Eli Lilly just reminded everyone why it’s winning the GLP-1 drug race, and it wasn’t even close. The pharmaceutical giant reported first-quarter earnings that sailed past analyst expectations, prompting the company to bump up its full-year revenue guidance by a cool $2 billion. We’re talking about a company now expecting 2026 revenues between $82 billion and $85 billion, up from the previous $80 billion to $83 billion range.
The numbers tell a story of relentless demand that, frankly, should worry Novo Nordisk.
The Blockbuster Duo Keeps Crushing It
Mounjaro, Lilly’s diabetes and obesity treatment, posted worldwide revenue of $8.66 billion for the quarter, a stunning 125% jump year-over-year. U.S. sales alone hit $4.2 billion. Analysts had penciled in $7.26 billion, so Lilly beat expectations by over $1.4 billion. That’s not a miss-and-beat situation. That’s dominance.
Then there’s Zepbound, the weight loss injectable that entered the market roughly three years ago. The drug pulled in $4.16 billion in U.S. revenue for Q1, up 80% from the same period last year. Wall Street was expecting $4.04 billion. Again, Lilly cleared the bar.
Here’s the kicker: both drugs achieved these numbers despite lower realized prices in the U.S. market. Translation, more people are buying the medications, even as the company makes less per dose. That’s a volume play, and it’s working.
Market Share Tells the Real Story
In the booming business of GLP-1 drugs, Lilly now controls 60.1% of the U.S. obesity and diabetes market, according to the company’s earnings presentation. Novo Nordisk? 39.4%. The gap is widening, and that margin matters when you’re talking about a drug category that’s reshaping the pharmaceutical industry.
The company’s overall first-quarter revenue hit $19.80 billion, up 56% year-over-year. U.S. revenue climbed 43% to $12.1 billion, driven by a 49% jump in prescription volumes for Mounjaro and Zepbound. Net income came in at $7.40 billion, or $8.26 per share, compared to $2.76 billion ($3.06 per share) in the prior year.
Shares rose more than 7% in premarket trading Thursday, though the broader context matters: investors already knew Lilly was winning. What they got Thursday was confirmation that the lead is bigger than expected.
The Pill Play and What Comes Next
The conversation around Lilly’s earnings call isn’t really about Q1 anymore. It’s about Foundayo, the company’s newly approved GLP-1 pill for obesity that launched in Q2. CEO David Ricks told CNBC that more than 20,000 people started taking Foundayo in its first few weeks on the market, with over 1,000 new patients daily. Crucially, 80% of them were new to GLP-1s entirely.
Early data from analysts, though, suggests a more cautious reality. Leerink Partners’ David Risinger characterized the pill’s initial rollout as “modest.” Novo Nordisk’s Wegovy pill had a three-month head start, which matters in a market where first-mover advantage and brand awareness still carry weight.
The real question isn’t whether Foundayo will succeed. It’s whether Lilly can replicate the injectable franchise’s momentum in pill form. Ricks has been optimistic about this, noting in late April that lower prices should accelerate prescription volumes. He also estimated global GLP-1 use will grow from roughly 20 million patients at the end of 2025 to 30 million by the end of 2026.
The Tailwinds and Headwinds
Lilly’s got several things working in its favor. Medicare is coming online with obesity drug coverage later this year, which should unlock an entirely new patient population. Continued worldwide demand for both Mounjaro and Zepbound remains resilient. But the company also flagged what it calls “pricing pressure” stemming from a drug pricing deal with President Trump and lower cash-pay prices for Zepbound.
It’s a delicate balance. Lower prices drive volume and market share gains, which is exactly what Lilly is achieving. But at some point, margin compression catches up. The company’s adjusted profit guidance for 2026 is $35.50 to $37 per share, up from $33.50 to $35 previously, so for now the math still works. Whether it continues to work when Medicare patients flood in remains genuinely unclear.
What’s not unclear is that Lilly’s stranglehold on this market is tightening, and that’s reshaping how the pharmaceutical industry thinks about obesity treatment. The question isn’t whether Novo can catch up. It’s whether the market is actually big enough for both players to thrive as originally expected.
