Novo and Lilly agree prices are falling — and disagree on what comes next

The two drugmakers behind the weight-loss drug boom see the market heading in the same direction — but their own futures diverging sharply.

Novo Nordisk and Eli Lilly together sold nearly $70 billion worth of their blockbuster GLP-1 drugs in 2025, up from roughly $41 billion in 2024. As pricing pressure intensifies — from government negotiations, insurers, and rising competition between the two companies — both drugmakers agree on the broad trajectory: prices are falling but the pie is getting bigger. 

Novo, long the category leader with its Ozempic and Wegovy injections, is entering 2026 bracing for a sales decline of up to 13%. “Net-net, it is price declines that drive US down,” Karsten Knudsen, Novo’s chief finance officer, told analysts on Wednesday.

Lilly doesn’t disagree. Lily’s CFO, Lucas Montarce, told analysts that “price is expected to be a drag on growth in the low to mid-teens.”

But while Novo sees sales slowing, Lilly forecast annual revenues to hit between $80 billion and $83 billion, a more than 20% increase and more than analysts were penciling in. Doing some reverse engineering, analysts and Deutsche Bank estimated that implies 42% year-over-year volume growth.

“To us, it looks like LLY and NVO could not be any more different in terms of Diabesity elasticity / portfolio,” the analysts wrote. 

Both companies reported financial results Wednesday morning. Lilly rose 9% by the afternoon on Wednesday. Novo, which gave an early look at its gloomy sales guidance on Tuesday, is down about 20% since Monday’s close.

The next frontier: Pills

Novo is betting that expanding access — especially through lower prices and new formulations — will eventually pay off. Central to that strategy is the newly launched Wegovy pill, the first oral GLP-1 approved for obesity.

Novo said early signs show its Wegovy pill is expanding the GLP-1 market and operating as a primarily cash-pay business. “We are all in on pushing the pill,” Knudsen, Novo’s CFO, said.

As of the week ended January 23, total prescriptions for the Wegovy pill were about 50,000, of which roughly 45,000 came through self-pay channels, the company said. Most of those prescriptions appear to be for patients who had never taken a GLP-1 before. 

Lilly is watching closely. 

Ken Custer, head of Lilly’s cardiometabolic segment, said he sees the early data from his competitor as “encouraging.” Lilly has its own weight-loss pill — orforglipron — coming to market in a few months. 

“We’re very encouraged by what we’re seeing with oral Wegovy as it validates our belief that there’s a substantial number of people [who are overweight or obese] who have been sitting on the sidelines waiting for an oral option,” he said. “It looks like these are mostly new starts. That means it’s expanding the market, and that’s good news for Lilly.”

A consumer drug, consumer price pressures 

Weight-loss drugs are increasingly behaving less like traditional prescription medicines and more like consumer products — and that shift is reshaping margins. Both companies have direct-to-consumer pharmacies, often partnering with telehealth companies to distribute their products. 

Knudsen noted the gross margin on the Wegovy pill is below the injectable version, but is still healthy. The cash-pay prices for Novo’s injectables are now lower than Lilly’s. He said lowering prices “is our investment for the future and for capturing more patients.” 

More than 1 million people used Lilly’s direct-to-consumer platform, LillyDirect, in 2025, and self-pay Zepbound vials now account for roughly a third of new obesity drug prescriptions in the US, Lilly CEO Dave Ricks told analysts.

“I am hard-pressed to think of an analog where you have this many people paying out of pocket for a prescription medication,” Ricks said.