Lilly posts $19.8 billion quarter as Mounjaro overseas sales pass US for the first time

Eli Lilly reported $19.8 billion in first-quarter 2026 revenue on April 30, a 56% increase from the same quarter a year earlier, and raised its full-year revenue guidance to $82 billion to $85 billion from a previous range of $80 billion to $83 billion ^[1][3]. The company's shares rose nearly 10%, closing up 9.7% at $933.76 ^[3].

Mounjaro (tirzepatide) brought in $8.66 billion worldwide, up 125% ^[1]. For the first time, sales outside the United States, at $4.43 billion, passed US sales of $4.23 billion ^[1]. US Mounjaro revenue rose 59% on demand, partly offset by lower realized prices ^[1]. International revenue was helped by volume growth and held back by lower prices after Mounjaro was added to China's National Reimbursed Drug List ^[1].

Zepbound (tirzepatide), the US weight-loss brand, generated $4.16 billion, up 80% from $2.31 billion a year earlier, driven by demand and partly offset by lower realized prices, including previously announced cuts to cash-pay prices ^[1]. Both products also benefited from a one-time adjustment to estimates for rebates and discounts in the quarter ^[1].

Companywide, volume rose 65% while realized prices fell 13% ^[1]. Non-GAAP earnings per share were $8.55, compared with $3.34 a year earlier and above analyst estimates of $6.66, according to LSEG data cited by Reuters ^[1][3]. Lilly now expects full-year non-GAAP earnings of $35.50 to $37.00 per share, up from $33.50 to $35.00; analysts had estimated $34.55 ^[3].

Foundayo launch draws attention

Foundayo (orforglipron), Lilly's once-daily GLP-1 pill, was approved by the US Food and Drug Administration and began selling in the US in early April, so it was not included in the quarter's results ^[3][4]. Lilly CEO Dave Ricks said more than 20,000 people have started taking it, with more than 1,000 new starts a day, and that more than 80% of them had not used a GLP-1 before ^[4]. Lilly said the drug has more than 8,000 prescribers, a third of whom had not previously written an oral GLP-1 prescription, and that more than 12 telehealth firms account for about 35% of launch volume ^[3].

Some analysts said early prescription data suggested the launch was lagging Novo Nordisk's oral Wegovy, which launched in January ^[3]. Lilly executives were upbeat. "Early indicators are positive," said Ilya Yuffa, president of Lilly USA ^[3]. Ricks said the launch "is going to play out over quarters, not days" ^[4]. Lilly said two of the three largest US pharmacy benefit managers will start covering Foundayo next month ^[3].

On a call with investors, Ricks addressed pricing pressure and agreements with the Trump administration to lower US prices of obesity drugs. "Pretty much every time we reduce pricing, we see a pretty large expansion," he said ^[3]. Lilly held 60.1% of the US obesity and diabetes drug market in the quarter, versus 39.4% for Novo Nordisk, according to a company earnings presentation cited by CNBC ^[4]. The FDA also proposed rules on April 30 that would exclude weight-loss drugs from the compounding list, which Reuters reported would squeeze large-scale production of compounded versions ^[3].

Why it matters for patients

Price and coverage are moving in opposite directions in these numbers. Lilly's average realized prices fell 13% across the business ^[1], and the company has struck discount deals with the federal government ^[3]. At the same time, what an individual pays depends on insurance, pharmacy benefit manager coverage and dose, none of which is settled by a companywide average.

Coverage for the newest option could shift within weeks. Two of the three largest US pharmacy benefit managers are set to start covering Foundayo next month, according to Lilly ^[3]. Patients now have two oral GLP-1 choices in the US: Foundayo (orforglipron) and Novo Nordisk's oral Wegovy (semaglutide) ^[3][4].

Compounded versions face an uncertain path. The FDA's proposed exclusion from the compounding list was announced the same day as Lilly's results, but it is a proposal, and what final rules would say has not been disclosed ^[3].

What happens next

Lilly's full-year guidance covers 2026, with revenue of $82 billion to $85 billion and non-GAAP earnings of $35.50 to $37.00 per share ^[1]. Foundayo's sales will first appear in later quarterly reports ^[4]. Lilly has scheduled an Investment Community Meeting for December 7, 2026 ^[1]. How Foundayo's launch compares with Novo's oral Wegovy over the coming quarters has not yet been reported.