Lilly forecasts 25% growth in 2026 while Novo Nordisk expects sales to fall
The two obesity drugmakers gave opposite 2026 forecasts, a split that reflects Lilly's stronger position and the pricing pressure both face [1].
Eli Lilly said Wednesday it expects 2026 revenue of $80 billion to $83 billion, a range whose midpoint implies growth of 25% and which lands above the $77.62 billion analysts surveyed by LSEG had forecast [1]. Novo Nordisk, reporting a day earlier, told investors its sales and profit could decline by 5% to 13% this year [1].
The two drugmakers face the same pressure at home: falling U.S. prices, including the "most favored nation" agreements each company reached with President Donald Trump in November to bring down the cost of obesity and diabetes medicines [1]. Lilly told investors it expects a "global pricing decline in the low- to mid-teens" in percentage terms this year [1]. Novo carries an added burden, with exclusivity on its biggest obesity and diabetes products expiring in China, Brazil and Canada [1]. The Trump deals are expected to cut into revenue at both companies while eventually increasing how many prescriptions are filled [1].
Analysts read the back-to-back guidance as evidence of a widening gap. David Risinger of Leerink Partners said the contrast stood out because Novo guided below consensus and Lilly above it within the same 24-hour stretch, and that it solidified the view that "Lilly is going to be the dominant player in obesity going forward" [1]. He credited tirzepatide, the active ingredient in Zepbound and Mounjaro, with being "superior" to semaglutide, the ingredient in Novo's Wegovy and Ozempic, in both effectiveness and tolerability [1], pointing to a head-to-head clinical trial Lilly conducted in 2024 and to prescription trends favoring Lilly among prescribers [1].
Lilly CEO David Ricks, in a CNBC interview, said 20 million to 25 million patients currently take medicines from the two companies, and described the total market of obesity patients as "gigantic" [1].
Two pills, different routines
Novo Nordisk reached the U.S. market with an obesity pill first, and oral Wegovy hit 50,000 weekly prescriptions in just under three weeks on sale [1]. Lilly's pill, orforglipron, is expected to launch in the second quarter, pending U.S. approval [1].
Risinger said Novo's early performance leans on the recognizable Wegovy brand and on direct-to-consumer advertising that began in early January [1]. He said Lilly may benefit from how its pill is taken. Orforglipron is a small molecule the body absorbs more easily and comes with no dietary restrictions, while the Wegovy pill is a peptide that patients must take with no more than four ounces of water and follow with a 30-minute wait before any food or drink [1].
Novo CEO Mike Doustdar told CNBC he remains confident, calling his company's product "the most efficacious weight-reduction pill that there is" [1]. Trial data suggest the Wegovy pill produces weight loss comparable to Novo's injectable form, roughly 15%, while Lilly's pill appears somewhat less effective in separate studies [1].
Patent life differs as well. Ricks said tirzepatide should stay protected into "the back half of the 2030s" in major markets, even as Novo loses exclusivity in some countries [1].
Why it matters for patients
Both directions of this split touch what patients can get and what they pay. The November pricing agreements were designed to lower costs for these medicines even as they reduce company revenue, and both firms have said lower prices should mean more prescriptions filled over time [1]. Lilly said government coverage of obesity treatment is set to begin for the first time by at least July; Ricks said that would open access to 40 million Medicare beneficiaries [1]. Which products Medicare will cover, and what enrollees will owe, has not been disclosed.
Oral options are expanding. Novo's Wegovy pill is already being dispensed, and orforglipron could reach the U.S. market in the second quarter if approved [1]. The daily routine for the two is not the same: one sets water and timing limits, the other does not [1]. Whether insurers will cover either pill on the same terms as the injections has not been reported.
What happens next
Lilly expects to launch orforglipron in the second quarter, contingent on U.S. approval [1]. Medicare coverage of obesity medicines is scheduled to start by at least July [1]. Novo's oral Wegovy holds an early prescription lead that investors will watch as Lilly's pill arrives [1].
Sources
Semaglutides.org provides information only, not medical advice. Talk to a licensed provider about your own care before making changes. Some telehealth links are affiliate links and are labeled where they appear.