Lilly's Mounjaro and Zepbound sales climb while Novo Nordisk's GLP-1 growth stalls

Eli Lilly's two tirzepatide medicines, Mounjaro for type 2 diabetes and Zepbound for obesity, together brought in about $14.9 billion in worldwide sales in the second quarter of 2026, while Novo Nordisk's shares fell 6% after its earnings report missed expectations on two fronts ^[1][2].

Novo's Ozempic generated $4.88 billion (31.4 billion Danish kroner) and its injectable Wegovy brought in $3.03 billion (19.5 billion kroner); both were essentially flat at constant exchange rates ^[2]. The oral Wegovy pill, sold as semaglutide and launched in January 2026, recorded 3.2 billion kroner, or about $494 million, below the 3.6 billion kroner analysts expected ^[1][2]. Lilly's oral medicine orforglipron, sold as Foundayo, posted $98 million in the second quarter against a consensus estimate of $104 million ^[1]. Novo's shares fell 6% Tuesday before recovering some of those losses Wednesday ^[1].

Novo also reported a research setback. Its experimental CagriSema, a next-generation weekly injectable now under Food and Drug Administration review, failed to control blood sugar as well as Lilly's tirzepatide in a head-to-head trial of patients with type 2 diabetes ^[1].

Lilly's total second-quarter revenue jumped 48% to almost $23 billion, beating a consensus estimate of $20.6 billion ^[1]. Mounjaro sales rose 91% to $9.94 billion and Zepbound rose 46% to $4.93 billion; together the two drugs accounted for nearly 65% of Lilly's quarterly revenue ^[2]. The growth was mostly driven by volume. U.S. Mounjaro revenue rose 45% to $4.8 billion and U.S. Zepbound revenue rose 44% to $4.9 billion, both despite lower realized prices, while Mounjaro sales outside the U.S. climbed 172% to $5.2 billion ^[2].

Both companies raised their full-year revenue estimates ^[1]. Lilly now expects $85 billion to $87 billion in revenue for the year, up from $82 billion to $85 billion. Novo said adjusted sales at constant exchange rates will be flat or fall as much as 6% this year, an improvement on its earlier projection of a 4% to 12% decline ^[1].

Why it matters for patients

There are now two oral options in the U.S. obesity market, Novo's Wegovy pill and Lilly's Foundayo, on top of the injectable versions of both companies' medicines ^[1][2]. Novo's pill had a head start and a faster launch, while Foundayo can be taken at any time of day without food or water restrictions, according to Lilly ^[1][2]. The earnings reports did not include a head-to-head comparison of the two pills for weight loss.

Both companies reported lower realized prices on some U.S. products, a figure that reflects what manufacturers collect after discounts and rebates rather than what patients pay at the pharmacy counter ^[2]. The reports do not say how list prices or out-of-pocket costs changed for patients during the quarter.

Coverage is also shifting. All three major U.S. pharmacy benefit managers now cover Lilly's obesity portfolio, and the Medicare GLP-1 Bridge program began giving eligible patients access to Foundayo and Zepbound in July, Lilly said ^[2]. Whether Novo's coverage position changed in the quarter has not been reported.

What happens next

Novo is waiting on an FDA decision for CagriSema and is also developing a higher-dose version of Wegovy ^[1]. Lilly is seeking approval for Foundayo in more than 40 additional countries and is pursuing a type 2 diabetes indication for the drug ^[2].

Other companies are moving toward the market. Viking Therapeutics plans to advance its oral candidate VK2735 into phase III testing for obesity in the fourth quarter of 2026, and Structure Therapeutics has begun dosing patients in a late-stage program for its oral candidate aleniglipron ^[2].

Whether the competition changes U.S. list prices or insurance coverage rules has not been disclosed.