GLP-1 and Weight-Loss Drugs Industry Explained: The U.S. View
GLP-1 drugs, first used for diabetes and now for obesity, have become one of the biggest growth stories in pharmaceuticals, and two companies dominate: Eli Lilly, with Mounjaro and Zepbound, and Novo Nordisk, with Ozempic and Wegovy. The story in 2026 is volume up, price down. Lilly's revenue rose 48% to $23.0 billion in the second quarter of 2026; Mounjaro brought in $9.9 billion and Zepbound $4.9 billion, while worldwide volume rose 60% and realized prices fell 13%. Lilly launched Foundayo (orforglipron), an oral GLP-1 pill, which sold $98 million in its first reported quarter, and plans to file for its next injectable, retatrutide, in early 2027. Novo's Wegovy pill passed 5 million U.S. prescriptions, but Novo expects 2026 adjusted sales to change by 0% to -6% at constant exchange rates. Washington is pushing prices down too: under a November 2025 deal, Medicare and Medicaid get these drugs for $245 a month, with Medicare covering obesity treatment for the first time and patients paying a $50 copay. Lower prices widen access, and the question for the industry is whether volume grows faster than prices fall.
- Lilly
- Q2 2026 revenue $23.0B, up 48%; volume +60%, prices -13%
- Pills
- Novo's Wegovy pill passed 5 million U.S. prescriptions by July 2026
- Medicare
- Nov 2025 deal: $245 a month for Medicare and Medicaid, $50 copay
How the chain works
Lilly and Novo Nordisk, Q2 2026
| Eli Lilly | Novo Nordisk | |
|---|---|---|
| Headline | Revenue up 48% to $23.0B | Adjusted sales up 7% at constant exchange rates |
| Key drugs | Mounjaro $9.9B (+91%), Zepbound $4.9B (+46%) | Wegovy injections and Wegovy pill |
| Oral pill | Foundayo $98M in first reported quarter | Wegovy pill over 5 million U.S. prescriptions |
| 2026 outlook | Revenue $85–87B, raised | Adjusted sales 0% to -6% at constant exchange rates |
Volume up, price down
GLP-1 drugs mimic a gut hormone that controls blood sugar and appetite. Demand has grown faster than almost anyone expected. Lilly reported second-quarter 2026 revenue of $23.0 billion, up 48% from $15.6 billion a year earlier. Mounjaro sales rose 91% to $9.9 billion, with sales outside the U.S. up 172%, and Zepbound rose 46% to $4.9 billion.
Prices are falling as access widens. Lilly's worldwide volume rose 60% while realized prices fell 13%; in the U.S. volume rose 37% and prices fell 3%, and outside the U.S. prices fell 36%, partly as Mounjaro was added to China's national reimbursement list. Lilly raised its 2026 revenue guidance to $85–87 billion.
Pills and the next generation
Pills could reach far more patients than weekly injections. Lilly's oral GLP-1, Foundayo (orforglipron), sold $98 million in the second quarter of 2026, its first quarter of reported sales, and Lilly has also submitted it for type 2 diabetes. Novo's Wegovy pill topped 265,000 weekly prescriptions in mid-July 2026 and more than 5 million in total since launch.
Newer drugs aim for more weight loss. Lilly said its retatrutide Phase 3 package is complete for obesity, sleep apnea and knee osteoarthritis pain, and plans to file with the FDA in the first quarter of 2027.
Washington and prices
In November 2025 the administration announced deals with Lilly and Novo. According to the National Community Pharmacists Association's summary, Medicare's price for Ozempic, Wegovy, Mounjaro and Zepbound is $245 a month, beneficiaries pay a $50 copay, and Medicare will cover Wegovy and Zepbound for patients with obesity and related conditions for the first time; state Medicaid programs can buy at the same price. Cash prices through the planned TrumpRx site were also to fall.
For drugmakers the trade-off is lower prices for much larger volumes. Novo expects 2026 adjusted sales to change by 0% to -6% at constant exchange rates even after raising its outlook.
How the U.S. view differs from the China view
The Chinese version of this page looks at Chinese companies developing their own GLP-1 drugs and biosimilars, the coming loss of patent protection for semaglutide in some markets, and China's reimbursement list pushing prices down.
From the U.S. side the market is led by two companies and shaped by U.S. pricing policy. The government deal lowers prices in exchange for wider coverage, and the race to sell pills and next-generation drugs decides which company leads.
2025–2026: the price-for-access deal
In November 2025 Lilly and Novo agreed to sell GLP-1 drugs to Medicare and Medicaid for $245 a month, with Medicare covering obesity treatment for the first time.
In 2026 prices kept falling: Lilly's realized prices dropped 13% in the second quarter, but volume jumped 60% and revenue rose 48%.
Novo guided to flat-to-lower adjusted sales. Lower prices have not shrunk the market so far, but results now differ sharply between the two leaders.
- In GLP-1s, volume growth has so far outrun price cuts for the leader.
- Government deals trade lower prices for wider coverage.
- Oral pills and next-generation drugs decide the next round of competition.
Common misreadings
MythPrice cuts will shrink GLP-1 revenue.
RealityLilly's revenue rose 48% in Q2 2026 even as realized prices fell 13%.
MythBoth leaders are growing equally.
RealityLilly raised guidance to $85–87B; Novo expects adjusted sales of 0% to -6%.
MythMedicare has always covered obesity drugs.
RealityThe November 2025 deal adds Medicare coverage for obesity for the first time.
MythGLP-1s are only injections.
RealityNovo's Wegovy pill passed 5 million U.S. prescriptions; Lilly launched Foundayo.
Pricing, coverage and competition: scenarios
| Scenario | Main effect | How it passes through |
|---|---|---|
| Medicare coverage starts at scale | Volume | Many more older patients treated |
| Further price cuts | Revenue per patient | Growth depends on volume |
| Oral pills gain share | Access | More patients, lower manufacturing cost |
| Retatrutide approved | Competition | Lilly extends its lead |
| Employers drop coverage | Commercial demand | More cash-pay patients |
| Patent expiries abroad | International prices | Generic competition |
Supply and demand by segment
| Segment | Supply rigidity | Concentration | New demand | Policy role | What to watch |
|---|---|---|---|---|---|
| Drug development | Very high (trials, patents) | Very high (two leaders) | Yes | High (FDA) | Approvals |
| Manufacturing | High (injectables) | High | Yes | Medium | Supply constraints |
| Pricing and coverage | Not applicable | High (big payers) | Yes | Very high (Medicare deal) | Net prices |
| Oral pills | Medium (easier to make) | High | Yes | High | Prescriptions |
Supply rigidity: how long new capacity takes and whether money can speed it up. Concentration: whether output sits in a few countries or companies. The more rigid and concentrated, the more prone to shortages.
How to track it
| Indicator | What it tells you | Where to find it |
|---|---|---|
| Quarterly GLP-1 sales, price and volume | Demand and pricing | Eli Lilly and Novo Nordisk quarterly results, free |
| Weekly prescriptions | Uptake of new drugs | Company disclosures and news coverage |
| Medicare and Medicaid coverage rules | Access | CMS announcements, free |
| FDA approvals | New products | FDA, free |
Sources
- Eli Lilly: second quarter 2026 results, SEC filing (2026-08-05)
- Novo Nordisk: Q2 2026 results via BioSpace (2026-08-04)
- NCPA: About the Trump, Eli Lilly and Novo Nordisk GLP-1 price deals (2025-11-11)
Last updated 2026-10-18.