Lilly says international incretin growth ran at 136% and flags generic supply constraints in Canada

Eli Lilly's chief financial officer, Lucas Montarce, told investors on the company's second-quarter earnings call that revenue outside the United States grew 136%, compared with 48% growth inside the US, with the gain led by Mounjaro sales in Latin America and Asia ^[1]. Global Mounjaro revenue rose 91% year over year to about $9.94 billion, beating analyst estimates of roughly $8.99 billion, and international Mounjaro sales of $5.2 billion have now overtaken the $4.8 billion booked in the US ^[2]. Zepbound added $4.93 billion in the quarter, with US sales up 44% for the quarter and 58% for the first half of the year, though lower realized prices partly offset that demand ^[1][2].

Patrik Jonsson, president of Lilly International, said the company was "pleasantly surprised" by its performance in Canada and noted that generic semaglutide entrants there "have significant supply constraints," something Lilly says it is watching closely ^[1]. Both Mounjaro and Zepbound remain under patent protection in Canada, so the generic pressure Jonsson described applies to the semaglutide market rather than to tirzepatide, the molecule in Lilly's own products ^[1].

Novo Nordisk, semaglutide's maker, described a similar picture in its own earnings call. Emil Kongshøj Larsen, the company's international operations chief, said "while the generic players have started to capture market share, we have so far been able to grow our absolute volumes," crediting a savings card program for Ozempic and Wegovy in cash and private insurance channels ^[1]. Novo's oral Wegovy pill has passed 5 million US prescriptions since launch, though analysts called the quarter's sales "slightly soft," and CEO Mike Doustdar said the company is now serving almost 70% more people than a year ago ^[1]. Doustdar also said Novo has been surprised by how many patients prefer a pill to an injection ^[1].

Elsewhere in Lilly's results, roughly 45% of total Zepbound prescriptions and 55% of new prescriptions in the US were self-pay, and the company's realized prices fell 13% overall, partly because adding Mounjaro to China's national reimbursement list expanded access but cut prices there ^[2]. Lilly's oral obesity pill, Foundayo (orforglipron), brought in about $98 million in the quarter, below the roughly $103-104 million analysts expected, though most international launches for that drug are not planned until 2027 ^[2]. Lilly raised its full-year 2026 revenue guidance to $85-$87 billion ^[2].

Why it matters for patients

The Canadian generic supply problems Jonsson described don't directly change what's available at a US pharmacy, since generic semaglutide is not yet approved for sale in the United States. But the episode is a reminder that manufacturing capacity for these drugs remains tight worldwide, even as demand keeps rising ^[1][2]. It also underscores that Mounjaro and Zepbound are still patent-protected in Canada, much as they are in the US, meaning lower-cost generic tirzepatide is not expected soon in either country.

For US patients paying cash, the finding that nearly half of Zepbound prescriptions are self-pay ^[2], alongside Novo's reliance on savings cards to hold onto customers ^[1], shows how much current pricing strategy for these drugs still depends on discount programs rather than list prices. The slower-than-expected launch of Foundayo, Lilly's oral pill, suggests that oral GLP-1 options are still working their way into wider use, even as both companies say patient interest in pills is growing ^[1][2].

What happens next

Lilly has said most international launches of Foundayo are expected in 2027 ^[2], and Lilly International said it will keep monitoring Canadian generic supply constraints closely ^[1]. Neither source gives a specific timeline for when generic semaglutide supply issues in Canada might ease or whether similar generic competition could reach the US market.