Wall Street’s Loss Could Be GLP-1’s Biggest Win Yet

Last week, Eli Lilly lost over $100 billion in market value in a single day.

The crime?

Releasing late-stage trial results for a once-daily oral obesity pill that… still made patients lose 12.4% of their body weight over 72 weeks.

Despite meeting the trial endpoint, Wall Street shrugged. Investors called it “underwhelming” because it didn’t match efficacy of the most potent injectables like Zepbound (~21%) or Wegovy (~15%).

But that’s looking at the wrong scoreboard. Lilly’s drug, orforglipron, isn’t trying to win the injectable race — it’s running an entirely different one.

This isn’t an injectable. This is a pill.

And history tells us that when you take an expensive, high-friction blockbuster drug and make it easy, cheap, and discreet to use… you change the market forever.

Let’s talk about it…

I’ve written many times that the creation of injectable GLP-1s was an inflection point in modern medicine. They proved that pharmacology could move the needle on obesity, diabetes, and related chronic diseases and showed how the right drug at the right time could capture the zeitgeist. I’ve said it before and I’ll say it again: history will be remembered as Before-GLP and After-GLP.

But injectable GLP-1s have built-in friction:

For many people, those barriers are deal-breakers. Orforglipron is none of those things.

It’s a small molecule (not a peptide drug like the current injectables) — easier and cheaper to make at scale, no refrigeration, shippable in a plain pill bottle that fits in your mailbox or simply carry home from the pharmacy. It doesn’t announce itself to your roommate, your kids, or your neighbors. And it can be prescribed by primary-care doctors without the logistical hurdles of injectables.

That’s not just convenience — that’s accessibility. And accessibility is how you go from a niche blockbuster to a mainstream, first-line therapy.

In other words: it’s positioned to do for GLP-1s what statins did for cholesterol — move from post-diagnosis intervention to first-line, preventative care.

This is how the curve goes from inflection point to parabolic.

Around 6% of U.S. adults are on a GLP-1 today — despite nearly 40% of the country being overweight or obese. But that’s likely an undercount. Add in compounded products, med spas, and the gray-market peptide trade, and the real number could be double or triple.

Either way, you have to wonder why adoption isn’t higher?

Cost, coverage hurdles, supply constraints, injection hesitancy — and, yes, the privacy problem.

A small-molecule pill changes at least three of those five barriers in one shot.

If you’re an endocrinologist treating severe obesity, you’ll likely still choose the more potent injectable with slightly better results. But the growth market isn’t just in that group — it’s in:

In these settings, a few points less weight loss is worth it for:

Lilly’s CEO has even hinted at “consumer-level” pricing for less complicated obesity — corporate-speak for cheaper, broader, earlier prescribing.

It’s Big Pharma Moneyball!

Lilly’s head start won’t last forever:

By 2027, the space will be crowded. But right now, Lilly has the lead on manufacturing and distribution advantages.

And yes — this could also reignite the compounding debate. Orals will be easier to copy. And safer too.

Cholesterol drugs are commonly referred to as “statins”. When they first came to market many years ago, statins functioned as treatment for heart disease. They were used to reduce cholesterol in people who’s numbers were too high.

But as time went on and we learned more about the benefits, statins went from a reactionary treatment to a preventive standard. Now, just about everyone over 40 is on one.

Oral GLP-1s could do the same — shifting from “fix the problem” to “keep the problem from happening.”

The real win won’t be how much weight patients lose — it will be how many people take the drug. Once tablets are widely available, we could see adoption at a scale that makes today’s GLP-1 market look tiny.

As long as we don’t discover any long-term unforeseen negative side effects (which is definitely still a possibility!), an entirely new market is about to enter the fold.

If injectable GLP-1s were the inflection point, oral GLP-1s are the acceleration.

Wall Street saw a “miss.” But I see the start of a new market entirely.

Orforglipron might be the blockbuster that makes GLP-1 pills as common as Lipitor. Or it might just be the opening act.

Either way, the pill is out of the bottle.
And we can’t put it back.

Watch this space.

Giddy up.

Alec Wade Ginsberg, PharmD, RPh
4th-Gen Pharmacist | Owner & COO, C.O. Bigelow
Founder, Drugstore Cowboy