Mounjaro early demand sits at high end of Lilly's expectations, analysts say

Mounjaro (tirzepatide) is drawing early demand at the top of Eli Lilly's expectations, roughly four months after its U.S. approval for type 2 diabetes, according to Morgan Stanley analysts who met with Lilly chief financial officer Anat Ashkenazi ^[1]. In a note to clients dated Sept. 14, 2022, the analysts wrote that the launch was "tracking at the highest end" of the company's demand expectations ^[1].

Lilly is "prepared to fully supply Mounjaro" in the U.S., the analysts said, and plans to double its incretin manufacturing capacity by the end of 2023. That expansion covers both tirzepatide and Trulicity, Lilly's older GLP-1 diabetes medicine ^[1]. Ashkenazi said more U.S. type 2 diabetes patients switching to Mounjaro are coming from competing drugs rather than from Trulicity ^[1].

Insurance coverage is a separate matter. Mounjaro coverage stood at just over 20%, with most patients relying on copay cards, according to the analysts ^[1]. Lilly called improving access a "top priority" and aims to "remain disciplined with respect to discounts," they wrote ^[1].

Outside the U.S., Lilly is running a "measured" rollout, partly because of shortages of Novo Nordisk's Ozempic (semaglutide) in certain markets, the analysts said ^[1]. The European Medicines Agency's Committee for Medicinal Products for Human Use backed marketing authorization for Mounjaro in type 2 diabetes in July ^[1].

Mounjaro is approved as an add-on to diet and exercise to help type 2 diabetes patients control blood sugar, not for weight loss ^[1]. Lilly is seeking a separate obesity indication. In the phase 3 SURMOUNT-1 trial, tirzepatide met both primary endpoints, producing a superior mean percent change in body weight from baseline and a greater share of patients reaching at least 5% body weight reduction versus placebo ^[1]. The analyst note did not break out how much of the early demand came from prescribing for weight loss, which the label did not cover at the time ^[1].

The drug is a first-in-class treatment that activates both the GLP-1 and GIP receptors, given as a once-weekly injection, with dosing that can be tailored to a patient's needs ^[1]. Evaluate Vantage has predicted $4.9 billion in sales for Mounjaro by 2026, and Morgan Stanley researchers estimated the global obesity market could be worth about $50 billion by the end of the decade ^[1].

Why it matters for patients

The reimbursement number is the practical one: coverage at just over 20% meant most people starting Mounjaro were relying on copay cards ^[1]. How long that copay support lasts, who qualifies, and what patients paid out of pocket have not been reported ^[1]. Lilly's stated approach of staying "disciplined" on discounts is a signal about how broadly it planned to negotiate with insurers, not a promise about any individual plan ^[1].

Supply decisions at Lilly and Novo Nordisk affect different medicines. Ozempic shortages in some markets and earlier supply constraints on Wegovy — both semaglutide products from Novo — were factors in Lilly's more cautious international launch of Mounjaro, the analysts said ^[1].

For anyone taking a GLP-1 medicine, the label distinction matters: Mounjaro's approval covered blood sugar control in type 2 diabetes, and weight-loss use was not covered ^[1].

What happens next

Lilly plans to double incretin manufacturing capacity by the end of 2023 ^[1]. The company said it could supply a potential early U.S. obesity launch in 2023, but its base case is a 2024 launch, contingent on additional phase 3 data ^[1]. Novo Nordisk expected all strengths of Wegovy to be available again in the U.S. by the end of 2022 ^[1].