In the high-stakes rivalry between the two weight-loss drug titans, Eli Lilly appears to have delivered a decisive verdict. On Wednesday, Eli Lilly reported robust fourth-quarter 2025 earnings and issued a 2026 performance outlook that significantly surpassed Wall Street's expectations. Propelled by this news, Lilly's stock surged by as much as 8% in pre-market trading. This optimistic forecast stands in stark contrast to the pessimistic warning issued by competitor Novo-Nordisk A/S on Tuesday, which cautioned that its sales could decline by up to 13% this year due to intensifying price wars, whereas Lilly anticipates its own sales to grow by a substantial 27%.
The financial report revealed that Lilly's Q4 revenue reached $19.3 billion, a 43% year-over-year increase, exceeding analyst expectations of $18 billion. Non-GAAP earnings per share (EPS) were $7.54, up 42% from the prior year and also significantly beating the market consensus of $6.73. This explosive performance was primarily fueled by robust demand for its GLP-1 "twin stars"—the diabetes drug Mounjaro and the weight-loss medication Zepbound. Data indicates that Zepbound's total prescriptions for 2025 have officially surpassed those for Novo-Nordisk A/S's Wegovy, marking a further consolidation of Lilly's leadership in the weight-loss drug market.
More importantly, Lilly's future outlook has significantly boosted market confidence. The company forecasts full-year 2026 revenue to be between $80 billion and $83 billion, easily surpassing Wall Street's average estimate of $77.7 billion. Adjusted EPS is projected to be between $33.50 and $35.00, also outperforming the analyst expectation of $33.08. Lilly is gaining an upper hand in the competition against cheaper generics from telehealth companies and Novo-Nordisk A/S by leveraging its patent moat, more aggressive capacity expansion, and upcoming oral formulations.
Core products are not just "cash cows": Mounjaro and Zepbound together contributed over 60% of revenue.
There is no doubt that Tirzepatide is the absolute engine behind Lilly's soaring performance. Financial report data shows that the combined revenue from just Mounjaro and Zepbound in the fourth quarter exceeded $11.6 billion, accounting for over 60% of the company's total revenue for the quarter.
Mounjaro (diabetes indication): Quarterly revenue reached a staggering $7.41 billion, an astonishing 110% year-over-year increase. Its revenue in the U.S. market was $4.1 billion, while growth in international markets was even more explosive, skyrocketing to $3.3 billion from $899 million in the same period last year, demonstrating a rapid acceleration in global penetration. Zepbound (obesity indication): As the current star in the weight-loss drug arena, Zepbound generated $4.26 billion in revenue in Q4, a massive 123% year-over-year surge. The U.S. market remains its primary battleground, contributing the vast majority of this income.
It is noteworthy that the breast cancer drug Verzenio performed steadily, with Q4 revenue of $1.6 billion, a 3% year-over-year increase, continuing to provide stable cash flow support for the company.
Volume-driven strategy proves effective: 46% surge in volume offsets price pressure.
A deeper analysis of the revenue drivers reveals that Lilly's growth is entirely volume-driven. In the fourth quarter, the volume of Lilly's global product sales grew by 46%, a formidable growth rate that completely offset the negative impact of a 5% decline in realized prices. In the U.S. market, volume surged by 50%, but realized prices fell by 7%. This primarily reflects concessions made on rebates and pricing strategies for Zepbound and Mounjaro to gain inclusion in more insurance formularies and expand patient access. Furthermore, Lilly announced an agreement with the U.S. government aimed at expanding access to obesity medications for millions of Americans; while this may lower the unit price, it will significantly widen the moat and consolidate market leadership through economies of scale. In international markets, volume grew by 38%, primarily driven by Mounjaro. This indicates that Lilly is successfully replicating its U.S. success globally, especially as production bottlenecks gradually ease, rapidly satisfying the pent-up demand in international markets.
Targeting $83 billion revenue in 2026, outpacing Novo-Nordisk A/S.
The most significant highlight of this earnings report is the starkly different future outlooks of Lilly and Novo-Nordisk A/S. Lilly's projected revenue ceiling of $83 billion for 2026 implies that, even from the high base of $65.18 billion in revenue achieved in 2025, the company will maintain robust growth exceeding 20%. In comparison, Novo-Nordisk A/S previously warned investors that intensifying price competition in the weight-loss drug market would lead to a 13% decline in its full-year sales. Novo-Nordisk A/S CEO Mike Doustdar stated bluntly that the company would face "unprecedented pricing pressure" in 2026.
Beyond the continued ramp-up of injectables, oral weight-loss drugs could be the next game-changer. Lilly is awaiting regulatory approval for its oral weight-loss medication, which could be granted as early as April this year. The company has already pre-produced billions of doses of the oral drug in preparation for launch. In response to demands for lower drug prices from figures like Trump and telehealth companies, Lilly indicated that if approved by the FDA, the monthly cost for its lowest-dose oral medication could be as low as $149. This highly aggressive pricing strategy is poised to deliver a two-pronged blow to both high-priced injectables and cheaper generics in the market. Regarding profit forecasts, the 2026 Non-GAAP EPS guidance is $33.50-$35.00. Compared to the full-year 2025 EPS of $24.21, this预示着 approximately 40% growth in earnings per share. This profit growth rate, which outpaces revenue growth, benefits from the increasing proportion of high-margin products (with a gross margin guidance raised to over 83%) and the realization of operating leverage. Although the company expects to continue increasing R&D and marketing investments in 2026, the scale effect of revenue is sufficient to cover these costs.
R&D Pipeline and Capacity Expansion: Building a Wider "Moat"
To maintain its long-term dominance, Lilly is accelerating its strategy for the "post-Tirzepatide era," focusing on improving convenience of administration and expanding indications: Oral weight-loss drug imminent: The company has submitted marketing applications for the oral non-peptide GLP-1 receptor agonist Orforglipron to the FDA and regulators in Japan and the EU. Once approved, this could be a blockbuster solution for many patients hesitant due to the inconvenience of injections, potentially further expanding the market. Triple-target drug (Triple G): Retatrutide achieved positive Phase 3 clinical results in patients with obesity and knee osteoarthritis, demonstrating not only its exceptional weight-loss efficacy (up to an average of 71.2 pounds) but also its potential in improving comorbidities. Autoimmunity and Oncology: Positive results were obtained from a Phase 3 trial combining the psoriatic arthritis drug Taltz with Zepbound; the BTK inhibitor Jaypirca also received expanded FDA approval for additional indications. On the supply chain front, Lilly is working at full throttle to resolve the long-standing production capacity issues that have constrained the rollout of weight-loss drugs. The company announced the construction of a new injectable manufacturing facility in Pennsylvania, a $6 billion investment in an active pharmaceutical ingredient (API) plant in Alabama, and plans for a $3 billion investment in Europe to expand oral drug production capacity. These massive capital expenditures are not only aimed at meeting current demand but also paving the way for the launch of new drugs in 2026 and beyond.