Eli Lilly posts 43% revenue growth as Zepbound and Mounjaro sales pull ahead of Novo Nordisk

Eli Lilly reported fourth-quarter 2025 revenue of $19.3 billion, up 43% from a year earlier, and said it expects $80 billion to $83 billion in revenue for 2026 — roughly 27% growth. Novo Nordisk, which reported the day before, guided to a 5% to 13% decline in 2026 sales and operating profit at constant exchange rates ^[1][2].

Lilly's tirzepatide products drove the quarter. Mounjaro, its diabetes drug, generated $7.4 billion, up 110%, while Zepbound, its weight-loss drug, reached $4.3 billion, up 123% ^[1]. A second account of the same results lists Mounjaro at $7.41 billion and Zepbound at $4.26 billion, a 122% increase for Zepbound ^[2]. For the full year, Mounjaro sales grew 99% and Zepbound 175%, lifting Lilly's gross margin to 82.5% of revenue ^[1]. Adjusted earnings were $7.54 per share, above the $6.67 that analysts expected ^[1].

Lilly's growth came from volume rather than higher prices. The company said volume rose 46% while realized prices fell 5%. U.S. revenue rose 43% to $12.9 billion on 50% higher volumes, even after price reductions of about 7% tied mainly to Mounjaro and Zepbound. International revenue also rose 43%, on 38% higher volumes ^[1].

Novo Nordisk's full-year 2025 sales grew 10% at constant exchange rates to 309 billion Danish kroner, below the 347 billion analysts expected, and operating profit slipped 1%. Fourth-quarter revenue fell 8%. The company told investors that adjusted 2026 sales and operating profit will decline 5% to 13% at constant exchange rates — its first sales drop since 2017 ^[1]. CEO Mike Doustdar attributed the outlook to U.S. pricing discounts on GLP-1 drugs, semaglutide patent expirations in China, Brazil and Canada, and competition from Zepbound, which has passed Wegovy in U.S. prescriptions ^[1]. Novo's shares fell 15% after the guidance and dropped another 4% the following day ^[1].

On weight loss, the two drugs have been reported at about 20% for tirzepatide versus about 14% for semaglutide in trials ^[1][2]. Novo has launched an oral version of Wegovy; the starter dose is priced at $149 per month for self-pay patients, and about 80% of users are new to the Wegovy brand, which Novo says suggests the pill is bringing in new patients rather than replacing the injectable version ^[1].

Why it matters for patients

The gap between the two companies shows up for patients mainly through price, coverage and which products are available.

Novo's outlook is tied directly to U.S. pricing discounts, to Medicare and Medicaid agreements that lower the price per prescription, and to the TrumpRx direct-to-consumer discount platform. One analysis says those measures could reduce per-unit profitability in the near term, with higher prescription volume expected to offset some of that effect in the second half of 2026. That analysis also cites Medicare's expansion of coverage for obesity therapies as a factor behind rising demand ^[2].

Cash-pay prices are already part of the competition. Novo's oral Wegovy starter dose is listed at $149 a month for people paying without insurance ^[1]. Whether Lilly's injectables or its experimental oral drug will be offered at a comparable cash price has not been disclosed.

The semaglutide patent losses Novo named in its guidance are for China, Brazil and Canada ^[1]. When semaglutide's U.S. exclusivity ends, and what that would mean for U.S. list or net prices, has not been reported.

Both companies cite the same pressures — pricing, competition and patent risk — but their reported trajectories have diverged sharply ^[1].

What happens next

Lilly says its oral GLP-1 drug orforglipron is on track for potential approval in the second quarter of 2026 ^[1], and one analysis notes the company expects to launch an oral obesity drug during 2026 ^[2]. Novo's guidance points to a sales decline over the same year, with the company counting on volume growth to offset pricing ^[1]. Neither company has said what these results will mean for what patients pay at the pharmacy counter.