Lilly reports 60.1% US incretin market share as Mounjaro and Zepbound sales climb

Eli Lilly said its share of the U.S. incretin drug market reached 60.1% in March 2026, up from about 45% a year earlier, as the company reported first-quarter revenue of $19.8 billion, a 56% increase from the same quarter in 2025 ^[1][2]. The U.S. incretin market itself grew 30% in the first quarter, and Lilly's international share was 53.2% as of February 2026 in a market that expanded 77% ^[2].

Lilly lists its incretin franchise as Mounjaro, Zepbound and Trulicity, part of the GLP-1 receptor agonist category ^[2]. The market-share figures come from Lilly's own earnings presentation ^[2].

What the sales numbers show

Mounjaro (tirzepatide) brought in $8.7 billion worldwide, up 125% from $3.8 billion a year earlier. U.S. revenue was $4.2 billion, up 59%, and sales outside the U.S. rose to $4.4 billion from $1.2 billion, driven mainly by volume growth and partly offset by lower prices after the drug was added to China's national reimbursement list ^[1]. Lilly said its U.S. share of the type 2 diabetes incretin segment was close to 51% ^[2].

Zepbound (tirzepatide), the weight-management version, recorded $4.1 billion in U.S. revenue, up 80% from $2.3 billion ^[1]. Lilly's earnings presentation put U.S. Zepbound sales at $4.2 billion plus $26 million internationally, and said the brand held more than 50% of the branded incretin obesity management market in the first quarter ^[2]. The company said demand drove the increase, while lower realized prices — including previously announced cuts to its cash-pay prices — partly offset it ^[1].

Prices fell across the business. U.S. revenue rose 43% to $12.1 billion on 49% volume growth, offset by a 7% decline from lower realized prices ^[1]. Gross margin as a share of revenue was 81.9%, down 0.6 percentage points, which Lilly attributed mainly to lower realized prices ^[1]. Non-GAAP earnings per share were $8.55, up 156% ^[1]. Lilly raised its full-year 2026 revenue guidance to $82 billion to $85 billion, from $80 billion to $83 billion ^[1][2].

The quarter also included U.S. Food and Drug Administration approval of Foundayo (orforglipron) for adults with obesity, or overweight with weight-related medical problems ^[1]. Lilly's chief executive, David Ricks, called it "the only approved GLP-1 pill that can be taken any time of day, without food and water restrictions" ^[1]. Early launch data showed more than 80% of Foundayo prescriptions went to patients new to incretin therapy, with retail availability reached by April 9 and more than 12 telehealth platforms accounting for about 35% of launch volume ^[2]. Commercial access was secured at two-thirds of major pharmacy benefit managers by mid-May, and Lilly said full-scale consumer promotion would start in the third quarter of 2026 ^[2].

Why it matters for patients

The market-share numbers describe how concentrated the category has become: one company now reports about 60 cents of every dollar spent on incretins in the U.S. ^[2]. At the same time, Lilly reports that realized prices for both Mounjaro and Zepbound came down during the quarter, including through its cash-pay price cuts ^[1]. What those changes translate to for any individual patient's bill has not been disclosed in these results.

The oral option appears to be reaching a different group. Lilly said more than 80% of early Foundayo prescriptions were written for people who had not previously used an incretin medicine ^[2], which the company said suggests the pill is expanding the number of people treated rather than shifting existing injectable users. That figure covers the early launch period and does not show how many of those patients stay on the drug or how coverage holds up.

Coverage remains the practical variable. Lilly reported access at two-thirds of major pharmacy benefit managers by mid-May and said Medicare access through the GLP-1 Bridge program was planned to begin July 1 ^[2]. The sources do not state which Medicare beneficiaries would qualify, what the program would cost them, or whether the two-thirds figure covers all plans in a given market.

What happens next

Lilly said Medicare access through the GLP-1 Bridge program is planned for July 1, 2026, and full-scale consumer promotion for Foundayo would begin in the third quarter of 2026 ^[2]. The company scheduled an Investment Community Meeting for December 7, 2026 ^[1]. Expected later readouts include Phase 3 data for orforglipron in obstructive sleep apnea and regulatory submissions for orforglipron in type 2 diabetes in the U.S., European Union and Japan ^[2].