After Novo Nordisk projected yesterday that its revenue could decline by as much as 13% in 2026, its share price has plummeted by 20%.
Because the Danish company attributed much of the shortfall to pricing pressures, its rival in the diabetes and obesity market, Eli Lilly, also sustained a slide in its share price of 5% on Tuesday, as investors assumed the pricing effects would also apply to the Indianapolis company.
Today, when Lilly presented its quarterly earnings, it acknowledged the negative pricing factors but also projected a significant increase in sales this year. The guidance, combined with its report of booming sales in the fourth quarter, prompted a 10% surge in Lilly’s shares, more than compensating for their decline the previous day.
Such is the momentum of the world’s most valuable drugmaker, which three months ago became the first in industry history to achieve a market cap of $1 trillion.
Lilly is projecting 2026 sales to come in at between $80 billion and $83 billion. The midpoint of the window represents a 25% increase on Lilly's 2025 sales of $65.2 billion. The 2026 projection sounds conservative, given that the company increased its sales by 45% last year.
“We expect to deliver industry-leading volume growth, driven by our key products, partially offset by our lower realized prices,” Lucas Montarce, Lilly’s chief financial officer, explained on a conference call. “Price is expected to be a drag on growth in the low- to mid-teens.”
Montarce specified three factors playing into Lilly’s price projections for its juggernaut metabolic products—diabetes treatment Mounjaro, obesity drug Zepbound and investigational weight-loss pill orforglipron, which is expected to reach the market in the first half of this year.
One of the factors is Lilly’s agreement with the White House to sell Zepbound and orforglipron at cut-rate prices to U.S. patients. Another is the company’s direct-to-patient pricing plan for multi-dose pens of Zepbound. Additionally, Mounjaro’s inclusion on China’s national reimbursement drug list for type 2 diabetes will bring down prices, as well.
One more factor Lilly cited is lower Medicaid pricing for later-lifecycle products, such as the psoriasis drug Taltz, the diabetes medicine Trulicity and the breast cancer treatment Verzenio.
“We believe these price concessions will be more than offset by increased volume over time as we expand the number of people who can benefit from Lilly medicines,” Montarce said.
In a note to investors, Cantor Fitzgerald analyst Carter Gould said Lilly "delivered the standout print" of the fourth quarter, "easily bettering Street estimates with broad geographic strength across the tirzepatide franchise, and an assertive ’26 guide that should counter critics."
Gould added that Lilly's report "stands in stark contrast" to the market "optics" presented by Novo.
"The high-end, the low-end, the narrower guide—all of it—express a far more confident view of the market than most of the Street were anticipating," Gould added.
Sales of Lilly’s tirzepatide products continued to scale up remarkably in the fourth quarter of 2025, smashing analyst expectations. Mounjaro generated $7.4 billion in the period, which was up 110% year over year and an increase sequentially from $6.5 billion. Analyst consensus had pegged Q4 sales of Mounjaro at $6.7 billion. Additionally, Mounjaro chalked up sales outside of the U.S. of $3.3 billion.
Meanwhile, Zepbound raked in $4.3 billion in the quarter, which was up 123% year over year and an increase from $3.6 billion in the third quarter. The Q4 figure exceeded the analyst estimate of $3.8 billion.
For 2025 overall, combined sales of Mounjaro and Zepbound reached $36.5 billion, which accounted for 56% of Lilly’s revenue and made tirzepatide the world’s best-selling drug. The tirzepatide duo outpaced Novo’s semaglutide treatments Ozempic and Wegovy, which generated combined sales of $33 billion, and Merck’s cancer therapy Keytruda, which pulled in sales of $31.7 billion.
As for how the potential approval of orforglipron will affect the overall sales of Lilly's cardiometabolic treatments, CEO David Ricks called it a “bit of a wild card in our short- and mid-term outlook.”
“I am hard pressed to think of an analog where you have this many people paying out of pocket for a prescription medication,” Ricks added.