Newsletter · 2026-10-02 · Ashutosh Agarwal

Lilly Obesity Data Gets Stronger as Employers Pull Back on GLP-1 Coverage - The Healthcare Pulse: Weekly Podcast Intelligence Brief - Week of October 2, 2026

The Healthcare Pulse weekly podcast intelligence brief for the week of September 25 to October 2, 2026. Eli Lilly's EASD data put its next obesity drugs at 23% to 28% weight loss while employers pulled back on paying for GLP-1s, FDA nominee Heidi Overton calmed the industry, and most favored nation pricing moved toward mid-size drugmakers.

The Healthcare Pulse: Weekly Podcast Intelligence Brief

Week of October 2, 2026: Lilly Obesity Data Gets Stronger as Employers Pull Back on GLP-1 Coverage

This Week at a Glance

Two weeks ago it was a cancer vaccine. Last week it was Novo Nordisk's rough investor day. This week the podcasts ran on a big European diabetes meeting, a calm FDA nominee, and a growing fight over who pays for weight-loss drugs.

The themes that kept coming up:

• Lilly's next obesity drugs keep getting stronger. At the EASD diabetes meeting in Milan (EASD is the European Association for the Study of Diabetes), Lilly showed that pairing an amylin drug with tirzepatide, the active ingredient in Zepbound and Mounjaro, produced about 23% weight loss at 48 weeks, against about 15% for tirzepatide alone. The full study of its triple-acting shot retatrutide reported 28.3% average weight loss at 80 weeks.
• Employers are pulling back on paying for GLP-1s. Two podcasts looked at companies dropping coverage. Bank of America alone spends about $250 million a year on these drugs. A Bloomberg reporter said economists had never seen employers cut out an entire class of drugs before.
• The FDA nominee calmed the industry. Heidi Overton's September 24 Senate hearing was the main policy story on BioCentury and Citeline. She called the measles vaccine safe, praised FDA staff, and said advisory committees would come back.
• "Most favored nation" pricing is coming for mid-size drug companies. On Biotech Hangout, Roivant's CEO said MFN deals look "constructive" and that the policy is "sort of coming for the mid-caps." A Bloomberg analyst argued Europe simply can't afford to pay more. Pharma tariffs widened on September 29, and Medicare's GLOBE pricing pilot started October 1.
• A good week for the pipelines of big drug companies. Amgen, Merck, Pfizer, AbbVie and Bristol all posted mid- or late-stage data, mostly in immune diseases. Wall Street analysts raised price targets on Merck, Amgen, AbbVie and J&J.
• China keeps showing up. Novo paid $300 million upfront for an early Chinese obesity pill. Beam Therapeutics is suing a former scientist who left to start a Chinese rival.

The People Driving the Conversation

The Biotech Hangout Panel: Sam Fazeli, Yaron Werber, Brian Skorney and Roivant's Matt Gline (Episode 197, September 25)

This was the most useful investing podcast of the week. Bloomberg Intelligence's Sam Fazeli hosted, with TD Cowen's Yaron Werber, Baird's Brian Skorney and Roivant CEO Matt Gline Biotech Hangout.

On the market. Fazeli said the money raised in each biotech IPO is now "the highest that we've seen ever for the biotech sector," even beating "the go-go days of 2021." He counted 22 biotech IPOs now trading. Skorney said it had still "been a rough week." He blamed hedge funds cutting back their bets, which traders call "degrossing," and rising interest rates. He said people had long been amazed at "how impervious the XBI has seemed... in the midst of escalating interest rates," and the market had now "crossed this threshold where... maybe people are taking it more seriously." (XBI is the main biotech stock fund.)

Gline joked about Roivant's own stock: "the moral for us is never get a drug approved and don't bother with clinical data." The stock fell about 8% on the day its drug was approved.

On Amgen (AMGN). Werber was the most bullish voice on any big-cap stock this week:

"We are the Amgen bulls on the street. We do think that they do have LOEs, which we all know about, but they have an underappreciated pipeline."

(LOE means "loss of exclusivity": when a drug's patents run out and cheaper copies arrive.) The trigger was a positive late-stage study of dazodalibep in Sjögren's disease, an immune disorder that causes dry eyes and dry mouth. Werber put the U.S. market at $5 billion for the "systemic" form and "another 20 for symptomatic." He expects pricing around $250,000 a year. He noted that Amgen is the only company with positive mid-stage data in both forms. He is also "very constructive" on MariTide, Amgen's monthly obesity shot, with data "early next year."

Skorney was more careful. He said the debate is whether dazodalibep becomes "a nice, you know, billion-dollar product" or something bigger, and whether Amgen "just designed a smart study to kind of, like, get it across the line." Gline added a nice detail: dazodalibep came with Amgen's purchase of Horizon, which was supposedly all about the eye drug Tepezza. "Sometimes the second, third, fourth drug in an acquisition can matter in the long run."

On Viking (VKTX). Fazeli called VK2735 a possible "best-in-class profile." The shot produced 19% weight loss beyond placebo at 21 weeks. Patients kept 97% of that loss on every-other-week doses and 90% on monthly doses. Bloomberg Intelligence models $5.4 billion in risk-adjusted 2035 sales, which he said is "about 25% or 20% above consensus." The stock "was up 35% on the data. Then it settled back." Viking raised $500 million, and "one investor took 33%" of the stock sold. Fazeli still thinks "partnering [is] still needed here."

On Celldex (CLDX). Werber called barzolvolimab, a hives drug, "one of those super, super controversial contentious stories." The fear was that removing mast cells (the immune cells that release histamine) would cause severe allergic reactions. In the late-stage trial, there were just two cases of anaphylaxis out of 1,500 patients on the drug, versus three on placebo. The stock swung from up 30% to down 30% before the market opened, then closed down 10% "in a bad market." Werber doesn't expect a black-box warning on the label.

Heidi Overton, FDA Commissioner Nominee, as Heard on BioCentury This Week (Ep. 389, September 29) and Citeline's Drug Fix (September 25)

BioCentury's Steve Usdin called the hearing "mixed" but said its main messages "will be encouraging to patient groups and the biopharma industry" BioCentury This Week. He said President Trump's direction to her was, quote, "to go fast." She tied that to competition with China. She backed Operation Trial Blazer, a plan to speed up early-stage drug trials, and the "plausible mechanism" pathway for very rare diseases.

He drew a sharp contrast with the previous commissioner, Marty Makary:

"Unlike McCary, she didn't denigrate FDA staff... She didn't accuse the biopharma industry of corrupting the agency... She unambiguously said the measles vaccine is safe, effective, and necessary."

Her confirmation, Usdin said, will turn on whether Senate Health Committee chair Bill Cassidy "believes that she meant what she said." Cassidy has pointed out that Robert F. Kennedy Jr. made him promises about vaccines and then broke them.

On Citeline's Drug Fix, the reporters were more confident Citeline Podcasts. An op-ed endorsing her from former FDA chiefs Scott Gottlieb and Mark McClellan "really sealed the deal." One panelist said: "It doesn't seem like there's any chance she won't be confirmed." The timing may slip, though. The Senate may not "bring it to the floor before the election" to avoid a high-profile fight over abortion or vaccines.

Two practical points for investors:

• Advisory committees are coming back. These are panels of outside experts that review drugs before FDA decisions. She called them "a critical part of the regulatory process" and said they "would definitely be happening." There have been very few in the past year and a half.
• Mifepristone is still unresolved. She would not say ahead of time what the FDA's internal safety review of the abortion pill should find. That study has to report its status to a federal court in early October.

Annika Kim Constantino, CNBC, on Squawk on the Street (September 30)

CNBC's health reporter broke down Lilly's new combination drug live on air Squawk on the Street. The drug pairs eloralintide, which mimics a gut hormone called amylin, with tirzepatide. In patients with obesity and type 2 diabetes, it "helped patients lose up to roughly 23 percent of their weight on average at 48 weeks," compared with "nearly 15 percent" for high-dose tirzepatide alone.

The catch: "We did see higher side effects with the combo." Lilly says it will adjust dosing in a late-stage trial that starts at the end of 2026. "That will be the real test for this treatment." She also flagged new real-world data from Novo, gathered through the telehealth company Ro. Patients who switched from injections to the Wegovy pill kept losing weight over three months, which suggests patients "may not have to actually stay on injections forever."

Wall Street mostly liked it. JPMorgan raised its Lilly target to $1,500 and said Lilly "is positioned to again raise its guidance" (news reports, September 28). UBS (Buy, $1,425) said the next-generation drugs "appear better than tirzepatide" and called EloraTZP "broadly in line with retatrutide" (news reports, October 1). The main bear is HSBC's Rajesh Kumar, who rates the stock Reduce with a $940 target. He calls the $150 billion-plus obesity market forecast "overly optimistic."

Dave Knapp, Host of On The Pen GLP-1 News (October 1)

Knapp is a patient and podcaster, and he was the most careful reader of the week's obesity data On The Pen GLP-1 News. He went through four stories.

Does triple-dose Wegovy catch Zepbound? Lilly's analysis said Zepbound 15 mg beat Wegovy's new 7.2 mg dose by 4.5 percentage points. Knapp pointed out that this figure counts everyone, including people who quit the drug. On a second measure that only looks at people who kept taking it, the gap shrank to 1.8 points, which was not statistically significant. Neither number comes from a true head-to-head trial. His summary: "Turning semaglutide up to 7.2 may not completely close the gap with tirzepatide, but it gets pretty close."

Novo's Chinese pill deal. Novo is paying $300 million upfront, and up to $2.6 billion in total, to Hengrui for HRS-1596. It is a once-weekly pill that hits both of the hormone targets tirzepatide hits. "This molecule... hasn't even entered phase one." He thinks Novo may really be buying the know-how to make protein-based drugs work as pills. Today's Wegovy pill "uses 10 times the amount of semaglutide per day" compared with the weekly shot. BMO's Evan Seigerman (Market Perform, $47 target) agreed, calling the deal "incremental rather than transformative."

Retatrutide's full results. The New England Journal of Medicine paper showed average weight loss at 80 weeks of 19% at 4 mg, 25.9% at 9 mg, and 28.3% at 12 mg. Patients on the top dose in an extension study reached about 30% at 104 weeks. To Knapp, the striking number is the low dose: "19% average weight loss is an extraordinary number by itself." Many patients "may never need 12 milligrams." Two things to watch: heart rate rose during dose increases, and more patients quit at higher doses.

The Wegovy patent fight. Viatris, through its Mylan unit, is challenging a Novo patent that runs to October 2038 and covers using semaglutide for weight control. "This is not a story about generic Wegovy coming necessarily sooner." It is about whether generic copies arrive in the 2030s or much later.

Helmy Eltoukhy, Co-CEO of Guardant Health, on Squawk on the Street (September 25)

Guardant (GH) is up about 75% this year. Eltoukhy explained its new FDA approval: a blood test that guides breast cancer treatment alongside an AstraZeneca drug Squawk on the Street. Patients are tested every three months. When the test spots signs that the tumor is starting to resist the drug, doctors can switch treatment. In the trial behind the approval, that led to "a 56% reduction in risk of death and progression."

He said Guardant's colon cancer screening blood test "detects 83 percent of everything a colonoscopy detects." He called it "the fastest-growing test in diagnostics history outside of COVID testing," and noted that "50 million Americans... are unscreened right now for colorectal cancer." Asked whether Guardant wants to be bought, he described "three S-curves that are really on fire," starting with a "$10 billion total addressable market" in late-stage cancer.

The Key Debates

1. Will "Most Favored Nation" Pricing Even Out Drug Prices Around the World, or Just Cut Access in Europe?

"Most favored nation" (MFN) means the U.S. pays no more than other rich countries do. Government records obtained through a public-records request show that Pfizer's MFN deal includes a revenue share: if Pfizer gets higher prices abroad, part of that money goes back to the U.S. government.

The optimistic side: Matt Gline, Roivant CEO Biotech Hangout:

"It would obviously be good for the U.S. ecosystem and for the global ecosystem... to see some equalization where the U.S. became a less disproportionate share of the market."

He called the revenue share "a relatively creative idea" and "very Trumpian," and said Roivant would be "open to" a deal. He also laid out the math: if U.S. prices fall, either investors earn less, "fewer drugs could be developed," or other countries pay more. "Mechanically, that's math. The rest is like a policy question."

The skeptical side: Sam Fazeli, Bloomberg Intelligence:

"The reality, unfortunately, may end up being that the Europeans just can't afford to pay the extra cash."

He pointed to high energy costs, more defense spending and weak growth across Europe. If Europe rations drugs instead, "the only option left is to raise prices in the U.S." He added another worry: cheaper Chinese copies of drugs like Keytruda could come in, as Chinese electric cars have in Europe, and leave "no benefit for the U.S."

How much spending MFN covers. The hosts of Telltales ("Three Times GDP," September 30) said the White House's figure of 90% of U.S. drug spending "is not correct, but... it's a large amount" Telltales.

2. Do GLP-1 Drugs Save Employers Money, or Only Cost Them More?

The case that they cost more. On Everybody's Business, Bloomberg's Taylor Nicole Rogers said employers pay "$500 and $700 per month just for one employee's treatment," and "about 1 in 10 Americans are on GLP-1" Everybody's Business. One worker went from paying $25 a month to about $300 a month for a compounded copy that the FDA has not approved. On This Time Is Different, the hosts cited a National Bureau of Economic Research study: each dollar spent on GLP-1s leads to "an additional 22 cents in non-GLP-1 spending," mostly on doctor visits This Time Is Different. The same study found that people who stay on the drugs cost about $60,000 over five years. The average is $23,000, because so many people stop.

The case that they pay off. Rogers noted that "Bank of America... said they're happy to spend tens of millions of dollars on these drugs" to avoid bigger bills later, but "the jury is still out." The This Time Is Different hosts said the savings "take 10 to 15 years," which is longer than most employees stay at one company. On Stock Club, the host argued the opposite: "if you were in the health insurance business and the life insurance business, you would have every single one of your customers on one of these" Stock Club.

Why investors care. Lilly and Novo are betting that cash-pay and direct-to-consumer sales can make up for weak insurance coverage. On The Readout Loud, STAT's Elaine Chen said Novo now "explicitly calls its GLP-1 drugs weight loss drugs" in ads with slogans like "Summer Glow Up," because "insurance coverage has stalled" The Readout Loud. She warned this weakens the argument that obesity is a disease, and that argument is what insurers rely on when they decide to cover the drugs.

3. Can Lilly Keep Compounding for 20 Years?

Bull. Stock Club asked whether Lilly could become the first $10 trillion company. That would take about 12.2% a year for 20 years, which "implicitly suggests it will outperform the S&P 500 on a very sustained basis." The hosts cited Q2 2026 revenue of $23 billion, up 48%, with Mounjaro and Zepbound at nearly $15 billion of it. They also cited full-year guidance raised to $85–87 billion. Their reasoning: there are 890 million adults with obesity worldwide, Lilly is building huge factories ("that will be the real advantage... the production capacity"), and new drugs like retatrutide keep coming.

Bear. The same hosts warned that "Ozempic and Mounjaro are going to be kind of seen as dinosaurs soon enough." The Telltales host noted Lilly trades at about "50 times free cash flow." HSBC's $940 target is the Wall Street version of that worry. On CNBC's Halftime Report the week before, Jim Lebenthal asked whether Lilly can "diversify beyond GLP-1s." This week Bloomberg reported that CEO Dave Ricks wants bigger deals in infectious disease, women's health and psychiatry (September 28).

Hot Topics Under Debate

• Merck's (MRK) skin-disease win. In a mid-stage trial for hidradenitis suppurativa, a painful skin disease, tulisokibart cleared symptoms in 72% of high-dose patients versus 35% on placebo. H.C. Wainwright called it the "first positive Phase 2 data for an anti-TL1A" drug in dermatology. UBS said the result was "in-line or better than" UCB's Bimzelx. Scotiabank raised its target to $180, calling Merck "underappreciated." Not everything went Merck's way: it withdrew its I-DXd lung cancer application after the FDA said the data did not support a fast-track approval. It also licensed a KRAS cancer drug from SciBrunch for $400 million upfront (news reports).
• Bristol's (BMY) liver-safety scare. A trial document for admilparant, a lung-scarring drug, mentions one death from multi-organ failure. Wells Fargo: "We still don't know if this is a drug issue or background noise," but "hepatic safety is now a meaningful overhang." UBS (Buy, $80) still sees a favorable balance of risk and benefit. The late-stage result is "likely in October."
• Pfizer (PFE). Tilrekimig, an eczema drug, cleared 75% of skin symptoms in 62.5% of patients versus 19.9% on placebo, and late-stage trials have started. The same day, Florida's attorney general sued Pfizer over how it marketed its COVID vaccine. The stock slipped about 1% to $28.22.
• J&J (JNJ) before earnings. JPMorgan raised its target to $285 but stayed Neutral, calling J&J "one of the cleaner names in the group" but already priced for that. BofA's survey now puts peak sales for J&J's psoriasis pill Icotyde at $4.5 billion, up from $2.4 billion.
• UnitedHealth (UNH). A judge let part of the CalPERS shareholder lawsuit go ahead. The surviving claim concerns statements about the company's "portfolio refinement" deals, and the stock fell 1.7% to about $369. Separately, UNH dropped prior-authorization rules (insurer pre-approval) on 1,700 billing codes starting October 1.
• Moderna (MRNA). The stock is up about 590% this year on its cancer vaccine with Merck. Citi's Geoff Meacham downgraded it to Sell while raising his target to $80.
• Beam Therapeutics (BEAM) vs. a Chinese rival. On The Readout Loud, STAT reported that Beam is suing a former scientist. Beam says she went into its systems "on weekends late at night," then left for a Chinese company, Yoltec, whose U.S. spinout, backed by American venture firms, now competes with Beam. Host Adam Feuerstein: "It just strikes to the heart of so much of what we've been talking about... whether it's a fair level playing field."

Emerging Themes to Watch

• Medicare Advantage is retreating, and smaller local plans are taking the hit. Medicare Advantage is the private-insurer version of Medicare. On Becker's Healthcare Podcast, Ceci Connolly of the Alliance of Community Health Plans said the number of plans fell 10% nationwide in 2026, forcing 4.6 million seniors to find a new plan Becker’s Healthcare Podcast. She expects more exits by big insurers: "those publicly traded companies, they answer to Wall Street. Our member plans, they answer to Main Street." She also says "one or two of the national publicly traded companies" collect "billions" more through risk adjustment, the system that pays plans more for sicker members. She wants CMS to switch to a model that "take[s] the coders out of the equation." That would hurt the big publicly traded insurers most. Star ratings arrive around October 8.
• AI drug discovery is moving from talk to spending. On House Calls, an M&A banker pointed to Anthropic buying the stealth biotech Coefficient Bio for $400 million in April, and to Lilly building, with Nvidia, "the world's most powerful supercomputer... owned and operated by a pharmaceutical company" House Calls. His most concrete point: biotech fundraising has been "more robust than it's been since '21," which is "rocket fuel" for drug-development service companies, and he is "pretty bullish on M&A for pharma services over the next 6, 12, 18 months." On BioCentury This Week's Amsterdam episode, panelists warned that robot labs still need the "knowledge" of human technicians or "you're just exploding your costs" BioCentury This Week.
• Is there a case against genetic targets? Novartis's failed trial of a drug against Lp(a), a cholesterol-like particle tied to heart disease, is still "ricocheting through the industry," BioCentury reported. That result also hit Amgen, which has its own Lp(a) drug. One editor asked: "If you're born with mutation and you're exposed to that thing for 50 years before you have disease, do you need to target something else at that point?" That matters for every company whose pitch to investors leans on "human genetic validation."
• The fight for the obesity pill market is about factories. Lilly's Foundayo is a small-molecule pill, an ordinary chemical rather than a protein, so it is "easier to manufacture, easier potentially to scale up," Knapp said. Novo's Hengrui deal looks like a bet that it can make protein drugs work as pills too. On Stock Club, the hosts noted Lilly's new Houston plant is part of a $50 billion U.S. manufacturing push.
• Profitable small biotechs are getting attention. On Stock Market Today With IBD, Ligand (LGND) rose more than 4% on September 28 Stock Market Today With IBD. Ligand is a "royalty aggregator": it helps pay for other companies' drug trials in return for a cut of future sales. The hosts said it "speaks to how a lot of these pharmaceutical biomed biotech companies... are doing well," and named Amgen as another stock closing strong.

Stocks on the Radar

Upcoming Catalysts (October 2 – October 16)

• Early October: The FDA reports to a federal court on the status of its mifepristone safety review (Citeline).
• About October 8: CMS releases 2027 Medicare Advantage and Part D star ratings. Matters for UNH, HUM, CVS and ELV.
• October 9: FDA decision on Roche's Tecentriq plus chemotherapy for stage III colon cancer.
• October 13: UnitedHealth (call at 8:00 a.m. ET) and Johnson & Johnson report Q3 before the market opens.
• October 14: FDA decision on Merck's nemtabrutinib for relapsed CLL/SLL, two types of blood cancer.
• October 15: FDA decision on Roche's Enspryng for thyroid eye disease.
• Sometime in October: Bristol's admilparant late-stage lung-scarring (IPF) readout ("likely in October," per UBS).
• Pending: The Senate Health Committee vote on Heidi Overton. Panelists on both FDA podcasts expect her to be confirmed, but the floor vote may wait until after the midterms.
• Just after the window: Elevance and Intuitive Surgical (October 20); Abbott and Thermo Fisher (October 21); CVS (October 28); Lilly, Merck, Bristol and Gilead (October 29); AbbVie (October 30); the ESMO cancer meeting in late October, where Moderna and Merck's cancer vaccine is the big test.

The Bottom Line

The healthcare podcasts were split this week. The science side was full of good news. Lilly's next obesity drugs hit 23% to 28% weight loss. Amgen, Merck, Pfizer and AbbVie all moved immune-disease drugs forward. Analysts raised targets across big pharma. And the FDA nominee said the things the industry hoped to hear.

The money side was more worrying. Employers are dropping GLP-1 coverage, and Novo is now selling these drugs as a "summer glow up." The MFN revenue-share idea only works if Europe pays more, and Sam Fazeli doubts it can. Medicare Advantage plans are shrinking.

What investors are really asking is whether the people paying for these drugs (employers, Medicare, foreign governments) can keep up with how fast the drugs are getting better. Star ratings next week and the UnitedHealth and J&J earnings on October 13 will give the first hard numbers.