Medicare coverage opens 15 million-patient opportunity

Novo Nordisk CEO Mike Doustdar on Wednesday said the company is aiming to capture around 15 million new patients, at least initially, when Medicare starts covering obesity treatments for the first time later this year.

Around 67 million Americans are covered by Medicare, but “when you take a look at specifically our products and the target group, I think around 15 million people would be a good number to target,” he told CNBC in an interview. 

Medicare is slated to start covering obesity medicines for the first time later this year under the landmark “most-favored-nation” drug pricing deals that Novo and its chief rival, Eli Lilly, struck with President Donald Trump in November.

Health experts say the long-awaited coverage could broaden the market for the medicines and spur more private insurers to cover them. Some experts estimate that 20 million to 30 million Medicare patients are suffering from obesity and related conditions.

Doustdar said Medicare coverage, along with the launch of Novo’s new obesity pill and other factors, should help the company gradually boost prescription volumes and offset lower prices in the U.S. following that agreement with Trump. 

But he said he doesn’t expect Medicare access to obesity treatments to open up overnight. 

“Now, it would be great if we could find a way to get access very, very fast. But I think that would be a bit naive,” Doustdar said, pointing to the slow adoption seen among eligible patients with commercial insurance. 

It’s a slightly more conservative tone on the initial impact of Medicare coverage compared with Lilly, which has cited that coverage as a key tail wind to its guidance this year. Last week, Lilly said it expects Medicare coverage to come online by July. 

Meanwhile, Doustdar said Novo is in the midst of negotiations with the government on “exactly which month, which week that is going to be opening.” 

Novo is under pressure to claw back market share in the booming GLP-1 space from Lilly and cheaper, compounded copycats. Last week, Lilly said its share of the U.S. obesity and diabetes drug market increased to 60.5% in the fourth quarter, while Novo’s was 39.1%.

Novo has also highlighted a gap in the “preference share” for its weight loss treatment Wegovy versus Lilly’s rival injections. In the U.S., Novo estimates that between 7 and 8 patients out of 10 go to Lilly. 

When asked how Novo plans to close that gap, Doustdar said one way to do so is “to do better on the pill.” The company’s Wegovy obesity pill has a head start compared with Lilly’s upcoming oral drug, orforglipron, which is expected to win approval from the Food and Drug Administration during the second quarter. 

Doustdar said Novo’s pill is slightly more effective than Lilly’s based on separate clinical trials, showing 16.6% weight loss compared with 12.4% with Lilly’s oral drug. 

“If you use these two numbers, basically you have a 40% difference between the efficacy of these pills,” he said. “I think this is going to be a very main, main selling point of the pill.” 

But Doustdar also pointed to the upcoming approval and launch of a higher dose – 7.2 milligram – of Wegovy that could help win market share from Lilly’s obesity treatment Zepbound. 

That higher dose helps patients lose around 21% of their weight, which is “very much on par” with the highest dose of Zepbound, he said. Zepbound’s higher efficacy has been a key factor in driving more patients and prescribers away from choosing Wegovy, which has shown around 15% weight loss on average in clinical trials. 

“When that comes to the market, my thought, my wish, my hope is that people will realize, OK, now we have two products with similar efficacy,” he said.