Eli Lilly has forecast 2026 profit and revenue above Wall Street expectations, reinforcing how fast the obesity market is reshaping Big Pharma growth plans. The recent Eli Lilly 2026 Guidance reflects the company's confidence in strong future performance. The company also beat estimates for fourth-quarter earnings, helped by strong demand for its injectable weight-loss and diabetes medicines.
For Q4, Lilly reported adjusted earnings of $7.54 per share on revenue of $19.3bn, ahead of analyst expectations of $6.67 and $17.96bn. In pre-market trading following the results, the shares rose more than 7%.
Lilly’s outlook comes as investor focus tightens on pricing, access, and demand durability as more patients move into self-pay channels. It also underlines the widening performance gap between Lilly and its closest obesity rival, Novo Nordisk.
Guidance Hinges on Volume Offsetting Price Cuts
Lilly expects adjusted earnings of $33.50 to $35.00 per share and sales of $80bn to $83bn for 2026, both above consensus estimates. Management flagged that lower prices are tempering sales, even while demand remains strong.
The pricing debate has sharpened after a US government agreement aimed at expanding patient access in return for steep price reductions. Lilly has argued that higher patient volumes should cushion the impact. For healthcare leaders, this is a familiar trade-off. Lower unit prices can drive broader uptake, but they also push manufacturers to defend margins through scale, supply reliability, and channel strategy.
Product performance remains the headline. Mounjaro generated $7.41bn in Q4 sales, beating expectations. Zepbound delivered $4.3bn, also ahead of forecasts. These results keep Lilly firmly in the lead as payers, providers, and employers grapple with demand that is outstripping many benefit designs.
Rival Pressure Builds as Novo Nordisk Warns of a Tougher 2026
Novo Nordisk, maker of Wegovy and Ozempic, has warned of “unprecedented” pricing pressure and forecast that sales and operating profit could fall 5% to 13% in 2026. The guidance triggered a sharp share sell-off, erasing about $50bn in market value.
Novo has pointed to a faster shift towards self-pay patients and rising rebate demands from US insurers. It has also highlighted competition and the growing presence of compounded versions of GLP-1 medicines. While Novo says strong early uptake of its oral Wegovy pill offers “a glimpse of hope”, the company also cautioned it cannot promise a return to prior extraordinary growth rates.
Oral Therapies And The Cash-Pay Playbook
Both companies are pushing deeper into cash-pay offers. Novo has priced lower-dose oral options at $149 a month in the US, rising to $199 from April. Lilly has indicated that, if approved, it would cap pricing for higher-dose oral treatment at $399 per month for repeat cash-paying patients.
Attention is also building around Lilly’s oral candidate orforglipron, viewed as a potential catalyst in 2026 and beyond. For healthcare systems, the next phase is less about whether demand exists and more about how access, pricing, and supply will be managed as obesity care becomes a long-term, high-volume category.
Read the Original Articles: Eli Lilly; Novo Nordisk