The rivalry in the GLP-1 market between pharmaceutical leaders Eli Lilly (NYSE:LLY | LLY Price Prediction) and Novo Nordisk (NYSE:NVO) has intensified following their latest fourth-quarter earnings reports.
Novo Nordisk initially dominated the space with its semaglutide-based drugs, Ozempic for diabetes and Wegovy for obesity, securing a strong foothold in both markets. However, Eli Lilly has since pulled ahead with tirzepatide — marketed as Mounjaro for diabetes and Zepbound for weight loss. The drug’s dual GLP-1/GIP receptor mechanism delivers superior weight loss — around 20% in trials compared to semaglutide’s 14% — propelling Lilly into the market leadership position.
Novo Nordisk is fighting back with the recent launch of an oral version of Wegovy, but the company issued a stark warning: it expects sales to decline 5% to 13% in 2026 at constant exchange rates. That outlook sent its stock tumbling 15%, with shares dropping another 4% today. In contrast, Eli Lilly reported robust growth and has oral orforglipron on track for potential approval in the second quarter, offering a chance to widen its lead further.
Novo Nordisk’s Challenging Outlook
Novo Nordisk released its full-year 2025 results yesterday, posting 10% sales growth at constant exchange rates to 309 billion Danish kroner — well below analysts’ expectations of 347 billion kroner. Operating profit edged down 1%, and earnings per share missed forecasts. The fourth quarter showed an 8% revenue decline, though it slightly beat expectations, while quarterly earnings surpassed Wall Street estimates.
The real concern came with the 2026 guidance: adjusted sales and operating profit are projected to fall 5% to 13% at constant exchange rates — the company’s first sales drop since 2017. CEO Mike Doustdar attributed the shortfall to U.S. pricing discounts on GLP-1 drugs, upcoming semaglutide patent expirations in China, Brazil, and Canada, and fierce competition from Lilly’s Zepbound, which has overtaken Wegovy in U.S. prescriptions.
Still, Novo remains optimistic about volume growth to counter pricing headwinds. Early signs for oral Wegovy are encouraging: priced at $149 per month for the starter dose for self-pay patients, roughly 80% of users are new to the Wegovy brand, suggesting it’s expanding the overall market rather than stealing share from the injectable version.
Eli Lilly’s Strong GLP-1 Momentum
Eli Lilly’s fourth-quarter performance told a very different story. Revenue jumped 43% to $19.3 billion, topping the $17.9 billion consensus estimates, fueled by 46% volume growth despite a 5% dip in realized prices. U.S. revenue rose 43% to $12.9 billion on 50% higher volumes, even with 7% price reductions tied mainly to Mounjaro and Zepbound. International revenue also grew 43%, driven by 38% volume gains. Adjusted earnings reached $7.54 per share, comfortably beating estimates of $6.67 per share.
Mounjaro sales surged 110% to $7.4 billion — above the $6.7 billion forecast — while Zepbound revenue soared 123% to $4.3 billion. For the full year, Mounjaro grew 99% and Zepbound 175%, lifting gross margin to 82.5% of revenue.
Looking ahead, Lilly guided for 27% revenue growth to $80 billion to $83 billion in 2026 — above the $77.6 billion consensus — and adjusted earnings of $33.50 to $35.00 per share, also exceeding expectations of $33.23 per share.
Key Takeaways
Both companies are confronting shared GLP-1 challenges — pricing pressures, intensifying competition, and patent risks — but their trajectories have sharply diverged. Lilly’s tirzepatide has outperformed semaglutide in efficacy, driving Zepbound ahead of Wegovy in U.S. prescriptions. Meanwhile, Novo faces patent losses on semaglutide in key markets, while Lilly’s pipeline — highlighted by orforglipron’s anticipated Q2 approval — sets it up for sustained strength. For investors, Eli Lilly stands out as the clearer winner in this high-stakes GLP-1 battle.
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