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Eli Lilly is poised to leapfrog Novo Nordisk and become the dominant player in an anti-obesity drug market that could reach $150 billion by the end of the decade.

Why it matters: The push to develop blockbuster weight loss drugs had been a two-horse race dominated by Novo Nordisk until the maker of Wegovy and Ozempic started backsliding on weaker sales growth.

• Since then, it's laid off thousands and revised earnings guidance downward.

State of play: While Novo leads in sales for the moment, Eli Lilly's injectables have shown better efficacy in clinical trials and are said by doctors and patients to be more tolerable, market analysts say.

• The Indianapolis-based company has also led in direct-to-consumer sales of GLP-1s and has a stacked pipeline of next-generation obesity treatments — including daily pills that could be more convenient and easier to manufacture than injectable versions.
• Market data firm Evaluate projects Lilly's sales of its flagship obesity drug Zepbound will reach $18 billion next year, surging past the expected $16.5 billion in sales for Wegovy, said Ben Folwell, Evaluate's business, development and licensing lead.

Yes, but: Last week, Novo got the FDA's nod for its own oral GLP-1 drug, called Rybelsus, to be used for heart disease. It's also awaiting FDA approval of an oral version of Wegovy in early 2026 — the first such oral option for obesity.

• Other drug giants including Roche, AstraZeneca, Merck, Amgen and Pfizer are all are chasing their own piece of the obesity market, largely through acquisitions of biotechs.

What we're watching: How big of an impact oral GLP-1s have in the U.S., whose patients have greater amounts of weight to lose.

• Both Lilly and Novo also are pushing legal challenges against a compounding industry that's producing cheaper knock-off versions of their top obesity treatments, eating into their marketshare.

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Senate Democrats are launching an effort to repeal a portion of Republicans' budget law that exempts certain "orphan drugs" from Medicare price negotiations, citing estimates that the cost of the carve-out has ballooned.

Why it matters: The measure targets a provision that the biotech industry argues is important for innovation, but that Democrats say is actually a costly handout to major pharmaceutical companies.

Driving the news: The bill, first shared with Axios, would repeal a provision passed in July that expands an existing exclusion for drugs that treat rare diseases from the price talks.

• Sponsors Peter Welch (D-Vt.), Ron Wyden (D-Ore.) and Catherine Cortez Masto (D-Nev.) cite a new Congressional Budget Office analysis finding the widened exemption will now cost $8.8 billion over 10 years, up from $4.9 billion.
• The new analysis takes into account that three blockbuster cancer drugs, Merck's Keytruda, Johnson & Johnson's Darzalex and Bristol Myers Squibb's Opdivo, would be cut out from price talks between manufacturers and the government, increasing the lost savings.

Between the lines: The Democratic bill would set up a new system where rare disease drugs are only exempted from negotiations if they account for less than $400 million in annual Medicare spending.

• Backers say this protects against drugs that are technically classified as orphan drugs but that are actually blockbusters with huge sales.

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Walmart will become the first U.S. retailer to sell an over-the-counter continuous glucose monitor in physical stores, as Abbott's Lingo rolls out to more than 3,500 locations and online, the health care company told Axios exclusively today.

Why it matters: It's the latest sign that health tech is going mainstream — making tools that previously required a prescription more accessible to consumers.

Driving the news: Abbott said Walmart is the first brick-and-mortar retailer to carry its Lingo device, previously available only at HelloLingo.com and Amazon.

• The two-week sensor pack at Walmart costs $48.97 for one sensor and access to the Lingo app, which currently is available only for iPhone.

Zoom in: Abbott calls Lingo its first consumer biowearable, making continuous glucose tracking — once limited to people with diabetes — available to anyone interested in monitoring their levels without needing to do multiple finger pricks.

• The small sensor, worn on the upper arm, delivers real-time glucose readings to a companion app that helps users see how daily habits affect their levels.
• As an over-the-counter device, Abbott says Lingo is designed to be more affordable and easier to access than prescription versions.
• Competitor Dexcom's OTC device, Stelo, is currently available on its website and Amazon.

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A genetic testing startup launched an AI genomics research arm today aimed at predicting the likelihood that IVF embryos will develop certain cancers, Alzheimer's and other chronic diseases.

Why it matters: Nucleus Genomics is taking preventative health to an entirely new level: before birth.

• But assigning embryos risk scores is expensive and controversial.

Driving the news: The company will use DNA analysis to scan for Alzheimer's, breast cancer, coronary heart disease, endometriosis, hypertension, prostate cancer, arthritis, and Type 1 and Type 2 diabetes.

• Through the company's IVF+ service, parents can opt for the nine risk tests, as well as screenings for over 2,000 genetic conditions and traits that offer IQ and hair color predictions.
• The process uses AI to analyze 7 million genetic markers using algorithms that are trained on 1.5 million people's data, CEO Kian Sadeghi said.
• The full concierge service isn't cheap: The cost starts at $30,000.

Nucleus Labs is a medical lab that is subject to the same regulations as other clinical genetic testing.

• But critics have said tests like these could draw a further divide between certain types of children in society.

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