Eli Lilly posts 43% revenue growth and guides well above Novo for 2026

Eli Lilly reported fourth-quarter 2025 revenue of $19.3 billion, up 43% from a year earlier, and told investors it expects $80 billion to $83 billion in revenue for 2026 ^[1][2]. The forecast lands in sharp contrast to rival Novo Nordisk, which said it expects sales to fall 5% to 13% in 2026 at constant exchange rates — its first annual sales drop since 2017 ^[1].

The two GLP-1 drugs patients know best drove Lilly's quarter. Mounjaro (tirzepatide for type 2 diabetes) brought in $7.4 billion, up 110% and above the $6.7 billion analysts expected ^[1]. Zepbound (the same molecule, approved for weight management) generated $4.3 billion, up about 123% ^[1]; a second account puts the figures at $7.41 billion and $4.26 billion, up 122% ^[2]. For the full year, Mounjaro grew 99% and Zepbound 175% ^[1].

Importantly for anyone watching prices, the growth came from volume, not higher prices. Lilly said overall volume rose 46% while realized prices fell 5% ^[1]. In the US, revenue rose 43% on 50% higher volume, with a 7% price decline tied mainly to Mounjaro and Zepbound ^[1]. Adjusted earnings were $7.54 per share versus a $6.67 estimate, and gross margin reached 82.5% of revenue ^[1]. For 2026, Lilly guided to adjusted earnings of $33.50 to $35.00 per share ^[1].

Novo's side of the ledger

Novo Nordisk, maker of Ozempic, Wegovy and Rybelsus (all semaglutide), posted 10% full-year 2025 sales growth at constant exchange rates to 309 billion Danish kroner, below the roughly 347 billion kroner analysts expected ^[1]. Operating profit slipped 1%, and fourth-quarter revenue fell 8% ^[1]. The stock dropped 15% on the guidance and another 4% the following day ^[1].

CEO Mike Doustdar pointed to three causes: US pricing discounts on GLP-1 drugs, semaglutide patent expirations coming in China, Brazil and Canada, and competition from Zepbound, which has passed Wegovy in US prescriptions ^[1]. One bright spot: the new oral version of Wegovy is priced at $149 a month for the starter dose for self-pay patients, and roughly 80% of users are new to the Wegovy brand, which Novo reads as growing the market rather than shifting patients off the injection ^[1].

Both sources attribute part of the divergence to efficacy differences, citing about 20% weight loss in trials for tirzepatide versus about 14% for semaglutide ^[1][2]. These are trial averages described in secondhand summaries, not head-to-head results reported in the sources, and individual results vary.

Why it matters for patients

Earnings reports are not clinical news, but they signal what the market may look like over the next year. Lilly's 5% to 7% decline in realized US prices, alongside rising volume, reflects discounting and new coverage arrangements rather than lower demand ^[1]. Lilly also flagged pricing pressure in 2026 from new agreements lowering prices for Medicare and Medicaid beneficiaries and from TrumpRx, a platform offering direct-to-consumer discounts ^[2]. Medicare coverage for obesity therapies has expanded, which helped drive volume ^[2]. What any individual pays still depends on insurance, plan formularies and whether a person pays cash.

Novo's projected decline does not mean its drugs are going away. Patent expirations in China, Brazil and Canada ^[1] generally open the door to lower-cost copies in those countries; the sources do not address US semaglutide patent timing. And the $149 starter-dose price on oral Wegovy shows price competition is now a visible part of the fight for patients ^[1].

What happens next

Lilly's oral GLP-1, orforglipron (brand name Foundayo), is described as on track for potential approval in the second quarter of 2026 ^[1], with a launch expected during the year ^[2]. An approved pill would add a non-injection option for people who prefer one ^[2]. The sources do not give an exact FDA decision date, a US price or coverage details for orforglipron — those are not yet known.

Lilly also reported clinical progress on treatments for psoriatic arthritis and knee osteoarthritis, and regulatory updates for Jaypirca and a Kwikpen product ^[2].