Eli Lilly Crushes Q4 as GLP-1 Dominance Widens Over Novo
Pharma giant posts $19.3B revenue, guides 2026 to $80-83B. Mounjaro and Zepbound sales soar as Lilly captures 60% of U.S. obesity market.
Eli Lilly is pulling away.
The pharmaceutical giant reported Q4 revenue of $19.3 billion Wednesday—up 43% from a year ago and well ahead of the $17.9 billion Street estimate. Adjusted EPS hit $7.54 versus the $6.91 consensus. Shares rose in premarket trading as investors digested what may be the most dominant quarter in Lilly's history.
The timing couldn't be more pointed. Hours earlier, rival Novo Nordisk warned that 2026 sales could fall as much as 13%. Lilly just guided to $80-83 billion in annual revenue—above the $77.6 billion analysts expected.
The GLP-1 Machine
Lilly's weight-loss and diabetes drugs aren't just growing—they're accelerating.
Mounjaro generated $7.41 billion in quarterly revenue, up 110% year-over-year. U.S. sales hit $4.1 billion despite lower realized prices, as demand continued to outpace supply. The drug has become the backbone of Lilly's diabetes franchise and a growing force in obesity treatment.
Zepbound posted $4.2 billion in U.S. revenue, up 122% from a year ago. That's $300 million above analyst estimates of $3.91 billion. The weight-loss drug launched in late 2024 and has already become one of the fastest-growing pharmaceutical products in history.
Combined, the two drugs generated over $11.5 billion in a single quarter. That's larger than most biotech companies' entire annual revenue.
Market Share Battle Won
Lilly now controls 60.5% of the U.S. obesity and diabetes drug market—up 2.6 percentage points from last quarter. Novo Nordisk's share has slipped to 39.1%.
That gap widened even as Novo slashed prices under the TrumpRx program and launched its Wegovy pill. Lilly's edge isn't just pricing—it's supply, efficacy data, and a pipeline that includes an oral obesity drug expected to launch in Q2.
The market share shift matters because GLP-1 drugs represent one of the largest pharmaceutical categories in history. Morgan Stanley estimates the class could reach $100 billion in annual sales by 2030. Being the dominant player in that market is worth hundreds of billions in enterprise value.
Guidance Puts Distance Between Rivals
Lilly's 2026 outlook stood in contrast to Novo's warning of declining sales.
The company expects full-year revenue of $80-83 billion and adjusted EPS of $33.50-35.00. Both figures beat consensus estimates. Management cited several tailwinds: Medicare coverage expansion, continued global demand for Mounjaro and Zepbound, and the expected U.S. launch of an oral obesity drug in Q2.
That oral launch is critical. Novo gained an early advantage with its Wegovy pill approval in December. If Lilly's oral tirzepatide gets FDA clearance on schedule, both companies will compete in the convenience-focused segment—and Lilly's overall momentum suggests it could take share quickly.
The Numbers That Matter
| Metric | Q4 2025 | Q4 2024 | Growth |
|---|---|---|---|
| Revenue | $19.3B | $13.5B | +43% |
| Mounjaro | $7.41B | $3.5B | +110% |
| Zepbound (U.S.) | $4.2B | $1.9B | +122% |
| EPS (adj) | $7.54 | $4.88 | +55% |
Net income reached $6.64 billion, or $7.39 per share, compared to $4.41 billion in the year-ago quarter. Volume drove 46% of the revenue increase—evidence that demand, not just price increases, is fueling growth.
What's Different This Time
The obesity drug market was supposed to be a two-horse race. But Lilly's execution advantage has turned it into a one-horse race with a fading competitor.
Novo faces pricing pressure from government negotiations, patent expiries in key markets, and leadership turnover at critical positions. Lilly faces none of those headwinds. Its patents are secure, its pricing power remains intact, and its pipeline continues to deliver.
For investors choosing between the two, Q4 made the decision easier. Lilly's market share expansion and guidance beat suggest the competitive dynamics are shifting structurally—not just cyclically.
What to Watch
The oral obesity drug timeline is the next catalyst. FDA approval in Q2 would give Lilly a direct competitor to Novo's Wegovy pill just months after launch.
Watch Q1 prescription trends. If Zepbound and Mounjaro continue gaining share at current rates, Novo's 5-13% sales decline guidance might prove optimistic.
And track manufacturing capacity. Lilly has invested heavily in production to meet demand. If supply constraints ease further, revenue could surprise to the upside.
The GLP-1 gold rush isn't slowing down. Lilly just made clear who's leading it.