The news: Novo Nordisk and Eli Lilly—the two drugmakers that control the GLP-1 drug market—reported sharply different financial results and outlooks in earnings this week.

• Novo expects adjusted sales and operating profits to both decline in the range of 5% to 13% this year. If projections hold, it would mark the first annual sales decline since 2017. Novo has lowered its full-year outlook for a fifth straight quarter.
• Conversely, Lilly topped analysts’ estimates for Q4 revenues, net income, and this year’s guidance. The company’s 2026 revenue forecast of $80 billion to $83 billion tops analysts’ expectations of roughly $78 billion.

Lilly’s earnings reinforce its status as the world’s top pharma company, with a $1 trillion valuation. Novo’s market value, meanwhile, has fallen from a $600 billion peak in 2024 to about $225 billion today, including roughly $50 billion wiped out after this week’s earnings release.

Why it matters: Three factors are driving Novo’s and Lilly’s diverging operational paths, despite each having multiple blockbuster GLP-1s.

1. Novo’s semaglutide products (Wegovy, Ozempic) are older than Lilly’s tirzepatide (Zepbound, Mounjaro) and nearing patent cliffs in some markets. Semaglutide patents will expire, with generic Ozempic expected to become available in Canada this month, then in China, India, and Brazil, per IQVIA. Tirzepatide is patent-protected well into the 2030s in key markets.

Drug sales typically slow as patent expiration approaches. For example, Ozempic generated 31.8 billion kroner (about $4.8 billion USD) in global revenues last year, but after nearly a decade on the market, Q4 sales rose just 1% YoY. Meanwhile, Q4 sales of Zepbound and global sales of Mounjaro jumped 123% and 110% YoY, respectively.

2. Lilly’s drugs outperform Novo’s.

• Studies comparing FDA-approved obesity drugs find Zepbound produces greater average weight loss than Wegovy.
• Consequently, Zepbound weekly prescriptions surpassed Wegovy’s last year, nearly doubling by year’s end, per Reuters tracking data.

3. Both companies face pricing pressure from Trump administration drug-price deals, but Lilly is better positioned to absorb it. Lilly expects 2026 prices in the US “to drag growth in the low to mid-teens percentage range” due to its negotiated drug deals with the administration; Novo executives see a similar hit. With GLP-1 injection sales slowing, Novo’s ability to offset lower US drug prices will hinge almost entirely on its new Wegovy pill, while Lilly’s still-growing prescriptions will cushion the impact of lower prices in the near term.

Implications for the weight loss drug market: Novo’s first-mover advantage in GLP-1s collided with an unavoidable reality: an influencer-led boom in patient awareness timed perfectly with Lilly releasing a more effective drug.

Still, Novo’s early success with its Wegovy pill and soon-to-come Ozempic pill for diabetics underscores that the company’s outlook isn’t all doom and gloom, while signaling to pharma companies entering the obesity drug space that there is strong demand for convenient, cheaper-to-make, and more affordable obesity drugs.