The drugs’ high cost – Wegovy costs $US1350 a month – and lack of insurance coverage for obesity medicines present a key barrier to uptake. “Outdated notions and persisting misconceptions” about the nature and seriousness of obesity stand in the way of effective weight-loss medications’ use, the health non-profit ECRI said this week. The group is appealing to insurers and politicians to change policies on paying for FDA-approved weight loss medications, Marcus Schabacker, the group’s president and chief executive, said in an interview.

The drug class “seems to be working, it seems to be safe, it seems to be effective,” he said.

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Although it’s in early-stage trials, Amgen’s AMG 133 is already the focus of investor interest. Patients on the highest dose saw an average loss of 14.5 per cent of their weight after 12 weeks of treatment in an early stage trial, according to results released in December. Although other companies are closer to the market, Amgen’s is still likely to be useful, said David Reese, the drugmaker’s executive vice president of research and development.

“It’s an area that’s obviously exploding right now,” he said. “It’s becoming a field unto itself.”

Pfizer is also testing two drugs that hit the GLP-1 pathway. While Wegovy is injectable, Pfizer’s drugs can taken as a pill, which the company is betting will prove to be a crucial advantage.

“GLP-1, clearly everybody’s excited about that,” chief executive Albert Bourla said. “This is a market that will grow to $US90 billion altogether, and we are very confident on that given the current size of the market and the current growth rates.”

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Bourla said Pfizer could capture about $US10 billion of that market. A Pfizer spokesperson said the $US90 billion referred to the combined obesity and diabetes markets for the GLP-1 class of drugs.

Novo is also developing CagriSema, a combination of Wegovy’s main ingredient, called semaglutide, and another drug that targets an eating hormone. And it’s developing a pill version of semaglutide.

Lilly’s tirzepatide is on the market for diabetes under the brand name Mounjaro. While it hasn’t been approved for obesity, some doctors are already recommending it for weight loss. Doctors are permitted to prescribe drugs for unapproved uses, a practice called off-label prescribing. Demand for Mounjaro and Ozempic, another GLP-1 drug from Novo, has already led to shortages.

Lilly has started a rolling submission to the US Food and Drug Administration that will allow it to quickly submit the new data to the FDA around mid-year, assuming the second final-stage trial succeeded, Skovronsky said. Depending on when and what regulators decide, the drug could be on the market for obesity as early as the year’s end, he said.

The drugmaker is working to make sure it has enough tirzepatide on hand so it doesn’t repeat the supply issues that afflicted Novo. It’s also testing the drug in obesity-linked conditions such as sleep apnea and heart failure, to see if patients benefit.

“We are adding new factories and making it as quickly as we can,” Skovronsky said. “The potential here is large.”

The Washington Post, Bloomberg