Earnings show Eli Lilly winning in the GLP-1 market over Novo Nordisk

It’s the story of two drugmakers in the hot obesity drug market.

both of them Novo Nordisk and Eli Lilly Pharmaceutical companies are facing falling prices in the United States, but their forecasts for 2026 vary sharply: While Novo is bracing for a decline in sales, Lilly expects revenues to rise again thanks to its blockbuster drugs.

The split in guidance – despite similar headwinds – underscores the strength of Lilly’s position in the obesity and diabetes drug market, supported by its more effective injectables and early foray into direct-to-consumer sales, among other factors. While Novo Nordisk effectively made the drug mainstream, Lilly has since gained a clear advantage in market share — and forecasts are that it is likely to increase its advantage this year.

“The difference in sales momentum and market share trend was evident throughout 2025, but the split between the two companies’ prospects emerged during the 24-hour period in which Novo was below consensus and Lilly was above consensus expectations,” David Reisinger, an analyst at Leerink Partners, told CNBC on Wednesday.

“This has really reinforced the investor’s mind that Lilly will be the dominant player in the obesity space in the future,” he added.

This year, all eyes will be on how Lilly’s upcoming obesity pill, Orforgliprone, will compete with Novo’s oral drug Wijovi, which had a massive launch in the US this year.

In an interview with CNBC’s “Squawk Box” on Wednesday, Lilly CEO Dave Rex said between 20 million and 25 million patients are currently taking the two companies’ drugs. But he said the total target market of patients in the obesity space is “huge.”

On Wednesday, Lilly forecast sales of $80 billion to $83 billion for 2026, exceeding the $77.62 billion that analysts had expected, according to LSEG.

The midpoint of this forecast translates to 25% sales growth this year.

In contrast, Novo warned on Tuesday that it expects sales and profits to fall by 5% to 13% this year, as prices fall in the United States and the end of exclusivity for blockbuster obesity and diabetes drugs in China, Brazil and Canada.

Lilly similarly noted “global prices are in the low to mid teens.” [percentages] This follows the two companies’ historic “most favored nation” deals with President Donald Trump in November to reduce the costs of obesity and diabetes drugs, along with their recent efforts to continue lowering the prices of their direct-to-consumer treatments.

The agreements concluded with Trump are expected to affect the sales of both companies, but ultimately increase the volume of prescriptions for their drugs. However, Lilly is optimistic about other factors that will help offset the price pressure.

This includes continued global demand for obesity drug Zibbond and its diabetes counterpart Mongaro, and the expected launch of the GLP-1 obesity pill in the second quarter, pending US approval. Lilly also noted that government Medicare coverage of obesity treatments will debut at least by July, one of the winning features of its drug pricing deals with Trump.

The coverage would open up access to 40 million new Medicare beneficiaries, “and that could be very expansive in terms of scale,” Lilly’s Ricks told CNBC.

Overall, Reisinger called Lilly’s guidance “very encouraging” and said the “price-per-volume tradeoff is working well” for the company.

He said tirzepatide, the active ingredient in Zepbound and Mounjaro, is “superior” in its efficacy and tolerability compared with semaglutide, the ingredient in Novo’s obesity and diabetes drugs. This was proven in a head-to-head clinical trial conducted by Lilly in 2024, and prescription trends show that the company’s drugs are preferred among prescribers.

“I think that’s what drives Lilly’s market share gains” compared to Novo, Reisinger said.

Another factor that sets Lilly and Novo apart is the exclusivity of their patents. While Novo said patent expirations in some international markets pose a challenge, Lilly’s Rex said tirzepatide should be protected in “the latter half of the 2030s” in key markets.

Reisinger noted that Lilly is still working to boost global uptake of terzepatide, which received U.S. approval to treat obesity in 2023.

Novo Nordisk is the first to market GLP-1 obesity pill, and has already reached 50,000 weekly prescriptions in less than three weeks of launch. But investors are watching to see how that changes once Lilly’s pills are released to patients later this year.

In an interview with CNBC’s Mad Money, Novo CEO Mike Doostdar said he was confident the company could compete with Lilly.

“It is clear that we have the most effective weight loss pills ever, and I am very optimistic and optimistic about it when they come with their pills and we have to fight for that,” Dostdar said.

He points to clinical trial data that suggests Novo’s Wegovy pill promotes weight loss similarly to its injectable counterpart, which is about 15%. Meanwhile, Lilly pills appear to be slightly less effective than that, based on data from a separate study.

Reisinger said Novo’s pill launch capitalized on the fact that the company is capitalizing on the Wegovy brand name, which is recognizable to many patients, and immediately launched direct-to-consumer advertising for the product in early January.

But he said Lilly could benefit from the convenience advantage of its pills.

Orforglipron is a small-molecule drug that is more easily absorbed into the body and does not require dietary restrictions like Novo Nordisk pills, which is a peptide drug. Patients are supposed to drink no more than four ounces of water with Wegovy pills and should wait 30 minutes before eating or drinking anything else each day.

Novo stresses that these requirements will not hinder uptake of the drug, but Reisinger said they could eventually help Lilly’s pills achieve greater sales globally.