were set for September 24. Three days earlier, the Justice Department filed a letter backing the FDA's scientific reasoning On The Pen GLP-1 News.

Knapp still expects Lilly to win: "They've just said too many things publicly that give me the impression they have a degree of confidence here." But he said the ruling matters beyond one drug. Novo's own next-generation molecule is 68 amino acids long, which "falls well within the FDA's framework for a biologic," so the decision could shape how the whole next wave of peptide obesity drugs is regulated. He also flagged new FDA warning letters to a big compounding pharmacy. The FDA's message was that you "can't just add B12 to tirzepatide and mass produce it."

Dr. Finny Kuruvilla, Co-CIO of Eventide Investments, on Faith & Finance (September 22)

Kuruvilla called the new RAS-targeting pancreatic cancer drug (Revolution Medicines' daraxonrasib) "the most exciting story of 2026." Normally, "metastatic pancreatic cancer has a median survival of 6.7 months. And with this particular therapy that targets RAS, survival is now 13.2 months." The drug works as a "molecular glue." It pulls in a second protein that switches off the cancer's "divide, divide, divide" signal Faith & Finance.

The Key Debates

1. Is Novo Nordisk Cheap, or a Trap?

The bear case: UBS's Yee: "It's a value trap." Novo is "a show me story" and "in this market, guys, I think people want to bet on the growth story, not the value story" CNBC's "Fast Money". Part of the 8% drop was about profit margins, not just sales. Yee said "the margin guidance was also a question."

The bull case: The gap in price is huge: Lilly at 32 times next year's earnings versus Novo at 11.5 times. Tim Seymour said Novo is focused on the fact that "this is a massive opportunity that we're the largest player. And even if margins are going down, we're in good shape." And the Wegovy pill is, in Doustdar's words, probably "the most successful pharma launch that has ever happened" BioSpace.

2. Is Eli Lilly Still Worth Buying at Around 30 Times Earnings?

Bulls: Terranova says Lilly is using its obesity profits to diversify through acquisitions, which "is going to set us for long-term future success" Halftime Report. Wall Street kept raising targets. Guggenheim's Seamus Fernandez moved his to $1,284 from $1,273, citing prescription trends and Zepbound returning to CVS's list of covered drugs on October 1 (The Fly, Sep 18).

Skeptics: Lebenthal's question: can Lilly grow "beyond GLP-1s, beyond obesity?" Commentators also debated the valuation, pointing to Q2 revenue up 48% against a price above 30 times earnings. There's also courtroom risk. A jury in Nektar's breach-of-contract case against Lilly was in its fourth day on September 23. B. Riley's Mayank Mamtani read the jury's questions as the panel "settling on breach," though possibly with only $1 in damages (The Fly, Sep 23).

3. Will Cheaper Obesity Drugs Help or Hurt the Drugmakers?

On InvestTalk, Luke Guerrero framed the question: "Competition is typically bullish... for the category, but it's bearish for the companies that were already seeing massive margins, that were essentially printing money because it was a duopoly." The question is "whether volume growth at these lower prices... can outweigh margin compression" InvestTalk.

The price drops are real. On The Dr. Francavilla Show, doctors noted that the government-negotiated price is about "250 to 60 a month" ($250–260), versus the "$1,300, $1,000" list prices people usually quote. Still, "if you have a med that's $260 a month, but half of your population could qualify for it, the math adds up really quickly" The Dr. Francavilla Show. One guest estimated that covering these drugs through Arizona's Medicaid program would cost $7–20 million a year, and said four states have already dropped coverage over budget overruns.

4. China: A Threat to U.S. Biotech, or Its Best Supplier?

The worry: The Readout Loud laid out the U.S. debate: "Have we become too reliant on Chinese drugs? Are we losing our competitive edge?... Or do we need to erect barriers?" The Readout Loud. China's 2026–2030 plan targets 25% of the world's first-in-class drugs by 2030.

The opportunity: Western drugmakers keep buying. Chinese out-licensing is at a record $120 billion. This week Lilly signed a deal with InnoCare worth up to about $3.25 billion in milestones (The Fly, Sep 24). Reuters reported on September 18 that the U.S. Treasury is drafting rules that could still allow licensing of Chinese drugs that don't involve pathogens or weapons risk. Pfizer and others had lobbied against broad restrictions. The rules aren't final and could shift before a Trump–Xi meeting.

5. Is the Biotech IPO Comeback Real?

Optimists: Commentators said biotech IPOs are reaching "escape velocity." Iambic Therapeutics, an AI drug-discovery company backed by Nvidia, filed right after signing a deal with AbbVie, and ADARx is targeting more than $318 million. BioSpace counted four more biotechs announcing IPO plans this week.

Skeptics: With the 10-year Treasury yield near 5%, the debate is whether higher interest rates will limit how far young, money-losing biotechs can run. When bonds pay 5%, investors are less willing to wait years for a drug company to earn anything.

Hot Topics Under Debate

Viking Therapeutics (VKTX) and the question of keeping weight off. Viking's shot VK2735 produced 16–19% weight loss at 21 weeks. The bigger news was what came next. Patients switched to every-other-week dosing kept "up to 97% of their weight loss," and monthly dosing kept 90% Closing Bell. On BioSpace, Heather McKenzie said Truist called the results its "best case scenario" and William Blair called them a "maintenance trifecta." Stomach side effects were similar to placebo, which matters after last year's pill trial, when 20% of patients dropped out and the stock fell about 40% BioSpace. Dave Knapp pointed to the 17.5 mg group, which hit 22% weight loss by week 33 "with no clear plateau." That's Zepbound-level weight loss in about half the time On The Pen GLP-1 News.

Roche's obesity push. Roche showed Phase 2 data for enosepatide, a shot from its $2.7 billion Carmot acquisition. It lowered blood sugar and body weight in type 2 diabetes patients at 48 weeks. On The Pen cited A1C drops of 2.65–4.13 points, with 90% of patients reaching an A1C of 6.5 or below at the top dose. (A1C is a standard measure of long-term blood sugar.) Doustdar's comments and the Viking and Roche data together are why Closing Bell said the obesity market "is no longer a two-horse race."

Amgen (AMGN) jumps on a Sjögren's win. On September 22, dazodalibep met its main goal in a Phase 3 trial for Sjögren's disease, an autoimmune condition that causes dry eyes and mouth. Improvement showed up from week 4. Shares rose as much as 3.6% to about $404. Citi (Neutral, $405) called the drug "potentially underappreciated" but said how well it works and how it compares to rivals "remain open questions." Jefferies raised its target to $410 from $367 (The Fly, Sep 22–23).

Johnson & Johnson (JNJ) had a strong week of data. Caplyta met its main goal in a key bipolar I mania trial, with benefit from day 3. UBS sees more than $5 billion in peak annual sales and rates the stock Buy with a $320 target. Separately, in the MajesTEC-3 multiple myeloma trial, about 83% of patients on Tecvayli plus daratumumab were alive at three years, and the risk of the cancer getting worse fell 90% (The Fly, Sep 21–23).

Merck (MRK) got approvals, and UBS sees upside few are watching. Europe's drug advisory committee recommended Keytruda plus Padcev for bladder cancer before and after surgery (47% lower risk of recurrence or other events, 35% lower risk of death). The FDA updated Winrevair's label with a 76% cut in clinical worsening. And the BRUNELLO eye-disease trial matched ranibizumab, an established treatment. UBS (Buy, $175) called BRUNELLO and a second ulcerative-colitis study two "overlooked" catalysts. TD Cowen lifted its target to $155 from $137 (The Fly, Sep 18–24).

Pfizer (PFE) and the fine print of its drug-pricing deal. Documents obtained by Public Citizen show Pfizer will share part of its extra overseas drug revenue with HHS under its "most favored nation" deal through January 20, 2029. The White House fact sheet says Pfizer must "repatriate increased foreign revenue on existing products" (MT Newswires, Sep 21). ("Most favored nation" pricing means U.S. prices are tied to the lowest prices paid in other wealthy countries.) Bulls point to a dividend yield of about 6.3% and Pfizer's entry into obesity through Metsera. Bears point to a price under 10 times earnings, which they say reflects upcoming patent expirations.

AI finds something new in biology. Several AI podcasts covered Anthropic's announcement. Within 21 hours of opening its San Francisco wet lab, Claude agents found a previously unknown enzyme system in bacteriophage DNA (bacteriophages are viruses that infect bacteria). CEO Dario Amodei said it "could represent a new gene editing mechanism" but its "biotechnological utility, if any or level of significance is not yet clear" AI Update. Tech Brew Ride Home reported the scale: 950 Claude agents working through 210 million tokens over 21 hours Tech Brew Ride Home. This ties to Novo's partnership with Anthropic to use Claude in its research, which Novo announced the week before its investor day.

Emerging Themes to Watch

1. Keeping the weight off is the new scoreboard. Last week the obesity conversation shifted from how much weight people lose to the quality of that weight loss. This week the focus was on maintenance: can patients take less drug and keep the weight off? Viking's data and Lilly's work on maintenance dosing for its pill both point that way. If patients can move to monthly doses, the economics change for insurers, patients and drugmakers alike.

2. Obesity drugs are showing up in other industries' numbers. On CNBC's Squawk on the Street, McDonald's CEO said GLP-1s have no meaningful impact on the business yet, but he expects more as usage rises from about 10% toward 20–30% of people. Users "purchase smaller portions" Squawk on the Street. InvestTalk's Guerrero noted that some analysts estimate GLP-1 users eat 5–10% fewer calories, across a projected 30 million users by 2030. He argued employer health costs are "probably... the most important angle," since "a lot of employers actually dropping GLP-1 coverage in general because the costs are just too high" InvestTalk. Illinois Governor J.B. Pritzker revealed he lost 80 pounds on a GLP-1. His state employee plan's coverage cost $147 million in fiscal 2025 Crain's Daily Gist.

3. Medicare Advantage insurers quietly cut extras. On A Health Podyssey, a researcher explained what happened when CMS changed how it pays Medicare Advantage plans for 2024–2026. The change was expected to save $7 billion in 2024 alone. Plans didn't raise premiums. Instead they trimmed "hearing coverage... meal coverage, gym memberships" A Health Podyssey. On the investor side, Cantor (Overweight, $495) argued UnitedHealth's commercial business will recover. It said 50 of the 100 basis points of 2026 margin pressure came from surprise-billing arbitration costs, and it expects full margin recovery by 2028. (A basis point is one-hundredth of a percentage point.) An Arm and a Leg told the patient side: about 3 million seniors lost their plans in 2025 as UnitedHealthcare, Aetna, Humana and Blue Cross pulled out of some markets An Arm and a Leg.

4. New ways to pay for expensive drug trials. Blackstone's royalty-for-capital model, reverse mergers paired with private stock sales (such as North Immunology's $180 million raise from Bain Capital, Janus Henderson and Deep Track), and the U.S. shell companies used to license Chinese drugs all solve the same problem. Phase 3 trials now cost more than $1 billion, and public markets alone won't fund them.

5. Hospitals and health AI now need to show a payoff. Healthtech commentator Colin Hung said health systems now want a return on AI within 3–6 months, not 5-year stories. On C-Suite Perspectives, Covista CEO Steve Beard gave the labor numbers behind the rush: more than 700,000 open healthcare jobs against about 350,000 available workers a month C-Suite Perspectives. A BCBSA study found that AI note-taking tools for doctors led to $942 million in extra billing over two years. That will interest insurers as much as hospitals.

Stocks on the Radar

Upcoming Catalysts (September 26 to October 9)

FDA decision dates (PDUFA dates, the deadlines for FDA approval decisions)

• Sep 26: Mirum/Incyte zilurgisertib for FOP, a rare bone disease (Priority Review)
• Sep 27: Elevar's lirafugratinib (some reports say it was already approved early)
• Sep 30: Bristol Myers Squibb's Camzyos for teenagers with obstructive hypertrophic cardiomyopathy, a heart-muscle disease
• Oct 4: Merck/Eisai Welireg + Lenvima in kidney cancer (sources conflict on whether it was already approved)
• Oct 9: Roche Tecentriq / Tecentriq Hybreza applications

Policy and regulation

• Sep 29: Section 232 pharma tariffs take full effect. Rates go up to 100%, with exemptions for companies committing to U.S. manufacturing, for cell, gene and rare-disease drugs, and under country deals: UK 0%; EU, Japan, South Korea and Switzerland 15%
• Sep 30: CMS sends final offers in the next round of Medicare drug-price negotiation (15 drugs plus one renegotiation)
• Oct 1: Government funding extended at current levels through Dec 11, so FDA keeps running. The GLOBE "most favored nation" pilot for Medicare Part B drugs is set to start. Zepbound returns to CVS's covered-drug list.
• Early October (typically Oct 5–10; date not confirmed): 2027 Medicare Advantage star ratings. Plans rated 4 stars or higher earn bonus payments
• Pending: A decision in the Lilly v. FDA retatrutide appeal (arguments were set for Sep 24), and the jury verdict in Nektar v. Lilly.

Medical meetings

• ~Oct 10: American Academy of Ophthalmology meeting, with Merck's BRUNELLO data
• Just beyond the window: ESMO, the big cancer meeting (Oct 23–27, Madrid), and ObesityWeek (Nov 14–17)

Earnings: None of the big names report in the next two weeks. Earnings season starts with JNJ and UNH on October 13, then Abbott on October 14. LLY, MRK, BMY and GILD report October 29, ABBV October 30, and PFE and AMGN November 3.

The Bottom Line

This week the obesity story became less about Lilly vs. Novo and more about what comes next. On the podcasts, Wall Street has mostly decided the first round. Lilly is winning 7 of every 10 new Medicare patients. Novo's own long-term plan dropped its stock 8%. So attention is moving to the next contest: who can keep the weight off with fewer doses (Viking), who can make enough drug (Novo's pill vs. Lilly's small-molecule pill), and how courts and regulators will treat the next wave of peptide drugs (the retatrutide case).

Outside obesity, the sector's routine business kept delivering. Amgen, J&J and Merck all posted clean trial wins with little fanfare. Biotech's funding sources, from IPOs to Blackstone royalties to Chinese licensing deals, are open again. The real test is the next two weeks: tariffs on September 29, Medicare negotiation offers on September 30, the new drug-pricing pilot on October 1, and Medicare Advantage star ratings right after. Those will show whether this week's optimism about drug data and deals holds up against Washington.