The recent fourth quarter earnings calls for Eli Lilly and Novo Nordisk highlighted the different paths the two pharmaceutical companies are taking, despite both having some of the best-selling medicines in 2025. Eli Lilly’s call was confident, while Novo Nordisk took a more defensive tone.
Both companies have achieved significant sales with their GLP-1 drug franchises, each bringing in over $30 billion in 2025. These therapies are among the most successful in pharmaceutical history. However, their market valuations differ greatly: Eli Lilly recently surpassed a $1 trillion valuation, becoming the first pharma company to do so, while Novo Nordisk stands at about $263 billion.
Novo’s semaglutide franchise regained its lead over Eli Lilly in the fourth quarter of 2025. This marks a reversal from earlier quarters when Lilly’s Mounjaro and Zepbound had overtaken Novo’s Ozempic and Wegovy. According to Novo CEO Maziar Mike Doustdar, “2025 marked the achievement of a goal set back in 2019: the company doubled sales and operating profit, with obesity sales increasing 1,299% to nearly $13 billion in 2025.” Despite this growth, investors remain concerned as Novo expects total sales to decline by around 5% in 2026.
Eli Lilly projects revenues between $80 billion and $83 billion for 2026. Analysts predict that the company could exceed $94 billion by 2027.
This year is expected to bring new developments as both companies expand into oral obesity treatments. The Wegovy pill has already been prescribed to more than 100,000 patients since its launch. Doustdar described oral Wegovy’s first four weeks on the market as “phenomenal—the best pharma launch ever.” While Novo has not yet analyzed these prescriptions in detail, Ken Custer, executive vice president of Lilly cardiometabolic health, said during Wednesday's earnings call that they believe these drugs are attracting new patients who had previously waited for an oral option: “they are pulling in completely new patients to obesity treatment that had previously been ‘sitting on the sidelines waiting for an oral option.’”
Lilly is awaiting FDA approval for orforglipron by early April. If approved, it will compete directly with Novo’s Wegovy pill. The two medications differ: Novo's achieves greater weight loss but Lilly's has fewer restrictions related to water and food intake.
Later this year, both companies expect to benefit from expanded Medicaid coverage for obesity medications following negotiations at the White House last fall involving Doustdar and Ricks. As part of those talks, lower prices were offered for GLP-1 medicines.
These pricing agreements mark a shift from focusing on high-cost treatments toward increased volume.
The competitive landscape is also changing as more companies enter the market. Pfizer is investing heavily through its Metsera deal; Amgen and Roche are developing new assets; GSK is targeting diseases linked to obesity; and several biotechs—including Viking Therapeutics—are also joining the field.
Despite being early leaders with distinct portfolios beyond obesity drugs, comparisons between Novo Nordisk and Eli Lilly continue as competition intensifies within an increasingly crowded market.
