Newsletter · · Ashutosh Agarwal

Viking Soars, Novo Stumbles, Medicare Seniors Pile Into Lilly - Healthcare Pulse - Week of September 28, 2026

A synthesis of what podcasts, operators, and analysts said about the GLP-1 and obesity-drug market for the week of September 21-28, 2026: Eli Lilly capturing about 7 in 10 of the roughly 700,000 seniors who have started GLP-1s since Medicare coverage began July 1, Novo's flat Capital Markets Day and its new openness to acquisitions, and Viking Therapeutics' maintenance-dosing data that reframes the race around keeping weight off with fewer shots.

Healthcare Pulse

Week of September 28, 2026: Viking Soars, Novo Stumbles, Medicare Seniors Pile Into Lilly

On Monday, Novo stood on a stage in London and told investors how it plans to win back the weight-loss market. Investors sold the stock down 8%.

On Tuesday, a $3.5 billion biotech called Viking Therapeutics put out data from a small, early trial, and its stock jumped 35% in a day.

And the day before either of those, Eli Lilly's CEO went on CNBC and casually mentioned that his company is signing up about 7 out of every 10 seniors who have started a GLP-1 since Medicare began paying for them in July.

That is the week in one paragraph. Lilly keeps pulling away, Novo is still trying to convince people it has a plan, and the next fight has already started. That fight is not about who can make people lose the most weight. It is about who can keep the weight off with the fewest shots.

TL;DR

  • Medicare coverage is a big, fast new market, and Lilly is winning most of it. About 700,000 seniors have started a GLP-1 since July 1, and Lilly says it is getting roughly 70% of them.
  • Novo's big strategy day fell flat. A $23 billion revenue goal for 2035, when it already did about $20 billion last year, sent the stock down 8%. Its CEO is now openly talking about buying companies.
  • Viking's maintenance data changed the question. Patients kept 90% to 97% of their weight loss after moving to shots every two weeks or once a month. That puts Viking on the shortlist of companies a buyer might want.

What's new

1. Medicare opened the door, and Lilly walked through it

This is the story that matters most for sales estimates, and it got less airtime than it deserved.

Starting July 1, Medicare began covering obesity drugs for the first time. On CNBC's Halftime Report (Sept 21), Lilly CEO David Ricks gave the first real numbers from the rollout:

"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. And a lot still on Zepbound."

Some context on why this matters:

  • These are new patients, not switchers. Ricks called it "market expansionary." In plain terms, Medicare is growing the pie, not just splitting it differently.
  • The price is much lower, but the volume is huge. On The Dr. Francavilla Show (Sept 21), an obesity physician put the negotiated Medicare and Medicaid price at "$245 exactly." List prices run roughly $1,000 to $1,300 a month, so this is a volume business now.
  • Seniors like pills. Ricks said older patients "seem to be interested in oral solutions," and that Lilly's new pill, Foundayo (orforglipron), is taking "about one out of three new starts for orals... and that's growing week on week."
  • The rollout worked. Ricks even tipped his hat to the government, joking that CMS "probably isn't letters you think about when you think about efficiency and effectiveness," before adding: "I really haven't heard that many problems with the logistics."

Ricks also drew a clear line between his two products. Zepbound, the weekly shot, goes to patients "with the most body weight and the most complications." Foundayo is for people who want convenience and "maybe just need to lose 25, 30 pounds."

The next leg is diabetes. Ricks expects a US decision on Foundayo for type 2 diabetes later this year, and made a point that sounds surprising at first:

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

He also said a heart benefit from Foundayo "seems to be emerging that's even beyond our expectations," and promised new data at this week's European diabetes meeting (EASD) on Foundayo, on retatrutide (Lilly's next-generation shot), and on a combination of tirzepatide with an experimental amylin drug called eloralintide. Amylin is a second gut hormone that also curbs appetite.

Lilly is also pouring concrete. On Inside INdiana Business (Sept 27), reporter Kylie Valletta noted Lilly broke ground on a $6.5 billion plant in Houston that will make Foundayo. It is one of 10 US sites Lilly has announced since 2020, part of a $50 billion push. Ricks put it simply: "We'll make it here in Texas and ship around the world."

2. Novo's strategy day: in line, which was the problem

Novo held its Capital Markets Day in London on Monday, Sept 21. The BioSpace weekly podcast (Sept 23) walked through it. Reporter Annalee Armstrong covered the event:

  • The goal: $23 billion in revenue by 2035, with five "multi-blockbusters" on the market by 2030, including CagriSema and cagrilintide.
  • The problem: Novo did about $20 billion last year. As host Jeff Axt put it, "not too much of a stretch to hit that $23 billion, but investors weren't impressed." Armstrong said analysts found everything "pretty much like in line with what investors and analysts expected." The stock fell 8%.
  • The cuts: About 4,000 more people have left, on top of roughly 9,000 last year. That is about 13,000 fewer staff. Novo said these came mostly from attrition and not backfilling roles, not layoffs.

The good news was the Wegovy pill. CEO Mike Doustdar said about 1.5 million patients are on oral Wegovy, which launched in January. BioSpace said he called it probably the most successful pharma launch ever.

But there is a real catch, and it explains why Lilly's pill is being watched so closely. Axt explained:

"For oral Wegovy, it can contain an order of magnitude more semaglutide than the injectable. So they just need a lot of this peptide. And peptides are not the easiest to manufacture, especially as compared with Eli Lilly's small molecule, Foundayo."

In plain English: Novo's pill is a protein-based drug that the body absorbs poorly, so each pill needs a lot of active ingredient. Lilly's pill is a simpler chemical that is far cheaper to make at scale. Novo says it will serve 10 times as many pill patients by 2030, and Doustdar told investors, in Axt's words, "you don't have to worry about this anymore." The market was not fully convinced.

Then came the M&A talk. On CNBC's Fast Money (Sept 22), the show played a clip of Doustdar:

"When the gap can be filled with that M&A, we are actually quite interested about it."

Novo also announced two smaller deals that week: three early-stage obesity molecules from Calliope, and a partnership with Danish company Orbis Medicines worth up to $1.4 billion for oral heart and metabolic drugs.

3. Viking: it's not how much weight you lose, it's whether you keep it off

Viking Therapeutics reported results from a small Phase 1 "maintenance" study of its weekly shot, VK2735. It works on the same two gut hormones as Lilly's Zepbound.

The first part of the trial was the familiar story. Patients lost 16% to 19% of their body weight after about 20 weeks, depending on dose. On On The Pen GLP-1 News (Sept 22), host Dave Knapp flagged that the highest-dose group kept going:

"The 17.5 milligram weekly arm that continued that treatment reached 22 percent weight loss by week 33... with no clear plateau."

For comparison, Knapp noted that Zepbound needed a trial of roughly 72 weeks to reach similar numbers.

But the real news was the second part. After the first phase, Viking moved some patients to lower doses given less often:

  • Patients switched to a shot every other week kept 97% of the weight they had lost over the next 12 weeks.
  • Patients switched to a monthly shot kept about 90%.

Why does that matter? Most people who stop these drugs regain the weight. And weekly shots forever are a big reason people quit. Knapp put it this way:

"If you can take it once a month or if you can take it once every two weeks. It also, it's using less medication. So the cost is part of that too. So it changes costs. It changes convenience. It changes treatment fatigue."

On the Biotech Hangout (Sept 25), the host put it more bluntly. He noted the 19% placebo-adjusted weight loss at 21 weeks (meaning the weight loss beyond what patients on a dummy shot lost) "beats on a cross-trial comparison" the tirzepatide data, and added:

"I'm going to dare call it the best-in-class profile."

His firm models $5.4 billion in risk-adjusted 2035 sales for the drug, which he said is "about 25% or 20% above consensus." ("Risk-adjusted" means the forecast is discounted for the chance the drug fails.) He also said Viking still needs a big partner to get the most out of it.

BioSpace reporter Heather McKenzie added that Truist said the results landed in its "best case scenario," William Blair called it a "maintenance trifecta," and stomach side effects were about the same as placebo during the maintenance period. That matters because Viking's pill version stumbled last year, when 20% of patients dropped out due to side effects versus 13% on placebo, and the stock fell about 40%.

The caveat, from a fan. Knapp, who has followed VK2735 for three and a half years, still warned:

"This is phase one maintenance trial data. And the overall trial was relatively small and spread across multiple treatment arms. And some of the individual groups were very, very tiny."

4. Employers are dropping GLP-1 coverage, and that has never happened before

While Medicare is opening up, private employers are closing down. On Bloomberg's Everybody's Business (Sept 25), workplace reporter Taylor Nicole Rogers explained why it is so unusual:

"As I was talking to economists who study employee benefits, they were saying there's never been an entire category of drugs that employers have carved out before."

The numbers she laid out:

  • $500 to $700 per month per employee on treatment.
  • About 1 in 10 Americans are on a GLP-1.
  • Employer health costs run about $18,000 to $19,000 per employee and are rising 6.7% on average.
  • One worker went from paying $25 a month to about $300 a month, but for a compounded copy, not the approved drug. Drugmakers' own discount programs still run "upwards of $300 a month in most cases."

The human side is stark. In union surveys, one worker said they were choosing "between buying groceries for the family and staying on their medicine."

State governments feel it too. On Crain's Daily Gist (Sept 21), Illinois Governor J.B. Pritzker revealed he lost 80 pounds on a GLP-1. The same episode noted that Illinois's coverage for state employees cost $147 million in fiscal 2025, and Pritzker admitted budget pressure could force changes. And on the Becker's Healthcare Podcast (Sept 24), UChicago Medicine Chief Pharmacy Officer Denise Scarpelli said simply: "GLP-1s is really driving the drug spend."

Why investors should care: If employers keep carving these drugs out, the US commercial market (the most profitable slice) shrinks, and more patients move to cheap government prices, cash-pay discount programs, or compounded copies. Medicare volume may make up for some of that. It won't make up for all of it at the same margin.

5. The FDA leans on compounders, and Lilly fights over retatrutide's rules

"Compounding" is when a pharmacy mixes its own version of a drug. It was allowed on a large scale during the GLP-1 shortage, and many compounders never stopped. Knapp reported on On The Pen that the FDA sent a warning letter to Empower Pharmacy, one of the largest compounders in the country, over versions like tirzepatide mixed with niacinamide and semaglutide mixed with B12. His summary of the FDA's position:

"You can't just add B12 to tirzepatide and mass produce it."

The FDA has said it generally won't act on a compounder making four or fewer prescriptions of a copy per month. Knapp pointed out that the big players are filling "hundreds of thousands." Still, he was clear-eyed: "A warning letter is not going after them... But this is the next step in the escalation."

In the same episode, Knapp covered Lilly's court fight over retatrutide. Lilly wants the FDA to classify it as a biologic, a category for complex protein drugs. That would block compounding and give Lilly longer exclusivity and more pricing power. The FDA refused, Lilly sued, and oral arguments were set for Sept 24. Three days before, the Department of Justice filed a letter pointing the court to a recent appeals ruling on how much deference judges should give the FDA. Watch the outcome: it decides how long retatrutide stays protected once it launches.

The debate

The bull case (on Lilly and the category)

  • The market keeps getting bigger. Medicare added about 700,000 new patients in under three months, and Lilly's CEO says diabetes pills alone are a market the size of obesity.
  • Lilly has the manufacturing edge in pills. A small-molecule pill is easier to make at huge scale than Novo's protein pill, and Lilly is building the plants now.
  • The valuation has cooled. On the Halftime Report, Joe Terranova, who owns the stock, noted it trades around 28 times next year's earnings and has spent about "$20 billion so far year to date in 2026" on acquisitions to diversify. Jim Lebenthal, who doesn't own it, still said the valuation "has come down quite a bit, and it's becoming quite attractive."

The bear case (on the category)

  • Lower prices may eat the volume gains. On InvestTalk (Sept 23), the hosts framed the core question as "whether volume growth at these lower prices, for Novo Nordisk, for Eli Lilly, can outweigh margin compression."
  • Employers are walking away. The Everybody's Business reporting shows the highest-price customers are the ones leaving.
  • A lot of patients don't stick with it. On Business of Biotech (Sept 21), Alex Aravanis, CEO of Moonwalk Bioscience, said "a quarterish" of patients lose less than 5% of their weight, and "more than half of people are off them" within two years. He added that "a quarter to a third" of weight lost can be muscle.
  • Lilly still depends on one product family. Lebenthal's question for the stock: "Can they diversify beyond GLP-1s, beyond obesity?"
  • Maintenance could shrink the market over time. On Fast Money, one panelist pointed out Viking's data could be "potentially troubling for the ones that have a model that's sort of based on the premise of maintaining." Fewer doses per patient means less revenue per patient.

The names in play

  • Eli Lilly (LLY): Medicare share, the Foundayo ramp, and a diabetes decision later this year are all moving in the right direction. The Houston plant supports the supply story. The retatrutide court case is a quiet but important swing factor for long-run pricing.
  • Novo (NVO): The plan was "in line," and in line wasn't enough. The Wegovy pill is a genuine success, but the manufacturing question hangs over it. The CEO now openly wants to buy growth.
  • Viking Therapeutics (VKTX): On Fast Money, the panel pegged a takeover at around $7.5 to $8 billion, against a roughly $3.5 billion market value before the data. Whether Novo could actually do that deal was left open. On Biotech Hangout, the panel said Viking just raised $500 million, with one investor taking a third of the stock portion.
  • Amgen (AMGN): Quiet week for MariTide. Biotech Hangout said data is expected early next year and pointed out that Amgen's drug is designed to be given monthly and possibly every two or three months, which is exactly the convenience Viking just showed is valuable. The panel was "fairly constructive."
  • Roche (RHHBY): Roche's CT-388, another dual-hormone weekly shot, posted Phase 2 diabetes data. Knapp on On The Pen highlighted that at the top dose, 90% of patients got their blood sugar (A1C) to 6.5 or below by week 48, and 62% got below 5.7, which is the normal range.

Read-throughs

  • Bariatric surgery (ISRG): On the Rheumnow Podcast episode "Obesity Treatment & Safety" (Sept 23), a clinician cited reports that "bariatric surgery in the last two to four years is down by 30, 40 percent. While the prescriptions for GLP-1 related therapies are up like over 140, 150 percent," and that "less than 1 percent of people who are eligible for bariatric surgery are going that route." That is a headwind for weight-loss surgery volumes at Intuitive Surgical.
  • Pills vs. shots (WST, Stevanato): The same episode put oral Wegovy at "around 15% to 17%" weight loss and orforglipron at "around 12.6%," with the clinician saying they use orforglipron less often because it is less effective, but that the oral drugs "are cheaper." Every patient who starts on a pill instead of a pen is one less injection device. Pair that with Lilly's pill-first Medicare numbers and Viking's monthly dosing, and the long-run number of injections per patient looks like it is heading down. That matters for the companies that make pen parts and do fill-finish (the sterile filling of drug into pens and vials).
  • Packaged food (PEP, MDLZ, GIS, HSY): On Shelf Help (Sept 25), Keith Bearden of Alter Eco said GLP-1s have "penetrated 26 percent of U.S. households now" and are projected to hit 35% by 2030. He is positioning a bar with 20 grams of protein, 15 grams of fiber, and 1 gram of sugar squarely at that shopper. InvestTalk cited analyst estimates of a 5% to 10% reduction in calories among users. The winners are high-protein, low-sugar products. The losers are the snack aisle.
  • Fitness and weight-loss services: On Escape Your Limits & LIFTS (Sept 20), the hosts noted WeightWatchers' clinical (GLP-1) subscribers were up 55% after it embraced the drugs. They cited a survey where GLP-1 users spent about $449 a month on fitness and wellbeing versus $120 for non-users, and 81% paid for a gym versus 43% of non-users. The survey was small (123 GLP-1 users, self-reported), so treat it as a hint, not proof.
  • Everyone else's profit margins: InvestTalk made a sharp point: watch employer health costs, because if GLP-1 spending "starts showing up as a meaningful line item in corporate earnings, it becomes a bit more of a margin story for companies that have absolutely nothing to do with the drug in the first place."

What changed

The competitive question shifted from "how much weight" to "how few doses." For two years, every new obesity drug was judged by one number: peak weight loss. Viking's data, Amgen's monthly design, and the Medicare shift toward pills all point the same way. The next winner may be whoever makes treatment cheapest and easiest to stick with, not whoever posts the biggest number.

Novo moved from "turnaround" to "buyer." Its CEO saying publicly that Novo is "quite interested" in M&A to fill the gap is a new posture. It turns every mid-sized obesity biotech into a possible target.